Pertussis outbreak in southern Ethiopia: challenges of detection, management, and response

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Abstract

Background

Despite the availability of effective vaccines, pertussis remains endemic with high fatality rates in low and middle-income countries (LMIC). This study aims to describe an outbreak of pertussis in a health district of Ethiopia. The study highlights the challenges faced by the health system in identifying pertussis cases and appropriately responding to the outbreak at the district level.

Methods

A descriptive cross-sectional study was conducted using data sourced from the District Public Health Emergency and Management (PHEM) surveillance service and outbreak management field reports. Stratified attack rates and fatality rates for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with a polymerase chain reaction used to confirm cases.

Results

From September 2018 to January 2019, 1840 suspected, probable, and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age. An outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Among confirmed, probable and suspected pertussis cases, only 41.1% had completed the three-dose pertussis vaccine’s primary schedule. The household survey revealed a population coverage of 73.4 and 40.8% for Pentavalent vaccine dose one and three respectively. Investigations suggested the existence of a poor cold chain management system in the study area.

Conclusions

There is an urgent need to build capacity to strengthen routine vaccination services and improve the maintenance of the vaccine cold chain. Other LMICs are urged to take lessons learned from this outbreak to strengthen their own vaccination programs and capacitate health workers to manage local outbreaks.

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Most cited references 19

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Infectious Disease Threats in the Twenty-First Century: Strengthening the Global Response

David Bloom, Daniel Cadarette (2019)

The world has developed an elaborate global health system as a bulwark against known and unknown infectious disease threats. The system consists of various formal and informal networks of organizations that serve different stakeholders; have varying goals, modalities, resources, and accountability; operate at different regional levels (i.e., local, national, regional, or global); and cut across the public, private-for-profit, and private-not-for-profit sectors. The evolving global health system has done much to protect and promote human health. However, the world continues to be confronted by longstanding, emerging, and reemerging infectious disease threats. These threats differ widely in terms of severity and probability. They also have varying consequences for morbidity and mortality, as well as for a complex set of social and economic outcomes. To various degrees, they are also amenable to alternative responses, ranging from clean water provision to regulation to biomedical countermeasures. Whether the global health system as currently constituted can provide effective protection against a dynamic array of infectious disease threats has been called into question by recent outbreaks of Ebola, Zika, dengue, Middle East respiratory syndrome, severe acute respiratory syndrome, and influenza and by the looming threat of rising antimicrobial resistance. The concern is magnified by rapid population growth in areas with weak health systems, urbanization, globalization, climate change, civil conflict, and the changing nature of pathogen transmission between human and animal populations. There is also potential for human-originated outbreaks emanating from laboratory accidents or intentional biological attacks. This paper discusses these issues, along with the need for a (possibly self-standing) multi-disciplinary Global Technical Council on Infectious Disease Threats to address emerging global challenges with regard to infectious disease and associated social and economic risks. This Council would strengthen the global health system by improving collaboration and coordination across organizations (e.g., the WHO, Gavi, CEPI, national centers for disease control, pharmaceutical manufacturers, etc.); filling in knowledge gaps with respect to (for example) infectious disease surveillance, research and development needs, financing models, supply chain logistics, and the social and economic impacts of potential threats; and making high-level, evidence-based recommendations for managing global risks associated with infectious disease.

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Duration of immunity against pertussis after natural infection or vaccination.

Aaron M. Wendelboe, Annelies van Rie, Stefania Salmaso … (2005)

Despite decades of high vaccination coverage, pertussis has remained endemic and reemerged as a public health problem in many countries in the past 2 decades. Waning of vaccine-induced immunity has been cited as one of the reasons for the observed epidemiologic trend. A review of the published data on duration of immunity reveals estimates that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years. Further research into the rate of waning of vaccine-acquired immunity will help determine the optimal timing and frequency of booster immunizations and their role in pertussis control.

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How best to estimate the global burden of pertussis?

