Original Article

Use of Birth Certificates and Surveillance Data to Characterize Reported Pertussis among Texas Infants and Young Children, 1995 to 2000

Authors: Jan W. Pelosi, MPH, Joann M. Schulte, DO

Abstract

BackgroundPertussis morbidity is increasing, especially among young infants and children, who are more likely to be hospitalized and have more severe complications. Maternal and pediatric factors associated with underimmunization and hospitalization for pertussis are poorly understood, but young maternal age and low birth weight have been associated with pertussis among young infants.MethodsWe used pertussis surveillance data, matching cases to the birth certificates of 416 Texas infants and children reported as pertussis cases during 1995 to 2000. Maternal/pediatric information gathered from birth certificates included birth weight, gestational age, and maternal factors (age, birthplace and education level, prenatal care, and previous live births). We assessed the immunization status of the cases and maternal/pediatric factors associated with underimmunization with a pertussis-containing vaccine and hospitalization using descriptive statistics and logistic regression.ResultsThe 416 cases represented 20% of the pertussis morbidity in Texas from 1995 through 2000. Most children had not been vaccinated (275 [66%]), even though 374 (90%) were old enough for at least one dose. Among those 374 children, only those younger than 6 months were associated with underimmunization (odds ratio [OR], 9.98; 95% confidence interval [CI], 6.24–15.97). Most patients (253 [61%]) were hospitalized. Hospitalization was associated with complications of apnea (OR, 2.13; 95% CI, 1.39–2.38), pneumonia (OR, 5.26; 95% CI, 2.94–11.59), and age younger than 6 months (OR, 2.11; 95% CI, 1.38–3.23).ConclusionMore than two-thirds of the children reported as pertussis cases were old enough to have at least one dose of a pertussis-containing vaccine but were not immunized. Maternal and pediatric characteristics on birth certificates were not useful in predicting either underimmunization or hospitalization for pertussis complications. More current assessments of maternal and pediatric characteristics should be part of pertussis contact investigations.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Campins-Marti M, Cheng HK, Forsyth K, et al. Recommendations are needed for adolescent and adult pertussis immunization: Rationale and strategies for consideration. Vaccine 2002; 20: 641–646.
 
2. CDC. Recommended childhood immunization schedule, United States, 2002. Available at:http://www.cdc.gov/nip/recs/child-schedule.pdf. Accessed May 2, 2002.
 
3. CDC. Pertussis: United States, 1997–2000. MMWR 2002; 51: 73–76.
 
4. Van Savage J, Decker DM, Edwards KM, et al. Natural history of pertussis antibody in the instant and effect on vaccine response. J Infect Dis 1990; 161: 487–492.
 
5. Wortis N, Strebel PM, Wharton M, et al. Pertussis deaths: Report of 23 cases in the United States 1992 and 1993. Pediatrics 1996; 97: 607–612.
 
6. Izurieta HS, Kenyon TA, Strebel PM, et al. Risk factors for pertussis in young infants to an outbreak in Chicago and 1993. Clin Infect Dis 1996; 22: 503–507.
 
7. Babon S, Njamkepo E, Grimprel E, et al. Epidemiology of pertussis in French hospitals for 1993 and 1994: Thirty years after a routine use of vaccination. Pediatr Infect Dis J 1998; 17: 412–418.
 
8. Langkamp DL, Davis JP. Increased risk of reported pertussis and hospitalization associated with pertussis in low birth weight children. J Pediatr 1996; 128: 654–659.
 
9. Zell ER, Dietz V, Stevenson J, et al. Low vaccination levels of U.S. preschool and school age children: Retrospective assessment of vaccination coverage, 1991–1992. JAMA 1994; 27: 833–839.
 
10. Langkamp DL, Hoshaw-Woodard S, Boye ME, et al. Delays in receipt of immunizations in low birth weight children: A nationally representative sample. Arch Pediatr Adolesc Med 2001; 155: 167–172.
 
11. Vohr BR, Oh W. Age of diphtheria, tetanus and pertussis immunization of special care nursery graduates. Pediatrics 1986; 77: 569–571.
 
12. Ruiz P, Nathanson R, Kastner T. Pertussis immunization patterns in special nursery graduates. J Dev Behav Pediatr 1991; 12: 38–41.
 
13. Lieu TA, Black SB, Ray P, et al. Risk factors for delayed immunization among children in an HMO. Am J Public Health 1994; 84: 161–165.
 
14. Schulte JM, Atkinson WL, Suarez L, et al. Use of Texas birth certificate data to predict measles immunization status. South Med J 1996; 89: 793–797.
 
15. Butz AM, Funhouser A, Caleb A, et al. Infant health care utilization predicted by pattern of prenatal care. Pediatrics 1993; 92: 50–54.
 
