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Pertussis (Whooping cough)

 

General information


Pertussis, a respiratory illness commonly known as whooping cough, is a highly infectious disease caused by the bacteria Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria release toxins, which damage the cilia and cause inflammation (swelling). It is spread by breathing in droplets expelled by an infected person when they talk, cough or sneeze.
  
The infection starts as an irritating cough which, usually within one to two weeks, becomes outbursts of coughing (paroxysms). This can often lasts for two to three months. Not all patients, particularly young babies, will have the characteristic 'whoop'. Coughing spasms may be followed by a period of vomiting.
 
Infants have the highest rates of pertussis infection. School aged children are often the source of infection for younger siblings at home.  Pertussis also occurs in adolescents and adults.
 
Pertussis is potentially a very serious infection especially for babies under 6 months old and it can lead to severe complications and even death. Over 50% of infants with the disease are admitted to hospital.
 
Serious illness is less common in older children and adults; however, they have the potential to transmit infection to vulnerable babies. Pertussis is treated with antibiotics but the illness will still last for 6-8 weeks even with treatment. Close contacts of pertussis cases and who are particularly vulnerable, unvaccinated, partially vaccinated or less than five years of age are given antibiotics as a preventative measure.
 
Due to the considerable increase in the rates of pertussis during 2011/12, a temporary vaccination programme has been established to offer pertussis vaccination to all expectant mothers in the UK from week 28 of pregnancy.  This is to help protect their newborn infants from whooping cough until they are old enough to receive their routine immunisations which start from 8 weeks of age. More details are available from the Welsh Government website at: http://wales.gov.uk/topics/health/protection/immunisation/leaf/ages/pertussis/?lang=en
 
Pertussis is one of a number of notifiable diseases in the UK. Any doctor who suspects that a patient has pertussis is required by law to report it.
 
More information about pertussis is available from the following websites:
 

Epidemiology


Prior to vaccine introduction in the 1950s, large epidemics of whooping cough occurred every three to four years, with the average annual number of notifications in England and Wales exceeding 100,000. In 1972, when vaccine acceptance was over 80%, there were only 2069 notifications of pertussis.
 
Public anxiety about the safety and efficacy of the vaccine, following a report published which suggested the vaccine was a common link between a group of children with brain damage, saw immunisation coverage drop to 30% in 1975 resulting in major epidemics in 1977/79 and 1981/83. As a result, there were more than 200,000 extra notifications and 100 deaths in 1970s and 1980s.
 
Vaccine coverage in England and Wales steadily increased over the next decade as public and professional confidence in the vaccine was restored, reaching 94% in 1995, at which level it has remained (for Wales alone, vaccine coverage has been over 95% for the past several years). Correspondingly, notifications decreased dramatically during this period with 2000 being the lowest on record. The Health Protection Agency (HPA) initiated a programme of enhanced surveillance to monitor the number of cases of whooping cough and vaccine efficacy in 1994.
 
However, despite a high vaccination uptake, the burden of pertussis in England and Wales remained highest in children too young to be fully protected.
 
Following a detailed study of pertussis in infants on paediatric intensive care units (PICUs) and mathematical modelling by the HPA, in November 2001, a pre-school booster dose of pertussis vaccine (given between 3-5 years of age) was added to the routine immunisation schedule with the aim of reducing illness in older age groups thereby reducing transmission of pertussis to babies too young to be fully protected. 
 
The number of notifications in England and Wales was 550 in 2006. In the same year, 29 notifications in Wales were recorded. From 2007-2010 the number of yearly pertussis notifications for England and Wales has varied between 400 (in 2010) and 1512 (in 2008). The recent increase in pertussis notifications corresponds with the availability of enhanced diagnostic methods; since mid-2006 there has been greater awareness and use of these testing methods compared to previous years. The number of notifications in Wales during 2010 was 22 with 14 cases confirmed by laboratory testing. In 2011, an increase in pertussis was observed with 100 notifications and 67 laboratory confirmations of pertussis infection in Wales. This UK-wide increase continued in 2012 with 333 notifications and 343 laboratory confirmations in Wales. During 2013, there were 276 notifications and 211 laboratory confirmations of pertussis in Wales.
   
