1. Pertussis Update 2012

2. Pertussis In CA & US 2012: CA – 169 (April) US (excluding CA) – 29,000 (September) 2010: CA - 9,394 US (excluding CA) – 18,156 No deaths from pertussis in CA in 24 months. - Longest stretch without a death in more than 20 years. - Our vaccination efforts may be working. - We are in the trough of the five year cycle

3. Pertussis in CA

4. Pertussis in WA

5. Acellular Vaccine Wanes Sheridan SL, Ware RS, Grimwood K, Lambert SB. Number and Order of Whole Cell Pertussis Vaccines in Infancy and Disease Protection. JAMA. 2012;308(5):454-456. doi:10.1001/jama.2012.6364.

6. A Better Pertussis Vaccine Vaccine wears off in as little as 3 years Leaves gaps in herd immunity Absolutely need research into a more durable (longer-lasting) vaccine Possibilities -Change acellular formulation (less PT) -Whole-cell vaccine with reactogenic components ( lipopolysacharides or endotoxins ) removed. CDC, Manufacturers, ACIP working on it. Will not be ready before next CA pertussis wave. Sources: Why Do Pertussis Vaccines Fail? James D. Cherry, MD, MSc

7. Preparing for the Next CA Wave Saving Babies’ Lives & Preventing Hospitalizations

8. Clinical Symptoms of Pertussis Clinical symptoms Catarrhal stage: Onset of cold-like symptoms (coryza, sneezing, occasional cough). Fever is absent or minimal. This stage lasts approximately 1-2 weeks with cough gradually becoming more severe. Paroxysmal stage: Spasms of severe coughing are followed by a sudden deep inspiration, often resulting in a characteristic “whooping” noise. Post-tussive vomiting is common in all ages. Illness may be milder in previously vaccinated people. Infants <6 months of age may present differently : may have a shorter catarrhal stage may gag, gasp or stop breathing (apnea) facial color changes (may turn blue, purple or red) may not have noticeable cough or “whoop” likely to have leukocytosis (high white blood cell count) with an increased absolute lymphocyte count

9. Adult Tdap IZ Rates - US GroupRate 19 – 64 y.o.8.2% Living with an infant aged <1 yr10.6% Hispanic or Latino5% Health Care Workers31% Source - CDC. Adult vaccination coverage—United States, 2010. MMWR. 2012;61(4):66-72.

10. Preparing for the Next CA Wave 2014-2015: California will likely experience the next wave of pertussis. Strategies to prepare the SF/Bay Area Cocooning – Immunize all those around infants Immunize Pregnant Women in third trimester Educate Providers About Pertussis Symptoms Increase Adult Tdap Immunization Rates Targeted Campaigns/Immunization Clinics (Latinos, pregnant women, HCWs) CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months – Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011; 60 (No. 41): 1426.

11. San Francisco Immunization Coalition Pertussis Task Force Next Meeting November 15, 12-1:30 p.m. 101 Grove Street, Room 302 http://www.sfimmunize.org/pertussis-task-force.html Contact: Andrew Resignato, MS San Francisco Immunization Coalition andrew@sfimmunize.org 415-554-2567