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Dr Rosemary Lester Acting Director and Acting Chief Health Officer Health Protection Branch 14 February 2012. Pertussis – the continuing epidemic. Rosemary Lester Overview of pertussis The epidemiology of pertussis in Victoria The Government’s response – parental vaccination program

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Presentation Transcript
Rosemary Lester

Overview of pertussis

The epidemiology of pertussis in Victoria

The Government’s response – parental vaccination program

Initial uptake – 2010 survey


Stacey Rowe

Parental Whooping Cough Vaccination Survey

  • Methodology
  • How to administer the survey
  • Questions
overview of pertussis
Respiratory illness caused by bacterium Bordetella pertussis

Highly infectious – spread by respiratory droplets

Incubation period – 6 to 20 days, usually <14 days

Infectious period – just prior to onset and, if untreated, for up to 21 days after cough onset

Infants <12 months are most at risk of complications and death

Most hospitalised, many ICU admissions

Morbidity – hypoxia and resultant brain damage, seizures lung scarring, broken ribs etc.

Mortality – approx 1 in every 200 cases <6mo will die

Overview of pertussis
the continuing epidemic
The continuing epidemic

Epidemics observed every 3-5 years

Remains endemic in developed countries:

    • Australia, Canada, Japan, Italy, The Netherlands, Sweden, USA
  • All report recent increases

Victoria’s current epidemic

  • Notifications increased markedly since 2008
  • 8,489 cases notified in 2011 alone; nearly 8-times greater than the 2007 annual total
the continuing epidemic infants aged 12 months
The continuing epidemic: infants aged < 12 months

Whilst the vast majority of cases are among adults, infants aged less than12 months are most vulnerable

  • In five years (2007 – 2011), 634 cases of pertussis were notified in children <12 months of age
  • Of these, 477 (75%) were aged <6 months
    • no immunity until received 3 doses of pertussis –containing vaccine at 2, 4, and 6 months of age
the government s response
15 June 2009 - Parental whooping cough vaccination program

Free pertussis-containing vaccine (Boostrix®)

Parents of new babies eligible (incl. adoptive/foster)

Time-limited program

Program rationale – to protect unimmunised babies from infection with pertussis by vaccinating parents – referred to as “cocooning strategy”

The Government’s response

Delivery of vaccine is being encouraged through:

  • Maternity hospitals
  • General practice
  • MCH nurses
  • Local Government immunisation
2010 survey
Attitudes, awareness, uptake survey

Smaller sample of parents whose babies were born in Q1 2010

10 LGAs – 5 rural, 5 metro

Mail-out survey direct to parents

2010 survey


  • 166 families participated from 9 LGAs
  • 69% mothers and 53% fathers had had the vaccine
  • Reasons for not being vaccinated:
    • Not being aware of the availability of the free vaccine
    • Time and effort involved to be vaccinated


  • Poor response rate – 41%
  • Logistical challenges – Sampling and distribution
next steps
Next steps


Vaccine effectiveness studies

Various laboratory research going on – to examine molecular characteristics of Bordetella Pertussis

? Additional booster in second year of life

Repeat survey to measure uptake of vaccine (Vic) – Stacey…

survey aim and methodology

To obtain a coverage estimate on the parental whooping cough vaccination

Survey Aim and Methodology


State-wide distribution

Four consecutive weeks – 15 February to 14 March, inclusive

Parents attending 4 month Key Ages and Stages consultation

MCH nurse administered

The survey

  • Short: focuses on whether, where and when
  • No personal identifying information being collected
  • Not onerous for either MCH nurses/parents
distribution of survey and related materials
Distribution of survey and related materials


Sent fro m our warehouse to all MCH coordinators on Friday 3 February

Most of you will have received it already

What will you receive?

  • The survey (1 pager)
    • 1 for each child expected to attend 4 month KAS consultation
  • Plain Language Statement (1 pager)
    • 1 for each parent(s)
  • Information sheet (1 pager, double-sided)
    • 1 for each MCH Office
  • Reply-paid envelopes
    • At least 1 per 20 surveys
how to administer survey
How to administer survey

How to administer survey

Who can participate?

Birth, foster and adoptive parents

One parent can respond for both – complete two columns

Single parent – complete one column

Informed consent

Explain to parents:

  • What the survey is about
  • Why it’s being conducted
  • What their participation will involve

Provide parents with Plain Language Statement

Request their consent – tick box on front of survey

frequently asked questions
Frequently asked questions

Some explanation about the questions

Question 4 – Have you had the whooping cough vaccine in relation to the birth of your most recent child?

Why “in relation to”?It excludes those who may have already had the vaccine for other reasons (captured elsewhere):

Previous child, or newborn relative

Vaccinated in year 10 at school

It helps narrow the subsequent question of “when”

Question 4b – What date did you have the vaccine?

  • Ideally – obtain actual date (dd,mm,yyyy)
  • Otherwise, use approximations (check boxes)
frequently asked questions cont
Frequently asked questions (cont.)

Question 4c – If you did not have the vaccine, why not?

Already had the vaccine since 2004

Boostrix only became available in 2004

People who have had vaccine since 2004 don’t need it again

Did not know the free vaccine was available

Other (use back of survey if need more room)

Not being aware of the risks of the disease

Don’t consider the disease serious enough to be vaccinated

Costs associated with going to the doctor

Time and effort involved with getting vaccinated

Potential side effects of the vaccine

Concerns regarding how well the vaccine works

Don’t like needles

My religious beliefs

other considerations
Other considerations
  • Parents need not feel that they are being criticised for not having received the whooping cough vaccination
  • You may wish to use this conversation with parent(s) opportunistically, and link unvaccinated parents in to your immunisation providers to encourage vaccination
survey returns
Survey returns

Return of surveys to Department of Health

End of survey period – 15 March 2012

Intermittently throughout survey period (large caseloads)

Reply-paid envelopes (call 1300 651 160 if requiring more)


Stacey Rowe – 1300 651 160

distribution of results
Distribution of results

Survey results reported to:

MCH workforce

LGA immunisation committees

Chief Health Officer


National communicable disease networks