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A "new age" in pertussis prevention new opportunities through adult vaccination
Margaret M Cortese1, Andrew L Baughman, Kristin Brown
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mcortese@cdc.gov
Insights
Adults experience significant pertussis (whooping cough) illness, with over 600,000 cases annually. Vaccination with tetanus, diphtheria, and acellular pertussis (Tdap) offers a crucial opportunity to reduce disease burden and protect infants.
Area of Science:
- Epidemiology
- Vaccinology
- Public Health
Background:
- Pertussis (whooping cough) continues to cause significant illness in the U.S. despite childhood vaccination programs.
- Tetanus, diphtheria, and acellular pertussis (Tdap) vaccines became available for adolescents and adults in 2005.
- Recommendations shifted to Tdap replacing tetanus-diphtheria boosters to mitigate pertussis spread.
Purpose of the Study:
- To summarize pertussis morbidity and incidence data in U.S. adults.
- To evaluate the role of adults in transmitting pertussis to infants.
- To provide background for Tdap vaccination recommendations in adults.
Main Methods:
- Conducted a MEDLINE search for U.S. adult pertussis data (incidence, cough illness, complications) in March 2006.
- Included prospective, non-outbreak studies.
- Analyzed national passive surveillance data in October 2005.
Main Results:
- Estimated adult pertussis burden exceeds 600,000 cases annually in the U.S.
- Adult pertussis symptoms include prolonged cough (2-4 months), leading to medical visits and work absence.
- Complications include pneumonia, rib fractures, and cough syncope; adults are key transmitters to infants, who face high hospitalization and death risks.
Conclusions:
- Pertussis causes substantial morbidity in U.S. adults, with high incidence rates.
- Adults are a significant source of pertussis infection for vulnerable young infants.
- Tdap vaccination presents an opportunity for healthcare providers to reduce the overall burden of pertussis.
Background:
For the first time, pertussis vaccines for adolescents and adults (combined with tetanus and diphtheria toxoids [Tdap]) became available in the United States in 2005. Despite a fully implemented U.S. childhood pertussis vaccination program, substantial morbidity because of pertussis continues to occur. To reduce this morbidity, the Advisory Committee on Immunization Practices recommended Tdap for all adolescents and adults in place of the next tetanus-diphtheria booster. As background for the basis of these recommendations, we summarize data on the morbidity and incidence of pertussis in U.S. adults and the role of adults in transmitting pertussis to young infants.
Methods:
A MEDLINE search was performed in March 2006 for data on pertussis incidence rates and cough illness because of pertussis among U.S. adults (prospective, nonoutbreak studies were selected) and pertussis complications in adults. Data from the national passive surveillance system were also analyzed in October 2005.
Results:
The true adult burden is estimated at more than 600,000 cases annually in the United States. Adults with pertussis commonly cough for 2-4 months, often resulting in repeated medical visits and missed work. Complications include pneumonia, rib fractures, and cough syncope. Adults are an important source of pertussis for young infants, who have the highest risk of hospitalization and death.
Conclusions:
The morbidity from pertussis in adults can be substantial, the incidence of pertussis in U.S. adults is high, and adults transmit infection to young infants. Providers now have the opportunity to reduce the burden of pertussis by vaccinating adults with Tdap.
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