Pertussis epidemiology can be affected by a number of factors, including changes in laboratory techniques and heightened awareness of the disease. Recent overall increases in laboratory confirmed cases have largely been in older age groups and subsequent to the introduction of new laboratory methods in 2002 and 2006. Pertussis still peaks every three to four years and over the last few years a greater number of cases are being confirmed in older age groups. 
 

Pertussis in Wales: 1998-2013


Rate of laboratory-confirmed cases and rate of notifications of pertussis per 100,000 population in Wales from 1999-2013

laboratory-confirmed cases and rate of notifications of pertussis - 1999-2013
Source: NOIDS and Enhanced Pertussis Surveillance Programme, Public Health England, February 2014  
  
    
Number of laboratory confirmed pertussis cases, notifications and rates per 100,000 in Wales: 1999-2013
  
Year
Number of laboratory-confirmed cases
Rate of confirmed 
pertussis per 100,000 population
Number of notifications
 Rate of notification of pertussis per 100,000 population
1999
32
1.1
62

2.1

2000
17
0.6
54

1.8

2001
10
0.3
37

1.3

2002
18
0.6
25

0.9

2003
17
0.6
23

0.8

2004
31
1.0
29

1.0

2005
20
0.7
27

0.9

2006
8
0.3
11

0.4

2007
9
0.3
19

0.6

2008
26
0.9
47

1.6

2009
26
0.9
30

1.0

2010
13
0.4
23

0.8

2011
67
2.2
100

3.3

2012

343

11.2

333

10.3

2013 211 6.9 276 9.0
Source: NOIDS and Enhanced Pertussis Surveillance Programme, Public Health England, February 2014
  
 
Notifications of pertussis in Wales 1999-2013 - all ages
 
Year
<1
years
01-04 years
05-09 years
10-14 years
15-24 years
25-44 years
45-64 years
65+ 
years
Age not known
Total
1999
15
21

17

3
2
2
0
0
2
62
2000
17
21

10

0
0
3
2
0
1
54
2001
12
7

3
1
3
1
0
1
37
2002
5
6

3
0
1
2
0
2
25
2003
13
4

0
1
0
0
0
2
23
2004
12
7

0
0
2
1
0
1
29
2005
7
5

1
2
2
0
1
1
27
2006
4
1

0

3
0
1
2
0
0
11
2007
3
5

0

4
1
3
3
0
0
19
2008
14
6

3

4
6
7
6
1
0
47
2009
8
5

5
2
6
1
0
0
30
2010
4
4

2

3
2
5
1
0
2
23
2011
26
11

3

9
7
17
22
4
1
100

2012

42

43

19

16

31

74

77

27

4

333

2013 15 27 19 24 29 61 79 22 0 276
Source: NOIDS, Public Health England, February 2014
    
 
Laboratory confirmations of pertussis in Wales by age range -  1998-2013 
Laboratory confirmations of pertussis in Wales by age range - 1998-2012
Source: Enhanced Pertussis Surveillance Programme, Public Health England, February 2014 
 
 
Laboratory confirmations of pertussis in Wales 1996-2013 - children under 15 years and adults
 
Year
under 3
months
3 - 5 months
6 -11 months
01 - 04
years
05 - 09
years
10 - 14
years
15 years and older
Not
known
Total
1999
14
5
1
6
3
2

1

0
32
2000
9
5
0
0
2
0
1
0
17
2001
8
1
0
1
0
0
0
0
10
2002
7
2
0
2
2
3
2
0
18
2003
10
2
0
0
3
0
2
0
17
2004
14
7
1
2
4
0
3
0
31
2005
14
1
0
3
1
1
0
0
20
2006
1
1
1
0
0
3
2
0
8
2007
2
1
1
0
1
0
4
0
9
2008
8
4
0
1
2
1
10
0
26
2009
8
1
1
0
0
5
11
0
26
2010
2
0
0
0
0
2
9
0
13
2011
22
1
0
1
2
1
40
0
67

2012

22

5

2

4

4

22

284

0

343

2013 6 2 0 1 7 22 173 0 211
Source: Enhanced Pertussis Surveillance Programme, Public Health England, February 2014  
 

Sources of surveillance data for Wales


Pertussis is one of a number of notifiable diseases. Doctors in Wales have a statutory duty to notify a 'Proper Officer' of the Local Authority of suspected cases of pertussis  based on clinical symptoms. Diagnosis can be confirmed through detection of the B. pertussis organism through microbiological testing. Laboratories have a similar duty to report the identification of the B. pertussis organism.
 
