2016 Student Case Study Competition

The Health Issue: Whooping Cough

Pertussis, more commonly referred to as “whooping cough”, is a notifiable disease reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System (NNDSS) (1).

A bacterial infection generally controlled through child and adult immunization, pertussis is characterized by sudden and violent coughing attacks, followed by the “whoop” sound made when trying to inhale after the cough. Vomiting frequently follows coughing attacks (2).

The infection is transmitted person-to-person by coughing in close proximity to others, who then inhale the bacteria that cause the disease (3).

While rates of Pertussis fell to less than 5,000 per year between 1968 and 1992, they have been rising steadily since 1992 and experienced a doubling in incidence in 2002 to over 25,000 cases in the United States. This trend has continued, peaking in 2012 with 48,277 cases (4).

While an increase of pertussis cases among the general population is a priority of public health officials, an increase in the number of pertussis cases among infants under 12 months of age is of particular concern. Approximately half of infants under 12 months old with pertussis will require treatment in the hospital, 23 percent will develop pneumonia, 61 percent will have apnea or other breathing problems, and one percent will die (5, para. 2).

Much of this increase in pertussis incidence is accompanied by a parallel trend of exemption to immunization policies. While the types and number of exemptions vary from state to state, generally a family can receive an exemption to these policies for medical, religious, or philosophical reasons. However, only 16 states allow for exemptions for philosophical reasons (6).

The CDC reports “there is a growing body of evidence regarding the…association of non-medical exemption rates with increased disease, and that use of philosophical exemptions…tend to cluster geographically, making some communities at greater risk for outbreaks,” in particular diseases like pertussis (7).

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Presented in Charlotte, North Carolina