Thomas Clark, MD, MPH Centers for Disease Control and Prevention Immunization Program Managers Meeting November 16, 2010 Pertussis Epidemiology in the.

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Presentation transcript:

Thomas Clark, MD, MPH Centers for Disease Control and Prevention Immunization Program Managers Meeting November 16, 2010 Pertussis Epidemiology in the United States National Center for Immunization & Respiratory Diseases Meningitis and Vaccine Preventable Diseases Branch/Division of Bacterial Diseases

BACKGROUND AND OVERVIEW

Impact of Vaccines in the United States Vaccine-Preventable Disease Number of Reported Cases 20 th Century Annual Morbidity* 2008** Smallpox48,1640 Diphtheria175,8850 Pertussis147,27113,278 † Tetanus1,31419 Polio (paralytic)16,3160 Measles503, Mumps152, Rubella47,74516 Congenital rubella8230 H. influenza (invasive <5 yrs)20,00030 * CDC, MMWR, April 2, (12); : ** CDC, MMWR, January 8, (51 & 52); † National Notifiable Diseases Surveillance System, CDC, 2008

Pertussis Immunization in the US Infants (1997) – DTaP at 2, 4, 6 months Toddler (1992) – DTaP at months Pre-school (1992) – DTaP at4-6 years Adolescent/adult (2005) – Single Tdap preferred at years

DTaP coverage among children aged 19 through 35 months CDC National Immunization Survey

Reported pertussis cases – DTP Tdap DTaP SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and , passive reports to the Public Health Service

Annual incidence (per 100,000) by state Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009) Incidence 2009 incidence 5.5

Annual incidence by State (per 100,000) by state - preliminary 2010* Source : CDC National Notifiable Disease Surveillance System, *Provisional data, cumulative to week ending September 25, 2010 (MMWR Week 38) CDC Wonder Population Estimates (Vintage 2009) Incidence

Reported pertussis incidence by age group SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System

TDAP IMPLEMENTATION AND EVALUATION

Proportion of reported pertussis cases by age group Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009)

Tdap coverage among adolescents aged years – CDC. National, State, and Local Area Vaccination Coverage Among Adolescents Aged Years - United States, MMWR 2008;58(36); CDC. Vaccination Coverage Among Adolescents Aged Years – United States, MMWR 2008;57(40) CDC. Vaccination Coverage Among Adolescents Aged Years– United States, MMWR 2007;56(34) CDC. National, State, and Local Area Vaccination Coverage among Adolescents Aged Years - United States, 2009 MMWR 2010 ;59(32); Percentage (%) 2009

Tdap Vaccine Effectiveness Bridging studies of ADACEL and BOOSTRIX 1 – 85-89% APERT study 2 – 92% (95% CI: ) Australia 3 – screening method – 78.0% (95% CI: ) St. Croix outbreak 4 – case-control study – 65.6% (95% CI: ) MN case-control study – 72.3% (95% CI: ) 1 Schmitt HJ et al. JAMA 1996;275:37-41; Gustafsson LH et al. NEJM 1996;334: Ward JI et al. N Engl J Med Oct 13;353(15): Rank C, et al. Pediatr Infect Dis J Feb;28(2): Wei SC, et al. CID 2010; 51(3):

Incidence of reported pertussis Tdap CDC unpublished data

Accelerated decline of pertussis Rate ratios of pertussis incidence among adolescents years, CDC unpublished data

EMERGENCE OF DISEASE IN CHILDREN AGED 7-10 YEARS

Pertussis incidence by age group Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009)

Pertussis cases by age –

Pertussis cases by age –

Incidence rate ratios of pertussis among children aged 7-10 years – Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009) In 2005, 7-10 year old cohort includes aP vaccine recipients

Waning Immunity by Vaccine Type

Priority Analytic Questions Comparative vaccine effectiveness using immunization registries Case-control study of effectiveness of 5 th DTaP dose in California Modeling impact of waning immunity and changes to vaccination schedule Impact of changing strain diversity on disease occurrence

Additional Activities ACIP Clinical Validation Study Laboratory training and tech transfer External review of vaccinology activities

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank You National Center for Immunization & Respiratory Diseases Meningitis and Vaccine Preventable Diseases/Division of Bacterial Diseases