Before 2011, these data were compiled into the statutory weekly Statutory Notifications of Infectious Diseases (NOIDs) report by the Health Protection Agency (HPA) Centre for Infections in Colindale, North London. The NOIDS reports are available to download from the HPA website. Since July 2010 the proper officers in Wales are obliged to disclose notifications made to them to Public Health Wales NHS Trust instead of NOIDS although in practice, many notifications in Wales are still also passed to NOIDS for completeness.
 
The data reported here include notifications as reported through the NOIDS system and through the Public Health Wales CoSurv system. The Health Protection Agency collects and collates data for the number of laboratory-confirmed cases of pertussis for England and Wales through its enhanced pertussis surveillance programme and these are the data that are published here.
 
 

GP surveillance of pertussis in Wales


A volunteer sample of 44 general practices in Wales (covering over 10% of the population of Wales) have reported cases of measles, mumps, rubella, shingles, chicken pox, pneumonia and influenza (plus data on some other conditions) each week by paper form to CDSC Wales since 1986.
 
Data items are: age, sex, disease, practice, year and week. Data is analysed by time, person, place and feedback is by weekly news-sheet to participating practices and public health professionals in Wales and Europe. Rates are presented as cases per 100 000 practice population.
 
Public Health Wales has been working with the NHS Wales Informatics Service’s Primary Care Informatics Programme to automate the surveillance scheme and make it easier for participating practices.  The new scheme uses the ‘Data Quality System’. This software, sponsored by Welsh Assembly Government and endorsed by GPC Wales, has a general practice based module, ‘Audit +’, and a central web-based repository of anonymous aggregated data that will support public health surveillance. This central repository, ‘AuditWeb’, is hosted at NHS Wales Informatics Service (NWIS). A core Audit+ module allows for transfer of data on cases of certain diseases as anonymised aggregated data. This process is scheduled to take place overnight outside of practice working hours and is fully automated. As is the case of all modules reporting to Audit Web, no personal identifiable information is extracted.
 
Since week 40 2010 (week ending 10 October), the sentinel GP practices are reporting data collected using the automated data collection system Audit+.
 
Data for pertussis consultations in Wales from the GP sentinel surveillance scheme is illustrated in the figure below. 
 
Pertussis rates (per 100,000 practice population per week) in Wales
  
Pertussis-GP surveillance
 
The latest GP surveillance newsletter can be viewed from the link: GP Surveillance Newsletter
 
 

Immunisation against pertussis


Pertussis is a vaccine preventable disease. The pertussis vaccine is included in the DTaP/PV/Hib ‘5-in-1 jab’ given to babies at 2, 3 and 4 months.
 
As immunity against pertussis wanes over time, a booster jab has also been included in the ‘4-in-1’ pre-school boosters (given between 3-5 years of age) with the aim of reducing illness in older age groups thereby reducing transmission of pertussis to unvaccinated or partially vaccinated babies.
 
Due to the considerable increase in the rates of pertussis during 2011/12, a temporary vaccination programme has been established to offer pertussis vaccination to all expectant mothers in the UK from week 28 of pregnancy.  This is to help protect their newborn infants from whooping cough until they are old enough to receive their routine immunisations which start from 8 weeks of age. More details are available from the Welsh Government website at: http://wales.gov.uk/topics/health/protection/immunisation/leaf/ages/pertussis/?lang=en
 
The uptake of pertussis (and other childhood) vaccination in Wales is recorded in the COVER (Coverage of Vaccination Evaluation Rapidly) report. This is published on both a quarterly and annual basis.  Quarterly trend reports for each LHB and GP practice-based reports are also published. These are all available from Scheduled Childhood Immunisations webpage.
 
More information about immunisation and vaccines in Wales is available to health professionals from the Public Health Wales Immunisation and Vaccination intranet site.
 
 

Requests for further surveillance data


If further surveillance data for pertussis in Wales is required, it may be possible to provide it on special request. Please use the surveillance data request form provided from this link.
 
  

Links to other pertussis surveillance


 


Last updated: 03/03/2014