Changing epidemiology of pertussis in the United States: Increasing reported incidence among adolescents and adults, 1990-1996

Since 1990, the reported incidence of pertussis has increased in the United States with peaks occurring every 3-4 years. On the basis of analysis of p ertussis cases reported to the Centers for Disease Control and Prevention, the incidence remained stable among children aged younger than 5 years, mos t of whom were protected by vaccination. In contrast to 1990-1993, during 1 994-1996, the average incidence among persons aged 5-9 years, 10-19 years, and 20 years or older increased 40%, 106%, and 93%, respectively. Since 199 0, 14 states reported pertussis incidences of greater than or equal to 2 ca ses per 100,000 population during at least 4 years between 1990 and 1996; s even of these states also reported that a high proportion of cases occurred in persons aged 10 years or older. Analysis of national data on pertussis did not provide sufficient information to fully elucidate the relative impo rtance of multiple possible explanations for the increase in the incidence of pertussis in adolescents and adults. Improvement in diagnosis and report ing of pertussis in this age group, particularly in some states, is an impo rtant factor contributing to the overall increase.