Transcript Meningococcal Disease and Meningococcal Conjugate

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
Dallam
Sherman
Hansford
Ochiltree
Lipscomb
Hartley
Moore
Hutchinson
Roberts
Hemphill
Oldham
Potter
Carson
Gray
Wheeler
Armstrong
Donley
Collings worth
Local and Regional
Public Health Coverage
Randall
Deaf Smith
1
Parmer
Castro
Swisher
Briscoe
Hall
Childress
Hardeman
Bailey
Lamb
Hale
Floyd
Wilbarger
Cottle
Motley
Wichita
Foard
Clay
Cochran
Lubbock
Hockley
Montague
Crosby
Dickens
King
Baylor
Knox
Cooke
Archer
Lamar
Grayson
Red River
Fannin
Bowie
Delta
Terry
Lynn
Garza
Kent
Stonewall
Haskell
Throck morton
Jack
Young
Wise
2/3
Denton
Collin
Dawson
Borden
Scurry
Fisher
Parker
El Paso
Loving
Midland
Howard
Glasscock
Mitchell
Sterling
Nolan
Coke
Eastland
Callahan
Comanche
Crane
Reeves
Reagan
Irion
Tom Green
Nacogdoches
7
Leon
Sutton
Travis
Washington
Edwards
Brewster
Val Verde
Fayette
Caldwell
Comal
Austin
Harris
Chambers
Bandera
Colorado
Guadalupe
Gonzales
Kinney
Uvalde
Medina
Fort Bend
Lavaca
Wharton
Bexar
8
6/5S
Brazoria
Wilson
DeWitt
Jackson
Zavala
Frio
Karnes
Atascosa
Matagorda
Victoria
Maverick
Goliad
Dimmit
La Salle
McMullen Live Oak
Local Health Department Provides Services
Calhoun
Bee
Refugio
San Patricio
Webb
Jim
Wells
Duval
Regional Headquarters Provides Services
11
Aransas
Nueces
Kleberg
Public Health Administrative Region
Zapata
Jim Hogg
Brooks
Kenedy
Regional Headquarters
Starr
Orange
Jefferson
Kendall
Real
Liberty
Bastrop
Hays
Kerr
Hardin
Montgomery
Lee
Blanco
Tyler
San
Jacinto
Grimes
Burleson
Kimble
Presidio
Polk
Walker
Brazos
Williamson
Terrell
Sabine
Madison
Milam
Llano
Gillespie
Angelina
Trinity
Robertson
Burnet
Mason
Houston
Falls
Bell
Pecos
Shelby
Limestone
McLennan
Menard
Crockett
4/5N
Lampasas
San Saba
Panola
Cherokee
Anderson
Concho
McCulloch
Schleicher
Rusk
Freestone
Coryell
9/10
Jeff Davis
Henderson
Hamilton
Mills
Upton
Smith
Navarro
Bosque
Harrison
Gregg
Ellis
Hill
Brown
Coleman
Johnson
Somervell
Erath
Ward
Culberson
Upshur
Kaufman Van Zandt
Taylor
Runnels
Wood
Marion
San
Augustine
Hudspeth
Ector
Winkler
Martin
Rains
Dallas
Tarrant
Hood
Andrews
Cass
Camp
Palo Pinto
Shackelford Stephens
Jones
Hopkins
Hunt
Rockwall
Gaines
Morris
Yoakum
Titus
Willacy
Hidalgo
Cameron
Galveston
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)
0
100%
Rubella
8,408 (1970)
0
100%
12 (1974)
0
100%
Mumps
32,939 (1950)
23
99.9%
Pertussis
21,588 (1947)
1882
91.2%
Diphtheria
1,544 (1946)
0
100%
55 (1954)
0
100%
2,778 (1950)
0
100%
CRS
Tetanus
Polio
(paralytic)
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
25000
20000
15000
10000
5000
* Provisional as of March 27, 2009
2000
1990
1980
1970
1960
1950
1940
1930
1920
0
Reported Cases of Pertussis
in Texas, 1998-2008*
2500
2000
1500
1000
500
0
1998
1999
2000
2001
2002
* Provisional as of March 27, 2009
2003
2004
2005
2006
2007 2008*
Incidence of Pertussis in Texas
Rate per 100,000
12
10
8
6
4
2
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Cases per 100,000 population
Incidence of Pertussis in Texas
by Age Group
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
72.5
39.1
2.3 0.8 1.1 1.1 0.6
8.4 11.3 4.8
1998
<1
1 to 4
2.3 1.9
2007
5 to 9
10 to 14
15 to 19
20+
Percentage of Texas Pertussis Cases
by Age Group
50
45
40
35
30
25
20
15
10
5
0
<1 year
1-4
years
5-9
years
1998
10-14
years
2007
15-19
years
20+
years
Deaths due to Pertussis in Texas
10
9
8
7
6
5
4
3
2
1
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008*
* Provisional as of 3/23/09
Percentage of Pertussis
cases by Race/Ethnicity
100
90
80
70
60
50
40
30
20
10
0
Black
Hispanic
1998
White
2007
Other
Comparison of 1998 and 2007 Cases
1998
2007
Number of Counties
reporting Cases
Avg cough duration
58
102
30 days
36 days
% Hospitalized
38
17
% Confirmed
55
47
% Lab Confirmed
54
67
Percentage of Cases by
Vaccination History
70
60
50
40
30
20
10
0
1998
2007
Yes
No
Unknown
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
[email protected]
(512) 458-7111 ext. 6335