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Reported Pertussis Among Adults Aged 65 Years and Older, Wisconsin, 2011-2012

Monday, June 10, 2013: 3:08 PM
Ballroom F (Pasadena Convention Center)
Roman Aydiko Ayele , Wisconsin Department of Health and Family Services, Madison, WI
Ashley B. Richardson-Haleem, MPH , Wisconsin Department of Health and Family Services, Madison, WI
Ruth S. Koepke, MPH , Wisconsin Department of Health and Family Services, Madison, WI
Stephanie L. Schauer, PhD , Wisconsin Department of Health and Family Services, Madison, WI
Daniel J. Hopfensperger , Wisconsin Department of Health and Family Services, Madison, WI
James H. Conway, MD , University of Wisconsin School of Medicine and Public Health, Madison, WI
Jeffrey P. Davis, MD , Wisconsin Department of Health and Family Services, Madison, WI
BACKGROUND:  During 2012, Wisconsin had the highest reported incidence of pertussis in the nation, 93.4 cases per 100,000 populations with all age groups affected. We examined the epidemiologic features of pertussis among Wisconsin adults aged ≥65 years.

METHODS:  Pertussis case data reported by local health departments to the Wisconsin Division of Public Health (WDPH) using the Wisconsin Electronic Disease Surveillance System during July 1, 2011 through December 31, 2012 were included in this study. Patients with acute cough illnesses meeting the CDC/CSTE case definitions for confirmed or probable pertussis were included and at least one follow up of each patient occurred after 14 or more days of coughing.  Data were analyzed using SAS version 9.3.

RESULTS:  Among 7003 reported cases (5010 confirmed, 1993 probable) of pertussis with cough onsets during the study interval, 141 (2%) cases (83 confirmed and 58 probable) occurred among adults aged ≥65 years (age range: 65 to 91 years). Clinical features among these 141 patients included paroxysmal cough, 137 (97%), whoop, 34 (24%) and posttussive vomiting, 31 (22%). Apnea occurred more frequently among patients aged ≥65 years than among patients aged <65 years (42% vs. 28%, p<0.01).  Ninety percent of patients were still coughing at the last interview (median cough duration at final interview: 21 days, range: 14 to 70 days). Appropriate antibiotics were received by 127 (90%) patients. Receipt of Tdap vaccine before cough onset was documented in 19 (13%) patients; median time since Tdap vaccination was 2.2 years. Ten (7%) patients (age range: 65 to 89 years) were hospitalized with median duration of 5 days (range: 1 to 13). No deaths were reported. The mean interval from cough onset to pertussis test date was longer among patients aged ≥65 years than among patients aged <65 years (18 vs. 14 days, p <0.01). Among 8 (6%) patients having source individuals with known age, 4 (50%) were linked to patients aged 8-13 years. The other 4(50%) patients were epidemiologically linked to their spouses whose age ranged from 54 to 67.

CONCLUSIONS:  The ACIP currently recommends a single dose of Tdap for all adults aged >65 years. Clinicians should increase their index of suspicion for pertussis among patients aged ≥65 years with cough illness, and encourage Tdap vaccination among individuals in this age group.

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