1. Epidemiology of Pertussis in Texas
Rita Espinoza, MPH
Lucille Palenapa, MS
Emerging and Acute Infectious Disease Branch
April 1, 2009

2. Background Information
Texas
254 counties
Total Population – 24 million
Birth cohort – 375,000
Public Health Structure
52 contracted LHDs
8 regional health departments
83% population resides in LHD jurisdiction

3. Public Health Coverage
Knox
Travis
Mills
Smith
Falls
Collin
Jones
Nolan
Ward
Potter
Burnet
Cottle
Nueces
Zapata
Real
Coryell
Bowie
Matagorda
Brown
Motley
Reagan
Houston
Taylor
Martin
Lamar
Garza
Dallas
Fisher
Maverick
Jasper
Moore
Young
Coleman
Baylor
Kleberg
Archer
Scurry
Cameron
Cooke
Mason
Parker
Castro
Navarro
Brooks
Hardin
Tom Green
Bailey
Deaf Smith
DeWitt
Lavaca
Donley
Atascosa
Hays
Goliad
Denton
Bosque
Fannin
El Paso
Wharton
Crane
Concho
Carson
Runnels
Fayette
Crosby
Borden
Schleicher
Tarrant
Haskell
Calhoun
Newton
Gillespie
Live Oak
Randall
Shelby
Sterling
Foard
Briscoe
Parmer
Jim Hogg
Jefferson
Mitchell
Wilson
McMullen
Victoria
Wood
Menard
Roberts
Panola
Howard
Trinity
Bastrop
Grayson
San Saba
Walker
Midland
Hockley
Dickens
Swisher
Gonzales
Winkler
Anderson
Dawson
Willacy
Grimes
Wheeler
Cherokee
Harrison
Colorado
Eastland
Lubbock
Red River
Karnes
Refugio
Austin
Hemphill
Williamson
Jackson
Blanco
Ochiltree
McCulloch
Loving
Sherman
Wilbarger
Hansford
Callahan
McLennan
Angelina
Hopkins
Lipscomb
Yoakum
Stephens
Palo Pinto
Stonewall
Hamilton
Montague
Bandera
Cochran
Jim
Wells
Limestone
Zavala
Fort Bend
Kaufman
Comal
Armstrong
Kendall
Freestone
Titus
Comanche
Glasscock
Galveston
Johnson
Henderson
Montgomery
Wichita
Brazos
Chambers
Robertson
Van Zandt
Sabine
Upshur
Waller
Hood
Hutchinson
Shackelford
Childress
Burleson
Nacogdoches
Lampasas
Collings -
worth
Hardeman
Throck -
morton
Guadalupe
Caldwell
Aransas
Marion
San Patricio
Madison
San
Jacinto
Delta
Washington
Orange
Rains
Gregg
Morris
Augustine
Franklin
Camp
Somervell
Rockwall
Local Health Department Provides Services
Regional Headquarters Provides Services
Dallam
Hartley
Local and Regional
Oldham
Gray
Public Health Coverage 1
Hall
Lamb
Hale
Floyd
Clay
King
Terry
Lynn
Kent
2/3
Jack
Wise
Hunt
Cass
Gaines
Andrews
Ellis
Erath
4/5N
Rusk
Hill
Ector
Coke
Hudspeth
Culberson 7
Reeves
Upton
Irion
Leon
9/10
Bell
Jeff Davis
Pecos
Milam
Polk
Tyler
Crockett
Llano
Sutton
Kimble
Lee
Terrell
Liberty
Presidio
Edwards
Kerr
Harris
Brewster
Val Verde
6/5S
Kinney
Uvalde
Medina 8
Bexar
Brazoria
Frio
Dimmit
Bee
La Salle
Webb
Duval 11
Public Health Administrative Region
Regional Headquarters
Kenedy
Starr
Hidalgo

4. Highest Case Count during 20th Century
Comparison of 20th Century Annual Morbidity and Current Morbidity, Vaccine-Preventable Diseases, Texas
Disease
Highest Case Count during 20th Century
2008*
Percent
Decrease
Measles
88,000 (1958)
100%
Rubella
8,408 (1970)
CRS
12 (1974)
Mumps
32,939 (1950) 23
99.9%
Pertussis
21,588 (1947)
1882
91.2%
Diphtheria
1,544 (1946)
Tetanus
55 (1954)
Polio (paralytic)
2,778 (1950)

5. Pertussis in Texas
Prior to vaccine availability, an average of 9,000 cases reported annually between 1940 through 1959 (range: 4,020-21,558)
1980 – 1999, the average number of cases reported annually was 300
(range: )
Resurgence in 2000 as a public health issue affecting many in Texas

6. Reported Cases of Pertussis in Texas 1920-2008*
Pertussis Toxoid Licensed in 1949
* Provisional as of March 27, 2009

7. Reported Cases of Pertussis in Texas, 1998-2008*
* Provisional as of March 27, 2009 7

8. Incidence of Pertussis in Texas

9. Incidence of Pertussis in Texas by Age Group

10. Percentage of Texas Pertussis Cases by Age Group

11. Deaths due to Pertussis in Texas
* Provisional as of 3/23/09

12. Percentage of Pertussis cases by Race/Ethnicity

13. Comparison of 1998 and 2007 Cases
Number of Counties reporting Cases 58
102
Avg cough duration
30 days
36 days
% Hospitalized 38 17
% Confirmed 55 47
% Lab Confirmed 54 67

14. Percentage of Cases by Vaccination History

15. 2005 Incidence of Pertussis

16. Summary Increase in pertussis since 2000
Introduction of PCR testing in 2003
Increase awareness
Age distribution seems to be similar, yet 5-9 year old group has been increasing over the years
No differences among race/ethnicity
Severity of disease similar, yet fewer hospitalizations reported
High proportion of cases are vaccinated appropriately against pertussis

17. Questions? Rita Espinoza, MPH rita.espinoza@dshs.state.tx.us
(512) ext. 6335