Pertussis Epidemiology Outline
Liberty University
Master of Nursing Informatics
HLTH 503
Pertussis Epidemiology Outline
Stephanie Uhnak
ID: L34856269
June 9, 2024
Words: 1387
Pertussis Epidemiology Outline
Pertussis Outline
I. There have been24,864 cases2of pertussis reported throughout the United States in
2024 so far, which is 1700 more than this time last year reported by the CDC1. In the
last two decades despite vaccination availability pertussis is still an epidemic in both
developed countries such as the United States and developing countries thus making
it a global concern2. Those that are at significant risk are infants, pregnant woman and
those that are not vaccinated1.
II. Four species of the agent Bordetella2infect humans:2B. pertussis, B. parapertussis, B.
holmesii,2and2B. bronchiseptica.2Of these,2B. pertussis2remains the most important
cause of pertussis, followed by2B. parapertussis2and2B. holmesii3. The agent
regardless of species is a gram-negative coccobacillus. Transmission occurs person-
to-person via aerosolized respiratory droplets or by direct contact with respiratory
secretions.
III. The agent causes significant respiratory illness and cough, otherwise known as
whooping cough in those infected. The symptoms and duration vary by age.
According to the CDC1, the infection occurs in three stages for most individuals
however infants’ disease is more significant:
a. Typical Clinical States of Pertussis
i. Catarrhal Stage: 5-24 days in length: common cold symptoms
1. Mild upper respiratory symptoms that occur 7-10 days from
exposure
2. Sneezing, runny nose
3. Most infectious stage
Pertussis Epidemiology Outline
ii. Paroxysmal Stage: 1-6 weeks, up to 10 weeks depending on case
1. Coughing paroxysms
a. Vary in frequency
b. May have apnea with or without cyanosis
c. Common to occur at night
2. Vomiting
a. Associated after coughing paroxysm
3. Fever
a. Absent or minimal
iii. Convalescent Stage, gradual recovery
1. Subsequent respiratory infections
2. Post-tussive vomiting.
3. Paroxysms cough
a. Lessening but can reoccur with subsequent URI can occur
months after diagnosis
b. Infant Clinical Presentation:
i. Shorten catarrhal stage
ii. Paroxysmal state occurs quickly
1. Gagging, gasping, apnea early
2. Fatality is 1% in <2 months of age
Pertussis Epidemiology Outline
IV. Morbidity and mortality is still high among pertussis given its age and vaccination
availability. The current table below available from the CDC4 is reflective of a now
steady increase in numbers of pertussis cases. The original decrease was most
associated with the COVID-19 pandemic era that isolation and masking was typical
practice, thus eliminating other respiratory droplet like viruses from spreading as
well. Typically, the most effective population are unvaccinated. Infants who have not
received their series or mothers who did not get boosters are most likely to suffer
comorbidities associated with Pertussis along with hospitalization and prolong
symptoms of the disease. In 2024, there were already nearly 4800 cases reported,
double from the data in 2022 that was available1.
Table 1-14
V. As above, according to the data from the CDC most affected cases seem to be those
under vaccinated or unvaccinated who did not complete their booster programs for
dTaP vaccine5. There is also way more significant uptick in underdeveloped or
developing countries and areas in developed countries.
a. Host characteristics: Pertussis is a human borne illness. There are no other vectors
noted outside the human population1.
Pertussis Epidemiology Outline
i. Age:
Table 1.24
1. Pertussis spreads easily from person to person mainly through
droplets produced by coughing or sneezing. The disease is most
dangerous in infants and is a significant cause of disease and death
in this age group6. Other populations would be pregnant women,
and under vaccinated or non-vaccinated.
ii. Sex:
1. Females are more susceptible to pertussis than their male
counterparts7.
iii. Nativity:
1. Pertussis is more likely to be prevalent in developing countries
with lack of preventive health measures and health care for vaccine
prevention and management6.
Pertussis Epidemiology Outline
iv. Marital Status:
1. There was no indication that martial status would play affect in
pertussis. Hypothesize that perhaps single parent household
without proper health prevention would be under or nonvaccinated
and more susceptible to disease.
v. Ethnic Group:
1. Severe pertussis in infants was higher than those of African
American households than White American households8.
