Strategic Approaches Towards Pertussis Control in Oman
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1Health Affairs Office, Ministry of Health, Muscat, Oman.
Insights
High DTP3 vaccination in Oman reduced pertussis incidence, but infants remain vulnerable. Maternal Tdap vaccination is recommended to protect newborns from this contagious respiratory illness.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Pertussis (whooping cough) is a highly contagious respiratory infection posing severe risks, particularly to infants and young children.
- Infant pertussis can lead to severe symptoms and fatalities, while adolescents and adults typically experience milder illness.
- Effective control strategies are crucial to mitigate the impact of pertussis outbreaks.
Purpose of the Study:
- To evaluate the progress and challenges in pertussis control within Oman.
- To analyze pertussis incidence trends and vaccination coverage over a defined period.
- To identify optimal strategies for preventing pertussis in vulnerable populations.
Main Methods:
- Utilized pertussis data from 1981 to 2015, sourced from official Omani health reports and surveillance newsletters.
- Calculated key pertussis indicators, including vaccination coverage and incidence rates across different age groups.
- Analyzed trends in disease occurrence, outbreaks, and case demographics.
Main Results:
- Diphtheria-tetanus-whole cell pertussis (DTwP3) vaccination coverage increased significantly from 19% in 1981 to 97% by 1992, maintained through 2015.
- Overall pertussis incidence dramatically decreased from 771 to 21 cases per 100,000 population between 1981-1985 and 2011-2015, respectively.
- Despite high DTP3 coverage, infants under 12 months accounted for the majority of cases (79.7%) between 2011-2015, with high hospitalization rates; no pertussis deaths were recorded since 2007.
Conclusions:
- Oman has achieved high DTP3 vaccination coverage, significantly reducing overall pertussis incidence.
- Infants under 12 months remain a vulnerable group, with pertussis posing a substantial health challenge.
- Maternal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination is proposed as the most effective strategy to protect infants.
Objectives:
Pertussis is a highly contagious disease that causes severe and serious symptoms among infants and young children with fatalities observed in early infancy. The disease is milder among adolescents and adults. In this paper, we describe the progress made towards pertussis control in Oman and the challenges ahead to achieve control and maintain it.
Methods:
Pertussis data were collected between 1981 and 2015 from various sources including Annual Health Reports, annual Ministry of Health progress reports, and Community Health and Diseases Surveillance Newsletter, which provided information for the calculation of different pertussis indicators.
Results:
Diphtheria-tetanus-whole cell pertussis 3 (DTwP3) vaccination coverage rose from 19% in 1981 to 97% in 1992 and has been at 3 97% until 2015. The overall incidence of pertussis dropped dramatically from an average of 771 cases per 100 000 population from 1981 through 1985, to 21 cases per 100 000 population between 2011 and 2015 (p < 0.001). Since 1987, pertussis cases were cyclical, with peaks every three to five years with three major outbreaks reported in some parts of the country. Between 2011 and 2015, 831 cases were notified of which 785 (94.4%) met the pertussis case definition. Of these 785 cases, 625 (79.7%) were in children aged < 12 months (average rate 185 per 100 000 population), and almost all were hospitalized. Of the 625, 357 (57.1%) were aged < 2 months (average incidence of 600/100 000 population), 129 (20.6%) were 2-3 months old (average incidence of 202/100 000 population), 80 (12.8%) were 4-6 months (average incidence of 119/100 000 population), and 59 (9.4%) were 6-12 months old (average incidence is 22/100 000 population). There were 160/785 (20.3%) cases reported in children 3 12 months old (average rate 4/100 000 population). Downward trend rates were reported in the 5-14 year age group and a very low disease rate was observed in the > 15 years group. Since 2007, no deaths recorded were attributed to pertussis.
Conclusions:
Oman has a high coverage of DTP3; however, pertussis control remains a challenge among infants < 12 months old. Therefore, tetanus, diphtheria, and acellular pertussis (Tdap) vaccination of pregnant women is likely to be the best strategy for preventing the disease in infants.
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