Dynamics of Pertussis Transmission in the United States

• Published in: American journal of epidemiology Vol. 181; no. 12; pp. 921 - 931
• Main Authors: Magpantay, F M G, Rohani, P
• Format: Journal Article
• Language: English
• Published: United States Oxford Publishing Limited (England) 15.06.2015; Oxford University Press
• Subjects: Disease transmission; Epidemics; Epidemiology; Epidemiology in History; History, 20th Century; History, 21st Century; Humans; Immunization; Incidence; Infectious diseases; Pertussis Vaccine - history; Public Health Surveillance; United States - epidemiology; Whooping cough; Whooping Cough - epidemiology; Whooping Cough - history; Whooping Cough - prevention & control; Whooping Cough - transmission; United States; United States > US; whooping cough; interepidemic periods; early vaccine era; vaccines; pertussis; susceptible recruitment
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwv024

Past patterns of infectious disease transmission set the stage on which modern epidemiologic dynamics are played out. Here, we present a comprehensive account of pertussis (whooping cough) transmission in the United States during the early vaccine era. We analyzed recently digitized weekly incidence records from Morbidity and Mortality Weekly Reports from 1938 to 1955, when the whole-cell pertussis vaccine was rolled out, and related them to contemporary patterns of transmission and resurgence documented in monthly incidence data from the National Notifiable Diseases Surveillance System. We found that, during the early vaccine era, pertussis epidemics in US states could be categorized as 1) annual, 2) initially annual and later multiennial, or 3) multiennial. States with predominantly annual cycles tended to have higher per capita birth rates, more household crowding, more children per family, and lower rates of school attendance than the states with multiennial cycles. Additionally, states that exhibited annual epidemics during 1938-1955 have had the highest recent (2001-2010) incidence, while those states that transitioned from annual cycles to multiennial cycles have had relatively low recent incidence. Our study provides an extensive picture of pertussis epidemiology in the United States dating back to the onset of vaccination, a back-story that could aid epidemiologists in understanding contemporary transmission patterns.