Thursday, October 25, 2012

The UK’s Whooping Cough Outbreak


Confirmed Pertussis England & Wales by year & Quarter - 2012 numbers through 2nd Quarter


# 6661


Pertussis, or `Whooping Cough’ is a highly contagious bacterial infection that can cause serious illness and even death.  Although it is thought of as a `childhood’ disease, anyone of any age can catch it.


It is caused by either Bordetella pertussis or Bordetella parapertussis bacteria, which are easily spread through the air by the characteristic violent coughing spasms it induces. Infection can last for 6 weeks or longer, which is why it is sometimes called the `100 days' cough’.


Whooping cough in England and Wales, just as we’ve seen recently in the United States (see The Never Ending Battle), is on the rise again after two very successful decades of control.



The chart above (from Accelerating Control of Pertussis in England and Wales – EID Journal Vol. 18, No. 1, January 2012) illustrates just how well their vaccination program worked in controlling this disease since its introduction in the mid-1940s.


From seeing 170,000+ cases a year before the vaccine was introduced, down to triple digits in the early 1970s, the Pertussis vaccination in England & Wales has been a huge success story.


While spikes in cases did occur in the 1980s, increased uptake of the vaccine brought those numbers down again by 1990.


The reasons behind this latest spike in Pertussis cases are complex, and not completely understood, but some factors may include:


  • lower vaccination uptakes
  • the move away from whole cell pertussis vaccines to safer – but less broadly protective  - acellular vaccines in the 1990s
  • evolutionary changes in the Bordetella pertussis bacteria.


Recent evidence published in the NEJM suggests that protection from the newer acellular pertussis vaccine – introduced in the early 1990s – may wane sooner than previously suspected. 


Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children

Nicola P. Klein, M.D., Ph.D., Joan Bartlett, M.P.H., M.P.P., Ali Rowhani-Rahbar, M.D., M.P.H., Ph.D., Bruce Fireman, M.A., and Roger Baxter, M.D.

N Engl J Med 2012; 367:1012-1019 September 13, 2012DOI: 10.1056/NEJMoa1200850



All of which brings us to an HPA press release this morning, indicating that more than 6,000 whooping cough cases have been reported through the end of September, and urging parents to follow the recommended Pertussis vaccination schedule for their kids.



Whooping cough outbreak continues

25 October 2012

According to figures published by the Health Protection Agency (HPA) today, 1,322 cases of whooping cough (pertussis) were reported in England and Wales in September 2012, bringing the total number of cases so far this year to 6,121*.


The total number of cases so far in 2012 (up to end of September) is more than five times higher than the annual total number of cases reported in 2011 (1,118) and almost seven times higher than the total in 2008 (902) – the last ‘peak’ year before this current outbreak. In September there was one pertussis-related death in an infants under three months of age, bringing the total number of deaths in this age group so far this year to ten.




“The introduction of a vaccine for pregnant women will not have an immediate impact on serious infection in infants so vigilance remains important. Working with the Department of Health we will continue to regularly monitor figures to evaluate the success of the programme.


“All parents should ensure their children are vaccinated against whooping cough on time, even babies of women who’ve had the vaccine in pregnancy – this is to continue their baby’s protection through childhood. Parents should also be alert to the signs and symptoms of whooping cough – which include severe coughing fits accompanied by the characteristic “whoop” sound in young children but as a prolonged cough in older children or adults. It is also advisable to keep babies away from older siblings or adults who have the infection.”


(Continue . . . )



This rise in Pertussis isn’t just a problem in the UK.


The Untied States saw a major upsurge in 2010, with more than 27,000 Whooping cough cases reported. Earlier this year the State of Washington declared a Pertussis epidemic (see MMWR Pertussis Epidemic — Washington, 2012).


And Australia has a record 38,500 cases (out of a population of just over 22 million) reported in 2011.


While admittedly not 100% perfect, the Pertussis vaccine remains the best way to prevent Whooping Cough.


For more on how to protect yourself, your family, and your community, the  CDC offers the following advice on Pertussis Vaccination.


Pertussis Vaccination

The best way to prevent pertussis is to get vaccinated. There are vaccines for infants, children, preteens, teens and adults. The childhood vaccine is called DTaP, and the pertussis booster vaccine for adolescents and adults is called Tdap. Talk to your healthcare provider about getting vaccinated against pertussis and read more about pertussis prevention.
For Those Getting Vaccinated
Pertussis Vaccine Basics
Offers comprehensive offers information about pertussis vaccines and other educational tools.
Td or Tdap Vaccine "What You Need To Know"Adobe PDF file (66 KB, 2 pages)
This one-page CDC vaccine information statement explains who should get Td or Tdap vaccine and when.
DTaP Vaccine "What You Need To Know"Adobe PDF file (58 KB, 2 pages)
This one-page CDC vaccine information statement explains who should get DTaP vaccine and when.
Vaccine Safety
Who Should Not Be Vaccinated with DTaP or Td-Tdap?

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