Public health perspectives on the rising incidence of pertussis

Abstract

Objectives: Pertussis is one of the few vaccine-preventable diseases on the rise in the United States, particularly among adolescents. We analyzed the epidemiology of pertussis, focusing on disease burden in public health, and examined methods for controlling pertussis and reducing its incidence. DESIGN, SAMPLE, AND MEASUREMENTS: We evaluated current knowledge about pertussis, reported cases of pertussis in the United States, and the changing recognition, diagnosis, and management of the disease. The development of a pertussis vaccine, now licensed and recommended for use in adolescents and adults, was reviewed.

Results: Of reported cases in 2004, 38% occurred in adolescents. The increased incidence of pertussis may be the result of better diagnosis, better reporting, and increased awareness of the disease. The burden of adolescent and adult pertussis is significant and includes medical visits, laboratory tests, treatment for cases and contacts, time lost from school and work, disruption of schools experiencing outbreaks, and public health and media turmoil. At current disease rates, the financial cost of adolescent pertussis in this decade is projected at $3.2 billion.

Conclusions: Efforts are needed to increase health care providers' knowledge of pertussis disease and vaccines, improve on-time infant immunization rates, promote immunization registries and public health surveillance, and ensure adequate compensation for vaccine purchase and administration. Universal recommendations for and widespread use of acellular pertussis vaccines in adolescents are the most effective measures in controlling the disease.