A pertussis outbreak saps resources — both time and money — from local health departments, according to an analysis of a school-based outbreak among 26 people in Omaha, Neb.
Over the course of just two months, response to the outbreak cost the Douglas County Health Department (DCHD) $52,131, or about $2,171 per case, researchers from the CDC and the DCHD reported in the Jan. 14 issue of Morbidity and Mortality Weekly Report.
More than half of the costs (59%) were consumed during an intensive 10-day period, when most of the tracking of close contacts was conducted and prophylaxis recommendations were made.
The “elevated incidence of pertussis and the burden of response placed on health departments warrants exploring the impact of alternative response and chemoprophylaxis strategies,” an accompanying editorial note stated in the MMWR.
Although introduction of a vaccine dramatically reduced cases of pertussis — bottoming out at 1,010 in 1976 — the highly infectious and potentially deadly respiratory infection has made a partial comeback, peaking at 25,827 cases in 2004. From 2002 to 2006, there was an average of 17 deaths per year.
Illustrating the lingering threat of pertussis, an outbreak that infected an estimated 8,383 people and killed 10 infants is currently winding down in California — although a “relatively high” number of cases were still being reported through the end of December — according to the state’s Department of Public Health. Such a widespread outbreak can put a major strain on local and state public health resources.
For the small Nebraska outbreak, the DCHD called in the CDC to analyze the costs of its response.
The first case of pertussis was identified in a five-year-old student on Sept. 26, 2008. The student attended a private school with about 600 other students from kindergarten through high school.
Consistent with CDC guidelines, local health officials identified and reached out to close contacts of the student and recommended chemoprophylaxis with antibiotics for 148 people. They also recommended that students with a cough stay home until getting evaluated by a doctor.
Despite the actions, 23 additional students and two teachers became infected by the second week of November. The CDC was called in on Nov. 17.
Surveys with DCHD staff indicated that 1,031 person-hours were spent in the response to the outbreak, including investigation, communication, decisions about and implementation of control measures, meetings with parents, and travel time.
Financial costs included a tally of overhead, labor, overtime, travel, and other costs. The tab worked out to nearly 1% of the health department’s annual program budget, excluding grants and external funding sources.
The most affected divisions were Epidemiology (156% of budgeted hours), including both epidemiology and disease control functions, as well as Administration (46%) and Media Relations (41%).
There were indirect costs, as well. Staff members reported a total delay of 83 days on other projects, although the type and number of projects were not analyzed.
According to the accompanying editorial note, there were two other limitations to the data. The analysis did not evaluate costs incurred by patients, individuals who were advised to get chemoprophylaxis, healthcare providers, or institutions. Also, the findings might not apply to other local health departments.
In the same issue of MMWR, the CDC published updated guidance on the use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine — making official the change in guidelines adopted in October at a meeting of the Advisory Committee on Immunization Practices.
The CDC continues to recommend a single Tdap dose for adolescents ages 11 through 18 who have completed the recommended childhood diphtheria, tetanus toxoids, and pertussis/diphtheria, tetanus toxoids, and acellular pertussis (DTP/DTaP) vaccination series — as well as for adults ages 19 through 64.
Additional recommendations include the use of Tdap regardless of the interval since the last dose of vaccine containing tetanus or diphtheria toxoid, as well as use in certain individuals older than 64 and in under-vaccinated children ages 7 to 10. The two Tdap vaccines on the market — Sanofi Pasteur’s Adacel and GlaxoSmithKline’s Boostrix — are not licensed for those two age groups.
Source: MedPage Today