Olanrewaju Medu1,2, Maureen Anderson3, Andrea Enns4, Judith Wright4, Terry Dunlop4, Simon Kapaj4, JohnMark Opondo4. 1. Saskatchewan Health Authority, Community Health Services, Weyburn, SK, Canada. oam310@mail.usask.ca. 2. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. oam310@mail.usask.ca. 3. Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada. 4. Saskatchewan Health Authority, Population and Public Health, Saskatoon, Saskatchewan, Canada.
Abstract
OBJECTIVES: Increased numbers of pertussis cases in September 2015 led to the declaration of an outbreak in the Saskatoon Health Region (SHR). SHR (population approximately 350,000) is a geographic area in central Saskatchewan consisting of both urban and rural municipalities. The purpose of this study was to describe the epidemiology and identify possible predictors of the outbreak. METHODS: Confirmed cases of pertussis in SHR from 2010 to 2015 were extracted from the integrated Public Health Information System (iPHIS) database. Univariate and bivariate analyses and a comparison of the two outbreaks were conducted. Poisson regression modelling was used to estimate incidence rate ratios (IRRs) of factors associated with pertussis infection. OUTCOMES: Two outbreaks between 2010 and 2015. Factors associated with the 2015 outbreak were residence in rural areas (IRR = 18.67, 95% CI 11.82-29.49; 11.37, 95% CI 6.40-20.21; and 6.31, 95% CI 3.43-11.62) for Humboldt, Watrous, and Rosthern areas, respectively, compared to the City of Saskatoon, and among children 11-14 years of age (IRR = 3.11, 95% CI 1.67-5.79) compared to children under 5 years of age. Unvaccinated persons had increased risk (IRR = 1.60, 95% CI 1.07-2.38). Multiple interventions, including enhanced contact tracing, supplemental immunization clinics, and cocooning, were employed in the 2015 outbreak. CONCLUSION: Pertussis is a cyclical disease with outbreaks occurring every 3 to 5 years. Teenagers have increased risk of disease compared to younger children, likely due to waning immunity. Rural residents had a higher incidence of disease, possibly due to clusters of conscientious objectors. Control efforts require recognition of waning immunity and unvaccinated susceptibles.
OBJECTIVES: Increased numbers of pertussis cases in September 2015 led to the declaration of an outbreak in the Saskatoon Health Region (SHR). SHR (population approximately 350,000) is a geographic area in central Saskatchewan consisting of both urban and rural municipalities. The purpose of this study was to describe the epidemiology and identify possible predictors of the outbreak. METHODS: Confirmed cases of pertussis in SHR from 2010 to 2015 were extracted from the integrated Public Health Information System (iPHIS) database. Univariate and bivariate analyses and a comparison of the two outbreaks were conducted. Poisson regression modelling was used to estimate incidence rate ratios (IRRs) of factors associated with pertussis infection. OUTCOMES: Two outbreaks between 2010 and 2015. Factors associated with the 2015 outbreak were residence in rural areas (IRR = 18.67, 95% CI 11.82-29.49; 11.37, 95% CI 6.40-20.21; and 6.31, 95% CI 3.43-11.62) for Humboldt, Watrous, and Rosthern areas, respectively, compared to the City of Saskatoon, and among children 11-14 years of age (IRR = 3.11, 95% CI 1.67-5.79) compared to children under 5 years of age. Unvaccinated persons had increased risk (IRR = 1.60, 95% CI 1.07-2.38). Multiple interventions, including enhanced contact tracing, supplemental immunization clinics, and cocooning, were employed in the 2015 outbreak. CONCLUSION: Pertussis is a cyclical disease with outbreaks occurring every 3 to 5 years. Teenagers have increased risk of disease compared to younger children, likely due to waning immunity. Rural residents had a higher incidence of disease, possibly due to clusters of conscientious objectors. Control efforts require recognition of waning immunity and unvaccinated susceptibles.