Pertussis Activity Spiking in Several States

Vaccination Critical in Preventing Illness

July 06, 2010 04:40 pm News Staff

An outbreak of pertussis has been declared an epidemic( by the California Department of Public Health. The agency said that as of June 15, the state had 910 reported cases -- four times more than at the same time last year -- and 600 potential cases were being investigated.

Pertussis bacteria, shown here, have caused more than 5,000 reported cases of the disease as of June 25, according to the CDC. California and South Carolina both reported case numbers above epidemic thresholds.

Five infants have died of the disease, commonly known as whooping cough, in California this year, according to the state's health department.

The CDC said June 25( that as of June 19, 5,120 cases of pertussis had been reported nationwide. Although that number was less than the 6,326 reported at the same time last year, several states reported significant increases in pertussis activity, including Texas (1,154 cases), Ohio (523 cases), Michigan (380 cases) and Arizona (163 cases).

In addition, the South Carolina Department of Health and Environmental Council issued a public health advisory( June 8, saying reported pertussis cases were above an epidemic threshold. The state agency said that in the first 20 weeks of 2010 there were 81 confirmed or probable cases of pertussis, which doubles the number of cases reported during the same period during each of the previous three years. The department said the case total was above an epidemic threshold because it was two standard deviations above the annual mean.

California Bill Addresses Vaccine Payment Issues

As California and several other states deal with significant spikes in reported pertussis cases, the California state legislature is considering a bill that would require insurers to increase physician payments for childhood and adolescent vaccines.

The bill(, which is co-sponsored by the California Academy of Family Physicians, would require health plans that cover immunizations to pay physicians an amount no less than the actual cost of acquiring a vaccine, including shipping and handling, as well as the cost of administering a vaccine, including physician time, staff time, storage, insurance, supplies and medical equipment.

Assembly member V. Manuel Perez (D-Coachella) introduced a similar bill last year, but it failed to pass the Appropriations Committee. He introduced a revised version of the bill in February, and it has received bipartisan support thus far.

The bill passed the California Senate's Health Committee by a 7-1 vote on June 30. It now moves to the Appropriations Committee, although no date for a hearing had been set as of July 1.

The bill draws attention to the fact that vaccines are one of the biggest costs incurred by pediatric and family practices, and the failure to adequately pay for the direct and indirect costs of providing immunizations can threaten the viability of a practice.

A study published last year in Pediatrics reported that 5 percent of pediatricians and 21 percent of family physicians surveyed said they had seriously considered not offering recommended childhood vaccines because of cost concerns.

South Carolina had 134 cases of pertussis as of June 25, according to the CDC.

In the news release on the California outbreak, Mark Horton, M.D., M.S.P.H., director of the California Department of Public Health, urged parents to vaccinate their children. He also said that parents, family members and caregivers of infants should get booster shots.

The CDC’s Advisory Committee on Immunization Practices, or ACIP, and the AAFP recommend(5 page PDF) that children receive five doses of diphtheria, tetanus, and pertussis, or DTaP, vaccine, including a primary series at 2 months, 4 months and 6 months. Additional doses should be given at 15-18 months and 4-6 years.

However, the California Academy of Family Physicians posted a recommendation on its website for members to use an accelerated DTaP infant schedule -- initial vaccination at 6 weeks of age with subsequent doses recommended at four-week intervals -- during the outbreak.

More than half of infants less than 1 year of age who get the disease must be hospitalized, according to the CDC. The agency also said one in 20 infants with pertussis get pneumonia.

The CDC said many infants are infected by older siblings, parents or other caregivers who don't even realize they have the disease, which is difficult to diagnose.

A single dose of tetanus, diphtheria and pertussis, or Tdap, vaccine is recommended for adolescents ages 11-18 and adults(4 page PDF) ages 19-64.

The CDC said protection received from DTaP, the childhood vaccine, fades over time, so adolescents and adults should receive Tdap even if they were vaccinated as children. The agency also said only 2 percent of adults received Tdap from 2005 through 2007.

The CDC issued the following recommendations for physicians June 30.

  • Make sure patients of all ages are up-to-date on pertussis-containing vaccines.
  • Consider the diagnosis of pertussis in patients and close contacts. Atypical presentation is common in infants. Their cough may be minimal or absent, and the primary symptom can be apnea.
  • Use the correct tests(
  • Treat suspected and confirmed cases promptly because pertussis may progress rapidly in infants.
  • Quickly report cases to local public health departments.

In addition to the recommendation for an accelerated DTaP infant schedule, the California Academy of Family Physicians posted the following recommendations for physicians on its website.

  • Use pertussis educational materials in your office.
  • Review clinical guidance materials.
  • Vaccinate all people with potential contact with infants.
  • Encourage your hospital to implement a postpartum Tdap immunization program.
  • Protect children, adolescents and adults through vaccination to improve community immunity levels.
  • Offer Tdap vaccination to staff to protect them and patients.
  • Stay informed of new developments and recommendations regarding pertussis.

California’s health department said in its news release that the state is on pace to suffer the most illnesses and deaths due to pertussis in 50 years. In 2005, California recorded 3,182 cases and eight deaths from pertussis, which peaks every three to five years.

More than 25,000 cases were reported nationally in 2005, which was the last peak year. However, the CDC said the actual number of illnesses likely was significantly higher because of cases that were not diagnosed or not reported.