Natasha S. Crowcroft, Patrick Birmingham, C Michael Stein … (2003)

In most countries, pertussis surveillance is inadequate for accurately estimating numbers of cases or deaths. Good estimates are needed to help set priorities for vaccination programmes. We aimed to develop a simple, reliable, and explicit method for estimating pertussis cases and deaths for children under 15 years to calculate the global disease burden in 1999. We estimated the proportion of susceptible children becoming infected in countries with poor vaccination coverage ( or =70%) at 10% by 1 year, 60% by 5 years, and 100% by 15 years. Vaccine efficacy was estimated at 80% for preventing infection and 95% for preventing deaths. We used UN population estimates and vaccination coverage reported to WHO (adjusted for specific survey data if available). Case fatality ratios for countries with high and low child mortality were derived from published and unpublished work. For some countries with good vital events registration we used reported deaths adjusted for underascertainment. In 1999 there were an estimated 48.5 million pertussis cases in children worldwide. Deaths from pertussis were estimated at 390000 and at 295000 after adjustment for local data sources. Based on this approach, disability-adjusted life years from pertussis (12.7 million) in 2000 exceeded those of other preventable diseases such as lung cancer (11.4 million) and meningitis (5.8 million). This simple approach yields estimates that can be used for setting vaccination programme priorities. Better data are needed on the public health importance of pertussis in high mortality countries, the benefits of incomplete vaccination, and the harm from delayed vaccination.

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Author and article information

Contributors

Aychiluhim D. Mitiku: aychidamtew@gmail.com

Mesele D. Argaw:

ORCID: http://orcid.org/0000-0002-9558-6619

mdamte5@gmail.com

Binyam F. Desta: binyam_desta@jsi.com

Zergu T. Tsegaye: zergu_tsegaye@et.jsi.com

Afework A. Atsa: afeayele55@gmail.com

Bekele B. Tefera: BBelayihun@pathfinder.org

Ephrem Teferi: ephrem_teferi@et.jsi.com

Deirdre Rogers: deirdre_rogers@jsi.com

Ismael A. Beshir: ismael_ali@et.jsi.com

Asrat G. Alemu: asrat_gebeyehu@et.jsi.com

Desta A. Ayesa: desta_anjulo@et.jsi.com

Derebe T. Abate: 22derebe@gmail.com

Agegnehu G. Sendeku: agegnehu_sendeku@et.jsi.com

Rudzani Muloiwa: Rudzani.Muloiwa@uct.ac.za

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 11 August 2020

Publication date PMC-release: 11 August 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 1223

Affiliations

[1 ]USAID Transform: Primary Health Care project, JSI Training & Research Institute, Inc. in Ethiopia, P.O. Box 1392, code 1110 Addis Ababa, Ethiopia

[2 ]Daro Malo Woreda Health Office, Dara Malo, Ethiopia

[3 ]USAID Transform: Primary Health Care project, Pathfinder International, Addis Ababa, Ethiopia

[4 ]GRID grid.420559.f, ISNI 0000 0000 9343 1467, JSI Research & Training Institute, Inc., ; Boston, USA

[5 ]GRID grid.7836.a, ISNI 0000 0004 1937 1151, Department of Paediatrics & Child Health, , Groote Schuur Hospital & University of Cape Town, ; Cape Town, South Africa

Author information

Mesele D. Argaw http://orcid.org/0000-0002-9558-6619

Article

Publisher ID: 9303

DOI: 10.1186/s12889-020-09303-2

PMC ID: 7422551

PubMed ID: 32781999

SO-VID: eb838811-baae-48a0-80cd-476615b43709

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 November 2019

Date accepted : 27 July 2020

Custom metadata

ScienceOpen disciplines: Public health

Keywords: pertussis,outbreak,investigation,dara malo,southern ethiopia

Data availability:

ScienceOpen disciplines: Public health

Keywords: pertussis, outbreak, investigation, dara malo, southern ethiopia

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Pertussis outbreak in southern Ethiopia: challenges of detection, management, and response

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Abstract

Background

Methods

Results

Conclusions

Related collections

Coronaviruses, COVID-19 and SARS-CoV-2

Most cited references 19

Infectious Disease Threats in the Twenty-First Century: Strengthening the Global Response

Duration of immunity against pertussis after natural infection or vaccination.

How best to estimate the global burden of pertussis?

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Cited by 2

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