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January 15, 1992, Vol 267, No. 3 >
ARTICLE | January 15, 1992

Pertussis Hospitalizations and Mortality in the United States, 1985-1988: Title and subTitle BreakEvaluation of the Completeness of National Reporting FREE

Roland W. Sutter, MD, MPH&TM; Stephen L. Cochi, MD
[+] Author Affiliations

Preliminary results presented in part at the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy, Atlanta, Ga, October 24, 1990.

Reprint requests to Information Services, Mailstop E07, National Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333 (Dr Sutter).


JAMA. 1992;267(3):386-391. doi:10.1001/jama.1992.03480030064038
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References

Objective.  —To determine the magnitude of hospitalizations for pertussis and pertussis mortality and to estimate the total burden of clinically significant pertussis in the United States.

Design.  —Capture-recapture methods for estimating population size from independent surveillance systems were used to analyze morbidity and mortality data from case report forms received at the Centers for Disease Control (CDC) from the states, and compared these data with pertussis hospitalizations compiled from a database of US hospitals participating in the Commission on Professional and Hospital Activities-Professional Activities Survey (CPHA-PAS) and death certificate reports compiled by the National Center for Health Statistics (NCHS).

Population Studied.  —All pertussis hospitalizations and pertussis-related deaths in the United States, 1985 through 1988.

Results.  —We estimated that 13557 pertussis hospitalizations (95% confidence interval [CI], 12953 to 14162) and 98 pertussis deaths had occurred during the 4-year study period (an average of more than 3300 hospitalizations and 25 deaths per year). The completeness of reporting hospitalizations to the CDC was 32% and to the CPHA-PAS, 23%, while the completeness of reporting pertussis deaths to the CDC was 33% and to NCHS, 23%. Patients who were hospitalized with pertussis and reported to CDC were at a higher risk for developing pneumonia (31.0% vs 20.0%, relative risk [RR], 1.6; 95% CI, 1.4 to 1.7), seizures (3.7% vs 2.1%; RR, 1.9; 95% CI, 1.4 to 2.5) and encephalitis (1.2% vs 0.2%; RR, 5.3; 95% CI, 2.4 to 11.6) compared with patients recorded in the CPHA-PAS system.

Conclusions.  —Our study suggests that there is substantial underreporting of pertussis, that severe complications of pertussis (including hospitalizations) are reported preferentially to the CDC, and that the national health impact of pertussis based on these indicators is considerably higher than previously published reports have suggested.(JAMA. 1992;267:386-391)

