Current Epidemiology of Pertussis in the United States(A. Current Epidemiology of Pertussis)(II. The Eradication of Pertussis: Current Unsolved Epidemiologic, Clinical and Public Health Problems which Impede This Goal)(Clinical Aspects of Acellular Pertus

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The incidence of pertussis in the United States decreased rapidly during the 20th century, with the most impressive decreases resulting from the widespread use of DTP vaccine since the late 1940's. As a result of immunization laws, vaccine coverage levels against pertussis at school entry have been greater than 95% since 1980. National surveillance for pertussis done by the Centers for Disease Control (CDC) consists of two parts: a weekly telephone reporting system and a written case report system providing more detailed demographic, clinical, and laboratory information. In addition, data on secondary spread of pertussis among household contacts of reported cases were available on a small proportion of reported cases during 1979-1983. During the period 1980-1986, a total of 17,396 cases of pertussis was reported to CDC by weekly telephone reports. The annual incidence of reported pertussis rose during this period from 0.5 cases per 100,000 population to 1.7/100,000. Infants less than 12 months of age had the highest average annual incidence, estimated at 32 cases per 100,000. Children 1-4 years of age accounted for 25% of all cases but had an average annual incidence only 1/7th that of infants. The incidence rates for all age groups increased consistently between 1982 and 1986. The most impressive relative increases occurred among older adolescents and persons 20 years of age and older. In 1986, 10% of reported cases were in this age group compared to only 5% in 1982. Rates of hospitalization and complications such as pneumonia, seizures, and encephalopathy associated with pertussis were highest in children less than 6 months of age and declined progressively with increasing age. In addition, the mortality ratio was highest in the same age group. Among children with pertussis ages 7 months to 4 years, about 3 of 5 had not received at least 3 doses of DTP (the minimum considered necessary for optimal protection), and about 1 of 3 had not received any doses of DTP. Based on the household contact data from 1979-1983, the clinical vaccine efficacy of 3+ doses of DTP among household contacts ages 7 months to 9 years was 90% (95% confidence interval 86-92). The increase in overall incidence of pertussis in the United States may be actual, or an artifact of increased diagnosis and reporting of cases, or a combination of both. On a nationwide scale there is little indication that there has been a decrease in the utilization of DTP despite publicity since 1982 concerning potential risks of DTP.
東海大学の論文
1988-09-22

Current Epidemiology of Pertussis in the United States(A. Current Epidemiology of Pertussis)(II. The Eradication of Pertussis: Current Unsolved Epidemiologic, Clinical and Public Health Problems which Impede This Goal)(Clinical Aspects of Acellular Pertus

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