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Bordetella pertussis surveillance in England and Wales: 1995-7
P G Van Buynder1, D Owen, J E Vurdien
1Communicable Diseases Surveillance Centre, Colindale, UK.
Abstract:
Available data sources on disease due to Bordetella pertussis, including notifications, hospital admissions, deaths, and an enhanced laboratory-based surveillance system commenced in January 1994, were reviewed for the period 1995-7. Pertussis notifications continued their approximately 3-year cycle although at historically reduced levels. A slight seasonal increase in late summer/early autumn existed over and above a relatively constant background rate. Over time, the proportion of pertussis cases in younger, unvaccinated children, and to a lesser extent, adolescents and young adults, is increasing. There is a continuing significant and underreported mortality associated with pertussis in the very young age group. Disease due to serotype 1,2 is on the increase despite persistent high vaccination levels and this serotype causes more severe disease. The provision of preventative antibiotics prior to disease onset reduced the severity of the disease but its use remains uncommon in England and Wales. While overall levels of pertussis notifications have declined in recent times, vaccination efficacy wanes with increasing age, and pertussis remains a significant cause of mortality and severe morbidity in the very young. This could be reduced by timely booster vaccination and increased recognition of mild disease in older cases followed by early antibiotic therapy for the very young household contacts.
Insights
Pertussis (whooping cough) notifications are decreasing but cases are rising in young children and adolescents. Serotype 1,2 pertussis is increasing and causes more severe disease, highlighting the need for timely booster vaccinations.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) surveillance data from England and Wales (1995-1997) were analyzed.
- Trends in pertussis notifications, hospital admissions, and deaths were examined.
- An enhanced laboratory-based surveillance system provided additional data.
Purpose of the Study:
- To review available data sources on pertussis (whooping cough) for the period 1995-1997.
- To identify trends in pertussis epidemiology, including age distribution and serotype prevalence.
- To assess the impact of vaccination and potential interventions.
Main Methods:
- Review of national surveillance data including notifications, hospital admissions, and deaths.
- Analysis of trends in pertussis incidence and seasonality.
- Examination of age-specific case proportions and serotype distribution.
Main Results:
- Pertussis notifications exhibited a 3-year cycle but at reduced levels, with a slight seasonal peak.
- An increasing proportion of cases occurred in younger, unvaccinated children, adolescents, and young adults.
- Serotype 1,2 pertussis, associated with more severe disease, was increasing despite high vaccination rates.
- Significant underreported mortality in infants was noted.
- Preventative antibiotics reduced disease severity but were rarely used.
Conclusions:
- Despite declining overall notifications, pertussis remains a significant threat, particularly to the very young.
- Waning vaccine efficacy with age and the rise of serotype 1,2 necessitate improved vaccination strategies.
- Timely booster vaccinations and early antibiotic treatment for contacts are crucial for reducing pertussis morbidity and mortality.