REFERENCES

1 +
National Office of Vital Statistics. Reported Incidence of Selected Notifiable Diseases: United States, Each Division and State, 1920-1950 . Washington, DC: US Dept of Health, Education, and Welfare; 1953;.
2 +
Centers for Disease Control.  Summary of notifiable diseases, United States, 1989 . MMWR . 1990;;38:51-59.
3 +
Centers for Disease Control. State Immunization Requirements: 1989-1990 . Atlanta, Ga: Centers for Disease Control; 1989;.
4 +
Eddins LE, Sirotkin BI, Holmgreen P, et al.  Assessment and validation of immunization status in the United States.  In: Campolucci RF, ed. Proceedings of the 20th Immunization Conference . Atlanta, Ga: Centers for Disease Control; 1985;:51-61.
5 +
Cherry JD.  'Pertussis vaccine encephalopathy': it is time to recognize it as the myth that it is . JAMA . 1990;;263:1679-1680.
6 +
Bowie C.  Lessons from the pertussis vaccine court trial. Lancet . 1990;;335:397-399.
7 +
Griffith AH.  Permanent brain damage and pertussis vaccination: is the end of the saga in sight? Vaccine . 1989;;7:199-210.
8 +
Broome CV, Fraser DW.  Pertussis in the United States: a look at vaccine efficacy. J Infect Dis . 1981;;144:187-190.
9 +
Sacks JJ.  Utilization of case definitions and laboratory reporting in the surveillance of notifiable communicable diseases in the United States . Am J Public Health . 1985;;75:1420-1422.
10 +
National Center for Health Statistics.  Mortality . In: Vital Statistics of the United States, 1986, II . Hyattsville, Md: US Public Health Service; 1987;. Part A, Technical Appendix.
11 +
World Health Organization. International Classification of Diseases, Ninth Revision, I . Geneva, Switzerland: World Health Organization; 1977;.
12 +
National Center for Health Statistics. Catalogue of Public Use Tapes . Hyattsville, Md: US Public Health Service; 1988;.
13 +
Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1985 . Ann Arbor, Mich: Health Care Knowledge Resources; 1986;.
14 +
 Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1986 . Ann Arbor, Mich: Health Care Knowledge Resources; 1987;.
15 +
Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1987 . Ann Arbor, Mich: Health Care Knowledge Resources; 1988;.
16 +
Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1988 . Ann Arbor, Mich: Health Care Knowledge Resources; 1989;.
17 +
Chandra Sekar C, Deming WE.  On a method of estimating birth and death rates and the extent of registration . J Am Stat Assoc . 1949;;44:101-115.
18 +
Cochi SL, Edmonds LE, Dyer K, et al.  Congenital rubella syndrome in the United States, 1970-1985: on the verge of elimination. Am J Epidemiol . 1989;;129:349-361.
19 +
Cormack RM.  The statistics of capture-recapture methods. Oceanography Marine Biol Annu Rev . 1969;;6:455-506.
20 +
Chapman DG. Some properties of the hyper-geometric distribution with applications to zoological samples censuses . Berkeley, Calif: University of California Press Publications in Statistics; 1951;;1:131-160.
21 +
Snedeor GW, Cochran WG. Statistical Methods . 8th ed. Iowa City: Iowa State University Press; 1989;.
22 +
SAS. Version 6 . Cary, NC: SAS Institute Inc; 1987;.
23 +
Onorato IM, Wassilak SGF.  Laboratory diagnosis of pertussis: the state of the art. Pediatr Infect Dis J . 1987;;6:145-151.
24 +
Mortimer EA.  Pertussis and its prevention: a family affair. J Infect Dis . 1990;;161:473-479.
25 +
Jenkinson D.  Whooping cough: what proportion of cases is notified during an epidemic? BMJ . 1983;;287:185-186.
26 +
Halperin SA, Bortolussi R, MacLean D, Chisholm N.  Persistence of pertussis in an immunized population: results of the Nova Scotia enhanced pertussis surveillance program. J Pediatr . 1989;;115:686-693.
27 +
Sutter RW, Cochi SL, Brink EW, Sirotkin BI.  Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984. Am J Epidemiol . 1990;;131:132-142.
28 +
Long SS, Welkon CJ, Clark JL.  Widespread silent transmission in families: antibody correlates of infection and symptomatology. J Infect Dis . 1990;;161:480-486.
29 +
Centers for Disease Control.  Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR . 1991;;40(No. (RR-10) ):1-28.
30 +
American Academy of Pediatrics. Report of the Committee on Infectious Diseases . 22nd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1991;:358-369.
31 +
Centers for Disease Control.  Pertussis—Maryland, 1982 . MMWR. 1983;:32:297-300.
32 +
Wassilak S, Smith G, Garbe P, Burstyn D, Manclark C, Orenstein W.  Pertussis outbreak in Colorado: use of a newly developed diagnostic test . In: Campolucci RF, ed. Proceedings of the 18th Immunization Conference . Atlanta, Ga: Centers for Disease Control; 1983;:37-41.
33 +
Nkowane BM, Wassilak SGF, McKee PA, et al.  Pertussis epidemic in Oklahoma. AJDC . 1986;;140:433-437.
34 +
Centers for Disease Control.  Pertussis—Washington, 1984. MMWR . 1985;;34:390-394, 399-400.
35 +
Biellik RJ, Patriarca PA, Mullen JR, et al.  Risk factors for community- and household-acquired pertussis during a large-scale outbreak in Central Wisconsin. J Infect Dis . 1988;;157:1134-1141.
36 +
Biellik RJ, Patriarca PA, Paul W, Sanden G, Brink EW, Silverman P.  Pertussis in an Amish community in Delaware.  In: Program and Abstracts of the 29th Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology; 1989;:145.
37 +
Hicks T, Kagawa K. Pertussis—Hawaii: Communicable Disease Report . Honolulu: Hawaii State Department of Health; 1987;.
38 +
Pollock TM, Miller E, Lobb J.  Severity of whooping cough in England before and after the decline in pertussis immunisation. Arch Dis Child . 1984;;59:162-165.
39 +
