Low Vaccination Adherence Leads To Pertussis Outbreak

11-29-2006 | Categories:

Public Health

Pertussis Outbreak in an Amish Community—Kent County, Delaware, September 2004–February 2005 From the Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report 2006;55:817-821. JAMA Vol. 296 No. 16, October 25, 2006. 1960-1964.

Noncompliance With Pertussis Vaccination

While the theological tenets of the Amish permit vaccination, the CDC continues to document low coverage for routine childhood vaccinations in many Amish communities. In this case, 345 cases of pertussis occurred, mostly in preschool children, during a September 2004–February 2005 outbreak in such a group in Delaware.

After the initial cases were reported, “control measures and active surveillance for additional cases were instituted, including enhanced contact investigation and outreach and special community pertussis clinics at Amish schools.” Laboratory confirmation of the diagnosis was also obtained.

In addition, a self-administered survey and interviews with volunteer households were used to obtain data re vaccinations. Pertinent results follow:

Of 123 patients aged 6 months–5 years residing in interviewed households, immunization registry results revealed that 88 (72%) had no records of vaccination with diphtheria-tetanus-pertussis (DTP/DTaP) vaccine, six (5%) had records of receiving 1 or 2 doses, and 29 (24%) had records of receiving ≥3 doses. For 163 children aged 6 months–5 years without clinical pertussis residing in households with pertussis patients, 106 (65%) had no records of vaccination with DTP/DTaP vaccine, eight (5%) had records of receiving 1 or 2 doses, and 49 (30%) had records of receiving ≥3 doses. Of the 96 households interviewed in which a pertussis case was discovered, a total of 43 (45%) reported not vaccinating any children in their household, 40 (42%) households reported vaccinating at least some children, and 13 (14%) did not provide this information. Of the 43 households not vaccinating children, 19 cited “fear of side effects” as the reason, 13 reported that they “didn’t think about it,” and 11 did not provide specific reasons for nonvaccination. Of the 40 respondents who reported that their children had received vaccinations, 29 (64%) reported vaccination at vaccine clinics set up at Amish homes by DPH nurses.

In an editorial note, the CDC points out that “among the diseases for which universal childhood vaccination is recommended in the United States, only pertussis has had an overall increase in reported cases since 1980, increasing from 1,730 cases in 1980 to 25,827 cases in 2004.” In the outbreak afflicting this Amish community, the younger children (1-5 year old) were overrepresented, accounting for 41% of all cases, a rate congruent with that seen throughout the US prior to the availability of vaccination.

Commentary

The too-often repeated sequence of inadequate community adherence to vaccination schedules followed by outbreaks of preventable disease is one more reminder of the importance of the need to actively promote compliance enhancement to prevent as well as treat disorders.

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