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Tuesday, March 22, 2005 - 11:05 AM
34

A Resource and Labor Intensive County-wide Outbreak of Pertussis, Wisconsin, 2003: High Impact on the Adolescent Population

Mark J. Sotir1, Diane L. Cappazzo2, Carol E. Schmidt2, David M. Warshauer3, Jean A. Zastrow1, Timothy A. Monson3, and Jeffrey P. Davis4. (1) Wisconsin Division of Public Health, Madison, WI, USA, (2) Fond du Lac Health Department, Fond du Lac, WI, USA, (3) Wisconsin State Laboratory of Hygiene, Madison, WI, USA, (4) Bureau of Communicable Diseases, Division of Public Health, Wiscosnin Department of Health and Family Services, 1 W. Wilson St, Madison, WI, USA


BACKGROUND:
The reported incidence of pertussis among adolescents and adults has steadily increased since the 1980's. Between May 2003 and February 2004, a large community-wide pertussis outbreak occurred in Fond du Lac County, Wisconsin (population 97,296), resulting in an extensive response from local and state agencies.


OBJECTIVE:
Describe the epidemiologic characteristics of the outbreak and use of data to address current pertussis-related issues.

METHOD:
Health department personnel conducted patient follow-up. Data on signs and symptoms, onset dates, exposures, antibiotic treatment, and vaccination history were collected using standardized report forms. CDC case definitions were applied; a clinical case was cough illness lasting >2 weeks with paroxysms, whoop, or post-tussive vomiting. Laboratory confirmation was determined by isolating Bordetella pertussis in culture (C) or a positive polymerase chain reaction (PCR) assay.

RESULT:
During the outbreak, 313 cases of pertussis illness were reported among county residents; 193 (62%) were laboratory-confirmed (including 79 PCR+/C+ and 94 PCR+/C-). Among case patients, 51% were female, the median age was 14 years, 70% were aged 10-19 years, 3 infants were hospitalized, and there were no deaths. While in session, >1 reported case occurred in students at 24 different county schools; 29 (55%) of the initial 53 cases were linked to a high school weight room. Four patients (ages 3 to 15 years) reported no pertussis vaccinations, including two of the initial 3 cases. Approximately 3100 nasopharyngeal swab specimens were obtained for testing and 5000 courses of antibiotic treatment (>90% azithromycin) were administered during the outbreak.


CONCLUSION:
Illness in two unvaccinated individuals and transmission in a high school weight room were instigating factors in this large outbreak. Because most illnesses occurred among adolescents, this labor and resource intensive outbreak highlights the need for a pertussis booster vaccination in adolescents.

LEARNING OBJECTIVES:
Address current issues regarding community-wide pertussis outbreaks and prevention of future outbreaks.

See more of Epidemiology Track Workshop: A Big Whoop: Current Challenges and New Directions for Pertussis in the United States
See more of The 39th National Immunization Conference (NIC)