16. Bobo JK, Gale JL, Thapa PB, et al. Risk factors for delayed immunization random sample of 1163 children from Washington and Oregon. Pediatrics 1983; 91: 308–314.
 
17. Schulte JM, Burkham S, Squires JE, et al. Immunization status of children born to human immunodeficiency virus (HIV)-infected mothers in two Texas cities. South Med J 2000; 93: 48–52.
 
18. Schulte JM, Burkham S, Hamaker D, et al. Syphilis among HIV-infected mothers and their infants in Texas from 1988 to 1994. Sex Transm Dis 2001; 28: 315–320.
 
19. Farizo KM, Cochi SL, Zell ER, et al. Epidemiologic features of pertussis in the United States, 1980–1989. Clin Infect Dis 1992; 14: 708–719.
 
20. Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization. Am J Public Health 1994; 84: 1414–1420.
 
21. Kotelchuck M. The adequacy of prenatal care utilization index: Its U.S. distribution and association with low birth weight. Am J Public Health 1994; 84: 1486–1489.
 
22. Dean AG, Dean JA, Coulombier D, et al. EpiInfo, Version 6: Outbreak of Word Processing, Database, and Statistics Program for Public Health on IBM-Compatible Microcomputers. Atlanta, Centers for Disease Control and Prevention, 1995.
 
23. SAS Institute. Principles of Regression Analysis. Cary, NC, SAS Institute, 1996.
 
24. CDC. MMWR morbidity tables. Available at: http://wonder.cdc.gov/mmwr/mmwrmorb.asp. Accessed May 7, 2002.
 
25. Gordon M, Davies HD, Gold R. Clinical and microbiologic features of children presenting with pertussis to a Canadian pediatric hospital during an eleven-year period. Pediatr Infect Dis J 1994; 13: 617–622.
 
26. Christie CD, Marx ML, Marchant CD, et al. The 1993 epidemic of pertussis in Cincinnati: Resurgence of disease in a highly immunized population of children. N Engl J Med 1994; 331: 16–21.
 
27. Halperin SA, Bortolussi R, MacLean D, et al. Persistence of pertussis in an immunized population: Results of the Nova Scotia enhanced pertussis surveillance program. J Pediatr 1989; 115: 686–693.
 
28. Halperin SA, Wang ELL, Law B, et al. Epidemiologic features of pertussis and hospitals patients in Canada, 1991–1997: Report of the immunization monitoring program active (IMPACT). Clin Infect Dis 1999; 28: 1238–1243.
 
29. Grandstrom G, Sterner G, Nord CE, et al. Use of erythromycin to prevent pertussis in newborns of mothers with pertussis. J Infect Dis 1987; 155: 1210–1214.
 
30. Aoyama T, Harashima M, Nishimura K, et al. Outbreak of pertussis in highly immunized adolescents and its secondary spread to their families. Acta Paediatr Jpn 1995; 37: 321–324.
 
31. Nelson JD. The changing epidemiology of pertussis in young infants: The role of adults as reservoirs of infection. Am J Dis Child 1978; 132: 371–373.
 
32. McCormick MC, Shapiro S, Starfield BH. Rehospitalization in the first year of life for high-risk survivors. Pediatrics 1980; 66: 991–999.
 
33. Cunningham CK, McMillan JA, Gross SJ. Rehospitalization for respiratory illness in infants of less than 32 weeks’ gestation. Pediatrics 1991; 88: 527–532.
 
34. Guris D, Martin R. General guidelines for pertussis case investigation and surveillance, in Guidelines for the Control of Pertussis Outbreaks. Atlanta, Centers for Disease Control and Prevention, 2000.
 
35. CDC. Pertussis surveillance: United States, 1989–91. MMWR 1992; 41: 11–19.
 
36. Kenyon TA, Izurieta H, Shulman ST, et al. Large outbreak of pertussis among young children in Chicago, 1993: Investigation of potential contributing factors and estimation of vaccine effectiveness. Pediatr Infect Dis J 1996; 15: 655–661.
 
37. Simpson DM, Suarez L. The immunization status of Texas children aged 3 to 24 months: Results of the 1994 Texas immunization survey. Tex Med 1996; 92: 60–65.
 
38. CDC. National, state and urban area vaccination covers levels among children aged 19–35 months: United States, 2000. MMWR 2001; 50: 636–641.
 
39. U.S. Department of Health and Human Services, Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC, U.S. Government Printing office, 1990.
 
40. Texas Department of Health. Pertussis in Texas. Dis Prev News 2001; 61: 1–5.
 
41. Texas Department of Health. Surge in pertussis cases continues. Dis Prev News 2002; 62: 1–2.