Abstract
Pertussis remains endemic in the U.S., despite routine use of
childhood pertussis-containing vaccines (DTP) in children since the
1940s. Although infants have the highest reported incidence rates
compared to other age groups, incidence in adolescents and adults
has been steadily increasing since the 1980s. In 1992, the Advisory
Committee on Immunization Practices (ACIP) recommended that
trivalent diphtheria-tetanus-acellular pertussis vaccines (DTaP) be
substituted for the whole-cell formulation (DTwP) for doses four
and five of the five-dose pertussis vaccine schedule, and in 1997,
DTaP was recommended for all five doses. To combat increasing
incidence in adolescents, the Advisory Committee on Immunization
Practices (ACIP) recommended adolescents and adults receive a
tetanus-diphtheria-acellular pertussis booster (Tdap) in 2006. To
date, however, no study has been done in the U.S. on the rates of
hospitalization across all age groups following the switch to
acellular vaccines for routine infant immunization. We
characterized the changing epidemiology of pertussis by examining
the rates and rate differences of hospitalization across all age
groups and infant subgroups in the acellular vaccine era.
Hospitalization records were obtained from the Nationwide Inpatient
Sample (NIS), which is part of the Healthcare Cost and Utilization
Project (HCUP). NIS and U.S. Census data were used to analyze
national trends of hospitalizations due to pertussis. We calculated
rates of pertussis hospitalizations for all ages during the years
1997-2011 and rate differences between the early acellular
pertussis (aP) vaccine period (1997-2001) and the late aP period
(2007-2011). Hospitalization rates decreased significantly in
infants between the early aP period (1997-2001) and the late aP
period (2007-2011), but increased in all other age groups over the
same period. Among infant subgroups, rates decreased significantly
among infants 0-1 month of age and infants 2-6 months of age
(-114.66 hospitalizations per 1,000,000 population (95% CI:
-151.88, -77.45) and -22.03 hospitalizations per 1,000,000
population (95% CI: -43.00, -1.07), respectively). Although the
decreasing rates of infant hospitalizations are significant, rates
of pertussis in infants are still high. Increasing rates of
hospitalizations in non-infant age groups suggests ongoing
transmission and susceptibility. This warrants research into new
mitigation strategies across the lifespan.
Table of Contents
Introduction to Pertussis-1 Pertussis Epidemiology-2 Bordetella
pertussis Microbiology and Pathogenesis-5 Characteristics of
Pertussis Disease-7 Surveillance-9 Transmission-10 Complications
and Hospitalization-13 Diagnosis in Adolescents and Adults and
Diagnostic Tools-15 Treatment and Chemoprophylaxis-22
Pertussis-Containing Vaccines and the Vaccine Schedule-23 Pertussis
Vaccination Coverage and Vaccine Efficacy-27 Waning Immunity and
Transmission Related to Vaccines-28 The Changing Epidemiology of
Pertussis in the Acellular Vaccine Era-41 Abstract-42
Introduction-43 Methods-45 Results-49 Discussion-57 Public Health
Implications and Future Directions: Strategies to Mitigate the
Burden of Pertussis-96 Appendix 1: Emory Institutional Review Board
Letter of Exemption-106 Appendix 2: Full Bibliography-107
About this Master's Thesis
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