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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 on theme: "Thomas Clark, MD, MPH Centers for Disease Control and Prevention Immunization Program Managers Meeting November 16, 2010 Pertussis Epidemiology in the."— Presentation transcript:

1 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

2 BACKGROUND AND OVERVIEW

3 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 Measles503,282140 Mumps152,209454 Rubella47,74516 Congenital rubella8230 H. influenza (invasive <5 yrs)20,00030 * CDC, MMWR, April 2, 1999. 48(12); :242-264 ** CDC, MMWR, January 8, 2010. 58(51 & 52); 1460-1468 † National Notifiable Diseases Surveillance System, CDC, 2008

4 Pertussis Immunization in the US Infants (1997) – DTaP at 2, 4, 6 months Toddler (1992) – DTaP at 15-18 months Pre-school (1992) – DTaP at4-6 years Adolescent/adult (2005) – Single Tdap preferred at 11-12 years

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

6 Reported pertussis cases – 1922-2009 DTP Tdap DTaP SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and 1922-1949, passive reports to the Public Health Service

7 Annual incidence (per 100,000) by state - 2009 Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009) 0-2.7 2.8-4.6 4.7-6.6 6.7-21.5 Incidence 2009 incidence 5.5

8 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) 0.0-1.8 1.9-3.2 3.2-5.0 5.1-10.0 Incidence

9 Reported pertussis incidence by age group - 1990-2009 SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System

10 TDAP IMPLEMENTATION AND EVALUATION

11 Proportion of reported pertussis cases by age group - 1990-2009 Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009)

12 Tdap coverage among adolescents aged 13- 17 years – 2006-2009 CDC. National, State, and Local Area Vaccination Coverage Among Adolescents Aged 33-17 Years - United States, 2008. MMWR 2008;58(36);997-1001. CDC. Vaccination Coverage Among Adolescents Aged 13-17 Years – United States, 2007. MMWR 2008;57(40)1100-1103. CDC. Vaccination Coverage Among Adolescents Aged 13-17 Years– United States, 2006. MMWR 2007;56(34) 885-888. CDC. National, State, and Local Area Vaccination Coverage among Adolescents Aged 13-17 Years - United States, 2009 MMWR 2010 ;59(32);1018-1023. 20062007 2008 Percentage (%) 2009

13 Tdap Vaccine Effectiveness Bridging studies of ADACEL and BOOSTRIX 1 – 85-89% APERT study 2 – 92% (95% CI: 32.0-99.0) Australia 3 – screening method – 78.0% (95% CI: 60.7-87.6) St. Croix outbreak 4 – case-control study – 65.6% (95% CI: - 35.8-91.3) MN case-control study – 72.3% (95% CI: 38.8-87.4) 1 Schmitt HJ et al. JAMA 1996;275:37-41; Gustafsson LH et al. NEJM 1996;334:349-355 2 Ward JI et al. N Engl J Med. 2005 Oct 13;353(15):1555-63. 3 Rank C, et al. Pediatr Infect Dis J. 2009 Feb;28(2):152-3. 4 Wei SC, et al. CID 2010; 51(3):315-321.

14 Incidence of reported pertussis - 1990-2008 Tdap CDC unpublished data

15 Accelerated decline of pertussis Rate ratios of pertussis incidence among adolescents 11-18 years, 1990-2008 CDC unpublished data

16 EMERGENCE OF DISEASE IN CHILDREN AGED 7-10 YEARS

17 Pertussis incidence by age group - 1990-2009 Source: CDC National Notifiable Disease Surveillance System, 2009 CDC Wonder Population Estimates (Vintage 2009)

18

19 Pertussis cases by age – 2002-2005

20 Pertussis cases by age – 2006-2009

21 Incidence rate ratios of pertussis among children aged 7-10 years – 1990-2009 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

22 Waning Immunity by Vaccine Type

23 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

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

25 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov 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

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