Epidemiology of Pertussis in Texas Rita Espinoza, MPH Lucille Palenapa, MS Emerging and Acute Infectious Disease Branch April 1, 2009

Background Information Texas 254 counties Total Population – 24 million Birth cohort – 375,000 Public Health Structure 52 contracted LHDs 8 regional health departments 83% population resides in LHD jurisdiction

Public Health Coverage Knox Travis Mills Smith Falls Collin Jones Nolan Ward Potter Burnet Cottle Nueces Zapata Real Coryell Bowie Matagorda Brown Motley Reagan Houston Taylor Martin Lamar Garza Dallas Fisher Maverick Jasper Moore Young Coleman Baylor Kleberg Archer Scurry Cameron Cooke Mason Parker Castro Navarro Brooks Hardin Tom Green Bailey Deaf Smith DeWitt Lavaca Donley Atascosa Hays Goliad Denton Bosque Fannin El Paso Wharton Crane Concho Carson Runnels Fayette Crosby Borden Schleicher Tarrant Haskell Calhoun Newton Gillespie Live Oak Randall Shelby Sterling Foard Briscoe Parmer Jim Hogg Jefferson Mitchell Wilson McMullen Victoria Wood Menard Roberts Panola Howard Trinity Bastrop Grayson San Saba Walker Midland Hockley Dickens Swisher Gonzales Winkler Anderson Dawson Willacy Grimes Wheeler Cherokee Harrison Colorado Eastland Lubbock Red River Karnes Refugio Austin Hemphill Williamson Jackson Blanco Ochiltree McCulloch Loving Sherman Wilbarger Hansford Callahan McLennan Angelina Hopkins Lipscomb Yoakum Stephens Palo Pinto Stonewall Hamilton Montague Bandera Cochran Jim Wells Limestone Zavala Fort Bend Kaufman Comal Armstrong Kendall Freestone Titus Comanche Glasscock Galveston Johnson Henderson Montgomery Wichita Brazos Chambers Robertson Van Zandt Sabine Upshur Waller Hood Hutchinson Shackelford Childress Burleson Nacogdoches Lampasas Collings - worth Hardeman Throck - morton Guadalupe Caldwell Aransas Marion San Patricio Madison San Jacinto Delta Washington Orange Rains Gregg Morris Augustine Franklin Camp Somervell Rockwall Local Health Department Provides Services Regional Headquarters Provides Services Dallam Hartley Local and Regional Oldham Gray Public Health Coverage 1 Hall Lamb Hale Floyd Clay King Terry Lynn Kent 2/3 Jack Wise Hunt Cass Gaines Andrews Ellis Erath 4/5N Rusk Hill Ector Coke Hudspeth Culberson 7 Reeves Upton Irion Leon 9/10 Bell Jeff Davis Pecos Milam Polk Tyler Crockett Llano Sutton Kimble Lee Terrell Liberty Presidio Edwards Kerr Harris Brewster Val Verde 6/5S Kinney Uvalde Medina 8 Bexar Brazoria Frio Dimmit Bee La Salle Webb Duval 11 Public Health Administrative Region Regional Headquarters Kenedy Starr Hidalgo

Highest Case Count during 20th Century Comparison of 20th Century Annual Morbidity and Current Morbidity, Vaccine-Preventable Diseases, Texas Disease Highest Case Count during 20th Century 2008* Percent Decrease Measles 88,000 (1958) 100% Rubella 8,408 (1970) CRS 12 (1974) Mumps 32,939 (1950) 23 99.9% Pertussis 21,588 (1947) 1882 91.2% Diphtheria 1,544 (1946) Tetanus 55 (1954) Polio (paralytic) 2,778 (1950)

Pertussis in Texas Prior to vaccine availability, an average of 9,000 cases reported annually between 1940 through 1959 (range: 4,020-21,558) 1980 – 1999, the average number of cases reported annually was 300 (range: 60-379) Resurgence in 2000 as a public health issue affecting many in Texas

Reported Cases of Pertussis in Texas 1920-2008* Pertussis Toxoid Licensed in 1949 * Provisional as of March 27, 2009

Reported Cases of Pertussis in Texas, 1998-2008* * Provisional as of March 27, 2009 7

Incidence of Pertussis in Texas

Incidence of Pertussis in Texas by Age Group

Percentage of Texas Pertussis Cases by Age Group

Deaths due to Pertussis in Texas * Provisional as of 3/23/09

Percentage of Pertussis cases by Race/Ethnicity

Comparison of 1998 and 2007 Cases Number of Counties reporting Cases 58 102 Avg cough duration 30 days 36 days % Hospitalized 38 17 % Confirmed 55 47 % Lab Confirmed 54 67

Percentage of Cases by Vaccination History

2005 Incidence of Pertussis

Summary Increase in pertussis since 2000 Introduction of PCR testing in 2003 Increase awareness Age distribution seems to be similar, yet 5-9 year old group has been increasing over the years No differences among race/ethnicity Severity of disease similar, yet fewer hospitalizations reported High proportion of cases are vaccinated appropriately against pertussis

Questions? Rita Espinoza, MPH rita.espinoza@dshs.state.tx.us (512) 458-7111 ext. 6335