Miller CL, Fletcher WB.  Severity of notified whooping cough. BMJ . 1976;;117-119.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National Office of Vital Statistics. Reported Incidence of Selected Notifiable Diseases: United States, Each Division and State, 1920-1950 . Washington, DC: US Dept of Health, Education, and Welfare; 1953;.
2 +
Centers for Disease Control.  Summary of notifiable diseases, United States, 1989 . MMWR . 1990;;38:51-59.
3 +
Centers for Disease Control. State Immunization Requirements: 1989-1990 . Atlanta, Ga: Centers for Disease Control; 1989;.
4 +
Eddins LE, Sirotkin BI, Holmgreen P, et al.  Assessment and validation of immunization status in the United States.  In: Campolucci RF, ed. Proceedings of the 20th Immunization Conference . Atlanta, Ga: Centers for Disease Control; 1985;:51-61.
5 +
Cherry JD.  'Pertussis vaccine encephalopathy': it is time to recognize it as the myth that it is . JAMA . 1990;;263:1679-1680.
6 +
Bowie C.  Lessons from the pertussis vaccine court trial. Lancet . 1990;;335:397-399.
7 +
Griffith AH.  Permanent brain damage and pertussis vaccination: is the end of the saga in sight? Vaccine . 1989;;7:199-210.
8 +
Broome CV, Fraser DW.  Pertussis in the United States: a look at vaccine efficacy. J Infect Dis . 1981;;144:187-190.
9 +
Sacks JJ.  Utilization of case definitions and laboratory reporting in the surveillance of notifiable communicable diseases in the United States . Am J Public Health . 1985;;75:1420-1422.
10 +
National Center for Health Statistics.  Mortality . In: Vital Statistics of the United States, 1986, II . Hyattsville, Md: US Public Health Service; 1987;. Part A, Technical Appendix.
11 +
World Health Organization. International Classification of Diseases, Ninth Revision, I . Geneva, Switzerland: World Health Organization; 1977;.
12 +
National Center for Health Statistics. Catalogue of Public Use Tapes . Hyattsville, Md: US Public Health Service; 1988;.
13 +
Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1985 . Ann Arbor, Mich: Health Care Knowledge Resources; 1986;.
14 +
 Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1986 . Ann Arbor, Mich: Health Care Knowledge Resources; 1987;.
15 +
Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1987 . Ann Arbor, Mich: Health Care Knowledge Resources; 1988;.
16 +
Commission on Professional and Hospital Activities. Pediatric Length of Stay, by Diagnosis, by Operation, United States, 1988 . Ann Arbor, Mich: Health Care Knowledge Resources; 1989;.
17 +
Chandra Sekar C, Deming WE.  On a method of estimating birth and death rates and the extent of registration . J Am Stat Assoc . 1949;;44:101-115.
18 +
Cochi SL, Edmonds LE, Dyer K, et al.  Congenital rubella syndrome in the United States, 1970-1985: on the verge of elimination. Am J Epidemiol . 1989;;129:349-361.
19 +
Cormack RM.  The statistics of capture-recapture methods. Oceanography Marine Biol Annu Rev . 1969;;6:455-506.
20 +
Chapman DG. Some properties of the hyper-geometric distribution with applications to zoological samples censuses . Berkeley, Calif: University of California Press Publications in Statistics; 1951;;1:131-160.
21 +
Snedeor GW, Cochran WG. Statistical Methods . 8th ed. Iowa City: Iowa State University Press; 1989;.
22 +
SAS. Version 6 . Cary, NC: SAS Institute Inc; 1987;.
23 +
Onorato IM, Wassilak SGF.  Laboratory diagnosis of pertussis: the state of the art. Pediatr Infect Dis J . 1987;;6:145-151.
24 +
Mortimer EA.  Pertussis and its prevention: a family affair. J Infect Dis . 1990;;161:473-479.
25 +
Jenkinson D.  Whooping cough: what proportion of cases is notified during an epidemic? BMJ . 1983;;287:185-186.
26 +
Halperin SA, Bortolussi R, MacLean D, Chisholm N.  Persistence of pertussis in an immunized population: results of the Nova Scotia enhanced pertussis surveillance program. J Pediatr . 1989;;115:686-693.
27 +
Sutter RW, Cochi SL, Brink EW, Sirotkin BI.  Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984. Am J Epidemiol . 1990;;131:132-142.
28 +
Long SS, Welkon CJ, Clark JL.  Widespread silent transmission in families: antibody correlates of infection and symptomatology. J Infect Dis . 1990;;161:480-486.
29 +
Centers for Disease Control.  Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR . 1991;;40(No. (RR-10) ):1-28.
30 +
American Academy of Pediatrics. Report of the Committee on Infectious Diseases . 22nd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1991;:358-369.
31 +
Centers for Disease Control.  Pertussis—Maryland, 1982 . MMWR. 1983;:32:297-300.
32 +
Wassilak S, Smith G, Garbe P, Burstyn D, Manclark C, Orenstein W.  Pertussis outbreak in Colorado: use of a newly developed diagnostic test . In: Campolucci RF, ed. Proceedings of the 18th Immunization Conference . Atlanta, Ga: Centers for Disease Control; 1983;:37-41.
33 +
Nkowane BM, Wassilak SGF, McKee PA, et al.  Pertussis epidemic in Oklahoma. AJDC . 1986;;140:433-437.
34 +
Centers for Disease Control.  Pertussis—Washington, 1984. MMWR . 1985;;34:390-394, 399-400.
35 +
Biellik RJ, Patriarca PA, Mullen JR, et al.  Risk factors for community- and household-acquired pertussis during a large-scale outbreak in Central Wisconsin. J Infect Dis . 1988;;157:1134-1141.
36 +
Biellik RJ, Patriarca PA, Paul W, Sanden G, Brink EW, Silverman P.  Pertussis in an Amish community in Delaware.  In: Program and Abstracts of the 29th Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology; 1989;:145.
37 +
Hicks T, Kagawa K. Pertussis—Hawaii: Communicable Disease Report . Honolulu: Hawaii State Department of Health; 1987;.
38 +
Pollock TM, Miller E, Lobb J.  Severity of whooping cough in England before and after the decline in pertussis immunisation. Arch Dis Child . 1984;;59:162-165.
39 +
Miller CL, Fletcher WB.  Severity of notified whooping cough. BMJ . 1976;;117-119.

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