Pertussis Outbreak in Kalamazoo County, 2006

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Pertussis Outbreak in Kalamazoo County, 2006

• Annie Wendt, B.S., M.P.H.
• Epidemiologist

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Overview

• Incidence trends
• Pertussis case definition
• Story of our outbreak
• Descriptive analysis
• Prevention and control measures

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Bordetella Pertussis

• Bacteria that causes whooping cough
• Classic inspiratory whoop common in infants
  toddlers, may not be present in older children
  adults.
• Symptoms resemble a cold the 1st 1-2 weeks runny
  nose, watery eyes, non-productive cough. Followed
  by episodes of severe (paroxysmal) coughing,
  often worse at night.
• Coughing can last for weeks.
• No long-term persistent immunity from vaccine or
  illness.

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State and Region 5 Pertussis Incidence, 2006
Includes probable and confirmed completed cases,
Michigan Disease Surveillance System as of 4/9/07
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Includes probable and confirmed completed cases,
Michigan Disease Surveillance System as of 4/9/07
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2007 cases as of 3/26/07. Includes probable and
confirmed completed cases, Michigan Disease
Surveillance System as of 3/26/07
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Pertussis Case Definition

• Clinical Case Definition
• A cough illness lasting at least 2 weeks with one
  of the following paroxysms of coughing,
  inspiratory "whoop," or post-tussive vomiting,
  without other apparent cause (as reported by a
  health professional)
• Laboratory Criteria for Diagnosis
• Isolation of Bordetella pertussis from clinical
  specimen
• Positive polymerase chain reaction (PCR) for B.
  pertussis

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Case Classification
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Kalamazoo County Pertussis Outbreak

• May 15, 2006 February 19, 2007
• Total investigations 295 cases and 223 not a
  case
• 185 Probable
• 110 Confirmed

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2007 cases as of 3/26/07
Includes probable and confirmed completed cases,
Michigan Disease Surveillance System as of 3/26/07
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All Ages (n295)
Infants only (n27)
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(No Transcript)
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Vaccination Status of Cases Age 5 11 Years
(n77)

• 97 ever vaccinated

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Prevention and Control Measures

• Shortened timeframe to administer Tdap after Td
  vaccination (2 year interval rather than 5) Tdap
  for pregnant woman and adults aged 65.
• Promotion of Tdap
• In-service for providers and staff at KCMS on
  case management and NP swabs
• Went to superintendent meetings to talk about not
  penalizing students for staying home in isolation
• School open houses and conferences (GIS mapping)

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Pertussis Cases in Kalamazoo County Week 1
06-01-06 7 Confirmed / Probable Cases Cumulative
count since June 1, 2006 7 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 2
06-8-06 7 Confirmed / Probable Cases Cumulative
count since June 1, 2006 14 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 3
06-15-06 5 Confirmed / Probable Cases Cumulative
count since June 1, 2006 19 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 4
06-22-06 6 Confirmed / Probable Cases Cumulative
count since June 1, 2006 25 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 5
06-29-06 7 Confirmed / Probable Cases Cumulative
count since June 1, 2006 32 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 6
07-06-06 7 Confirmed / Probable Cases Cumulative
count since June 1, 2006 39 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 7
07-13-06 6 Confirmed / Probable Cases Cumulative
count since June 1, 2006 45 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 8
07-20-06 6 Confirmed / Probable Cases Cumulative
count since June 1, 2006 51 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 9
07-27-06 5 Confirmed / Probable Cases Cumulative
count since June 1, 2006 56 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 10
08-03-06 2 Confirmed / Probable Cases Cumulative
count since June 1, 2006 58 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 11
08-10-06 11 Confirmed / Probable Cases Cumulative
count since June 1, 2006 69 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 12
08-17-06 4 Confirmed / Probable Cases Cumulative
count since June 1, 2006 73 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 13
08-24-06 7 Confirmed / Probable Cases Cumulative
count since June 1, 2006 80 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 14
08-31-06 19 Confirmed / Probable Cases Cumulative
count since June 1, 2006 99 Data extracted from
the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 15
09-07-06 28 Confirmed / Probable Cases Cumulative
count since June 1, 2006 127 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 16
09-14-06 25 Confirmed / Probable Cases Cumulative
count since June 1, 2006 152 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 17
09-21-06 34 Confirmed / Probable Cases Cumulative
count since June 1, 2006 186 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 18
09-28-06 14 Confirmed / Probable Cases Cumulative
count since June 1, 2006 200 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 19
10-05-06 11 Confirmed / Probable Cases Cumulative
count since June 1, 2006 211 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 20
10-12-06 12 Confirmed / Probable Cases Cumulative
count since June 1, 2006 223 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 21
10-19-06 10 Confirmed / Probable Cases Cumulative
count since June 1, 2006 233 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 22
10-26-06 10 Confirmed / Probable Cases Cumulative
count since June 1, 2006 243 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 23
11-02-06 2 Confirmed / Probable Cases Cumulative
count since June 1, 2006 245 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Pertussis Cases in Kalamazoo County Week 24
11-09-06 3 Confirmed / Probable Cases Cumulative
count since June 1, 2006 248 Data extracted
from the Michigan Disease Surveillance System
(MDSS). Includes cases reported to the HCS
Communicable Disease Control Office.
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Tdap Promotion

• Letters to school parents, attended open houses
  and conferences
• Broadcast faxes to providers provider in-service
• Media
• County website

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Pertussis Cases and Non-Cases Reported by Week
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Kalamazoo County Investigation and Response
Efforts

• and many thanks to Kim Kutzko, Region 5
  Epidemiologist and Sonya LeBrecque, Sanofi
  Pasteur rep