PERTUSSIS AT HISTORICALLY HIGH LEVELS IN LA COUNTY

    

Los Angeles County (LAC) is currently experiencing a significant increase in the number of reported cases of pertussis, with a similar trend evidenced throughout California and the United States. From January 1 - August 31, 2005, 178 pertussis cases have been reported to the LAC Immunization Program, which is nearly a three-fold increase in the number of cases reported during the same time period of the previous 5 years and exceeds the total number of cases reported during the entire year of 2004. Not since the 1970s has LAC experienced this magnitude of pertussis morbidity during this specified time period. Of these 178 cases, 43.3% are less than one year of age, 23.6% are children ages 1-14, and 33.1% are over 15 years of age. Less than half of the cases (n=80) were laboratory-confirmed with culture or PCR, the only two tests that are currently accepted for the laboratory diagnosis of pertussis.

Adolescents and adults continue to be the primary reservoir for transmission to infants who are too young to have received at least 3 doses of a pertussis-containing vaccine. Historically during the Fall, Winter, and early Spring seasons in LAC, a high number of pertussis cases among adolescents and adults is identified, followed by a higher number of cases reported among infants beginning in the late Spring and through the Summer months than any other time of the year. The need to protect infants from pertussis infection is underscored by the fact that to date in 2005, there have been two pertussis-related deaths among infants less than 2 months of age in LAC.

It is, therefore, extremely important that health care providers in LAC heighten their clinical suspicion for pertussis in individuals of all ages and order appropriate laboratory tests (see attached Pertussis Fact Sheet). Consider pertussis in any child, adolescent, or adult that presents with a persistent cough illness of 2 weeks or more whether or not it is associated with coughing paroxysms or whoop. Consider pertussis in infants experiencing a cough illness of any duration. Do not wait for culture or PCR confirmation before reporting a suspected case of pertussis to the LAC Morbidity Central Reporting Unit at 888-397-3993 (phone) or 888-397-3778 (fax).

New TdaP Vaccines Approved for Adolescents

Adolescents and adults are susceptible to pertussis yet are not eligible for childhood DTaP vaccines. The FDA recently licensed two new tetanus-diphtheria-acellular pertussis (TdaP) vaccines for use in adolescents in the US, one for persons aged 10-18 years (BOOSTRIX‚, GlaxoSmithKline) and the other for persons aged 11-64 years (ADACELTM, Sanofi Pasteur). These new vaccines should protect adolescents and adults as well as protect infants from exposure to pertussis. The vaccines are expected to become available to California VFC providers in September or October and are expected to replace Td booster doses in adolescent populations.

For additional information about pertussis, see attached Pertussis Fact Sheet or visit the Los Angeles County Immunization Program's website at http://lapublichealth.org/ip/index.htm or call 213-351-7800.

 

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