2. There was a small disparity noted in Hispanic households of
adolescents when comparing to both White and African American
households7.
b. Environmental Attributes:
i. Geographic Areas:
1. Higher incident in developing nations6
2. Higher incident in United States:
a. 2000 to 2016, Skoff, Hadler & Hariri9, showed that
pertussis incidence was highest in:
i. central mid-west 11.9 per 100,000
ii. Rocky Mountain 11.5 per 100,000
b. 2000 to 2016, Skoff, Hadler & Hariri9 showed lowest
annual average incidence was seen in:
i. South Atlantic region at 2.5 per 100,000
ii. Southeastern region 3.1 per 100,000
Pertussis Epidemiology Outline
ii. Social and Economic Factors
1. Income:
a. Median income10
i. Working families, less time to maintain up to date
with vaccines
ii. More likely to utilize childcare at early age
2. Housing
a. Rural homes10
i. Less access to health promotion
iii. Occupation
1. Health care professionals1
2. Childcare professional1
3. Teachers1
c. Temporal Variation
i. Secular:
1. 1940-1950 more than 1 million cases in the United states, pre
vaccine era.
2. Gradual decline until 1980s, then there has been a steady increase
3. Large epidemic peaks in disease have been observed since the mid-
2000s
ii. Cyclic and Seasonal:
1. Pertussis has no distinct seasonal pattern, but it may increase in the
summer and fall5.
Pertussis Epidemiology Outline
iii. Epidemic
1. Pertussis is still considered a global epidemic, most recent peak in
the mid-2000s. We are approaching another increase now as
numbers are rising from most recent numbers reported by CDC.
VI. Hypothesis for Epidemic, Gaps in knowledge
a. Waning of vaccine immunity
b. Lack of proper education of vaccine schedules to maintain immunity.
c. Lack of access to health care in geographically rural areas
d. Distrust in vaccines and current choices to not vaccinate
e. Mutation of Gensis of Bordetella, causing other species that are not protectant in
current vaccines.
VII. Further research
a. Current research to be done on those that are not pro-vaccination and the
susceptibility to pertussis.
i. Survey and data from reported agencies such as CDC
b. Access and availability to vaccine clinics and vaccine schedule adherence
i. School requirements and adherence
VIII. The data still shows a significant epidemic of Pertussis, with increasing numbers
since 2020. Partly the drop in 2020 is hypothesized from the deterrent of close
contact, adherence to masking in public and overall decrease of availability of
transmission of pertussis. Now, as we enter 2024 numbers are beginning to climb and
estimate to continue to climb for a number of potential reasons. Vaccine
nonadherence and choices to not vaccinate for various personal reasons may bring
Pertussis Epidemiology Outline
back many diseases like pertussis that were relatively controlled. Anticipation of
increased mortality and morbidity in this disease will continue to rise and the chance
of the disease changing pathogenic may be due to the virus ability adapt against
vaccinated barriers. When reviewing data, although the significant cases are affected
in those younger due to their more weakened immune systems. It seems more
prevalent in adolescent and those over 20 years old. Probability is again, non-
adherence to vaccine schedules and decreased immunity over the course of time.
Pertussis Epidemiology Outline
References
1. Centers for Disease Control and Prevention. Accessed June 7, 2024. http://www.cdc.gov/.
2. Di Mattia G, Nicolai A, Frassanito A, Petrarca L, Nenna R, Midulla F. Pertussis: New
preventive strategies for an old disease. Paediatric Respiratory Reviews. 2019;29:68-73.
doi:10.1016/j.prrv.2018.03.011
3. Elgarini M, Mennane Z, Sobh M, Hammoumi A. Bordetella holmesii: Causative agent of
pertussis. Archives de Pédiatrie. 2024;31(3):172-175. doi:10.1016/j.arcped.2023.10.012
4. 2022 Provisional Pertussis Surveillance Report. Accessed June 6, 2024.
https://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2022_provisional.pdf.
5. Havers F, Moro P, Hariri S, Skoff T. Epidemiology and Prevention of of Vaccine-Preventable
Diseases: Chapter Pertussis. Published online May 11, 2020.
6. Pertussis. World Health Organization. Accessed June 8, 2024. https://www.who.int/health-
topics/pertussis#tab=tab_1.
7. Peer V, Schwartz N, Green MS. A multi-country, multi-year, meta-analytic evaluation of the
sex differences in age-specific pertussis incidence rates. PLOS ONE. 2020;15(4).
doi:10.1371/journal.pone.0231570
8. Patel JC, Cole M, Rubis AB, et al. Differences in pertussis incidence by race and ethnicity in
the United States, 2010–2017. Open Forum Infectious Diseases. 2024;11(4).
doi:10.1093/ofid/ofae177
Pertussis Epidemiology Outline
9. Skoff TH, Hadler S, Hariri S. The epidemiology of nationally reported pertussis in the United
States, 2000–2016. Clinical Infectious Diseases. 2018;68(10):1634-1640.
doi:10.1093/cid/ciy757
10. Tandy CB, Odoi A. Geographic disparities and socio-demographic predictors of pertussis
risk in Florida. PeerJ. 2021;9. doi:10.7717/peerj.11902
