Clinical and economic effects of pertussis outbreaks

Background: The reported incidence of pertussis is increasing, especially among the adolescent population. Current outbreak managernent strategies include investigating cases, contact follow-up, diagnostic testing, and antibiotic prophylaxis and treatment. The cost of these methods is substantial and can be attributed to the mobilization within public health departments to control the outbreaks. Methods: Through an extensive review of the literature, the clinical and economic effects of pertussis outbreaks in various nonhousehold settings are discussed. Results: The reported incidence of pertussis among adolescents and adults in the United states since the early 1980s continues to rise. The challenges of preventing and controlling pertussis outbreaks involve diagnosing pertussis in a timely, accurate, and standardized fashion and understanding the true burden of disease in different age and socioeconomic groups. The economic effects of pertussis have been demonstrated to be significant to individuals and communities, both locally and globally. Costs associated with pertussis often include diagnostic testing, hospitalization, emergency and/or medical office visits, antibiotic and symptomatic treatment, lost work days, and other reductions in productivity. In outbreak settings, increased surveillance, antibiotic prophylaxis, isolation of infected cases, and enhanced communication and education add to the economic burden of this disease. The potential opportunity to apply the use of pertussis booster vaccination to these populations, particularly among adolescents, likely would reduce the occurrence of pertussis and minimize the clinical and economic repercussions of pertussis outbreaks. Conclusions: In the near future, it is anticipated that evaluating the effects of a licensed acellular pertussis booster vaccine in persons 10 years of age will become routine in pertussis prevention and outbreak-control activities.