NCHS Data on Pertussis Hospitalizations in Young Children
Leah Sirkus, M.P.H.; Susan Lukacs, D.O., M.S.P.H.;
Figure 1. Pertussis Hospitalization Rate Among Children Under
age 2 Years:
United States, 1994-98 and 1999-2003
Figure 2. Pertussis Hospitalization Rate Among Children Under
age 2 Years, by
Region: United States, 1994-98 and 1999-2003
The variation in hospitalizations may be associated with differences in vaccination exemption policies and rates of exemption by geographic region. Areas with high exemption rates have been shown to create pockets of susceptible populations, which subsequently lead to outbreaks of disease (4,5). All States grant exemptions for medical reasons, however, only some offer religious and philosophical exemptions. The West has the highest proportion of States that offer all three types of exemptions, and data from the National Immunization Survey suggest that States that allow philosophical exemptions have significantly higher rates of unvaccinated children (6). It has been suggested that in some western States, it may be easier to claim an exemption than to acquire all vaccinations required for school entry (7).
Expected Source of
1994-98 and 1999-2003. In 1999-2003 Medicaid or other government funding was the expected source of payment for the majority of pertussis hospitalizations among young children.
This shift in the source of payment could be partially explained by a series of Medicaid expansions that raised eligibility thresholds to cover more children. Additionally, rising premiums and cost-sharing involved with private insurance may have influenced lower-income families to switch to Medicaid or public insurance (8).
Children under 6 months of age are too young to receive adequate protection from immunization. A booster vaccine was recently licensed in 2005 for adolescents and adults, and recommended for adolescents by the Advisory Committee on Immunization Practices (ACIP) of CDC (9). Increased vaccination coverage in adolescents and adults may lead to fewer infants contracting pertussis, which may result in decreased morbidity and fewer hospitalizations in young infants.
About the Data
2. Tan T, Trindade E, Skowronski D. Epidemiology of Pertussis. Pediatr Infect Dis J 24:S10-S18. 2005.
3. American Academy of Pediatrics. Pertussis: In Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious Disease. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics 435-48. 2000.
4. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, et al. Individual and Community Risks of Measles and Pertussis Associated with Personal Exemptions to Immunization. JAMA 284:3145-50. 2000.
5. May T, Silverman RD. Clustering of exemptions as a collective action threat to herd immunity. Vaccine 21:1048-51. 2003.
6. Smith PJ, Chu SY, Barker LE. Children Who Have Received No Vaccines: Who Are They and Where Do They Live? Pediatrics 114:187-95. 2004.
7. Rota JS, Salmon DA, Rodewald LE, Chen RT, et al. Processes for Obtaining Nonmedical Exemptions to State Immunization Laws. Am J Public Health 91:645-48. 2001.
8. Dubay LC, Kenney GM. The Effects of Medicaid Expansions on Insurance Coverage of Children. Future Child 6:152-61. 1996.
9. Centers for Disease Control and Prevention. ACIP Recommends Adolescent Vaccination for Tetanus, Diphtheria, and Pertussis Vaccine. [NIP Web site]. 2005.
This page last reviewed
August 02, 2007