Connect
MJA
MJA

Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000–2011

Marlena C Kaczmarek, Lisa Valenti, Heath A Kelly, Robert S Ware, Helena C Britt and Stephen B Lambert
Med J Aust 2013; 198 (11): 624-628. || doi: 10.5694/mja13.10044

Summary

Objective: To better understand the role that diagnostic test-ordering behaviour of general practitioners has on current pertussis epidemiology in Australia.

Design and setting: Analysis of Australian general practice encounter data (from the Bettering the Evaluation and Care of Health [BEACH] program) on 13 “pertussis-related problem” (PRP) codes that were most likely to result in a pertussis laboratory test request and Australian pertussis notifications data (from the National Notifiable Diseases Surveillance System [NNDSS]) for the period April 2000 to March 2011.

Main outcome measures: The change in the proportion of PRP general practice encounters with a pertussis test request between 2000 and 2011, and the change in national pertussis notifications over the same period.

Results: The proportion of PRP encounters resulting in a pertussis test request increased from 0.25% between April 2000 and March 2004 to 1.71% between April 2010 and March 2011 (odds ratio, 7.0; 95% CI, 5.5–8.8). The BEACH data on pertussis testing and NNDSS data on pertussis notifications were highly correlated (r = 0.99), and the notification data mirrored the likelihood of a pertussis test request in general practice. The proportion of NNDSS pertussis notifications with a polymerase chain reaction (PCR)-confirmed diagnosis increased from 16.3% between April 2000 and March 2004 to 65.3% between April 2010 and March 2011.

Conclusion: An increase in pertussis testing following recognition of early epidemic cases may have led to identification of previously undetected infections, resulting in a further increase in notified disease and awareness among GPs. The changing likelihood of being tested may also be due to expanding availability and use of PCR testing in Australia.

Please login with your free MJA account to view this article in full

  • Marlena C Kaczmarek1,2,3
  • Lisa Valenti4
  • Heath A Kelly3
  • Robert S Ware1,2
  • Helena C Britt4
  • Stephen B Lambert1

  • 1 Queensland Children’s Medical Research Institute, Brisbane, QLD.
  • 2 School of Population Health, University of Queensland, Brisbane, QLD.
  • 3 Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC.
  • 4 Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW.


Acknowledgements: 

We thank the Australian Government Department of Health and Ageing and the Family Medicine Research Centre, School of Public Health, University of Sydney, for providing data used in this study. Marlena Kaczmarek is the recipient of a Sidney Myer Health Scholarship. During the data period included in this study, the BEACH program was funded by: the Australian Government Department of Health and Ageing (1998–2004, 2007–2011); the National Prescribing Service (2005–2009); AstraZeneca (Australia) (1998–2011); Merck, Sharp and Dohme (Australia) (2002–2011); Pfizer Australia (2003–2011); Sanofi-Aventis Australia (2006–2011); Novartis Pharmaceuticals Australia (2009–2011); GlaxoSmithKline Australia (2010–2011); CSL Biotherapies (2010–2011); Bayer Australia (2010–2011); Janssen-Cilag (2000–2010); Abbott Australasia (2006–2010); Wyeth Australia (2008–2010); Roche Products (1998–2006); and Aventis Pharma (1998–2002).

Competing interests:

Stephen Lambert has received honoraria for serving on the GlaxoSmithKline advisory boards for pneumococcal conjugate vaccine, serving as an investigator on clinical studies sponsored by GlaxoSmithKline and Sanofi-Pasteur (both manufacturers of pertussis-containing vaccines), and serving on GlaxoSmithKline and Sanofi-Pasteur advisory boards for pneumococcal and influenza vaccines, respectively.

  • 1. Edwards K, Decker M. Pertussis vaccines. In: Plotkin S, Orenstein WA, Offit PA, editors. Vaccines. 5th ed. Philadelphia: Elsevier, 2008: 467-517.
  • 2. Heininger U. Pertussis: what the pediatric infectious disease specialist should know. Pediatr Infect Dis J 2012; 31: 78-79.
  • 3. Rohani P, Drake JM. The decline and resurgence of pertussis in the US. Epidemics 2011; 3: 183-188.
  • 4. Fisman DN, Tang P, Hauck T, et al. Pertussis resurgence in Toronto, Canada: a population-based study including test-incidence feedback modeling. BMC Public Health 2011; 11: 694.
  • 5. Crespo I, Cardeñosa N, Godoy P, et al. Epidemiology of pertussis in a country with high vaccination coverage. Vaccine 2011; 29: 4244-4248.
  • 6. Reid S, Wilson E. New Zealand pertussis epidemiology and the Global Pertussis Initiative immunisation strategies. N Z Med J 2011; 124: 63-64.
  • 7. NNDSS Annual Report Writing Group. Australia’s notifiable disease status, 2010: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell Q Rep 2012; 36: 1-69.
  • 8. Jenkinson D. Increase in pertussis may be due to increased recognition and diagnosis. BMJ 2012; 345: e5463.
  • 9. Tozzi AE, Celentano LP, Ciofi degli Atti ML, Salmaso S. Diagnosis and management of pertussis. CMAJ 2005; 172: 509-515.
  • 10. Spokes PJ, Quinn HE, McAnulty JM. Review of the 2008-2009 pertussis epidemic in NSW: notifications and hospitalisations. N S W Public Health Bull 2010; 21: 167-173.
  • 11. Britt H, Miller G, Charles J, et al. General practice activity in Australia 2009–10. Canberra: Australian Institute of Health and Welfare, 2011. (AIHW Cat. No. GEP 27; General Practice Series No. 27.) http://www.aihw.gov.au/publication-detail/?id=6442472433 (accessed May 2013).
  • 12. Wonca International Classification Committee. ICPC-2 — English: International Classification of Primary Care — 2nd Edition. Singapore: Wonca, 1998. http://www.kith.no/upload/2705/ICPC-2-English.pdf (accessed Dec 2008).
  • 13. Australian Government Department of Health and Ageing. Australian national notifiable diseases case definitions. Pertussis case definition. http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-casedefs-cd_pertus.htm (accessed May 2012).
  • 14. Centers for Disease Control and Prevention. Pertussis epidemic — Washington, 2012. MMWR Morb Mortal Wkly Rep 2012; 61: 517-522.
  • 15. Cherry JD. Epidemic pertussis in 2012 — the resurgence of a vaccine-preventable disease. N Engl J Med 2012; 367: 785-787.
  • 16. Guiso N, Wirsing von König CH, Forsyth K, et al. The Global Pertussis Initiative: report from a round table meeting to discuss the epidemiology and detection of pertussis, Paris, France, 11-12 January 2010. Vaccine 2011; 29: 1115-1121.
  • 17. Australian Government Department of Health and Ageing. MBS Online Medicare Benefits Schedule. http://www.health.gov.au/internet/mbsonline/publishing.nsf (accessed May 2013).
  • 18. Australian Government Department of Health and Ageing. Review of Australia’s health sector response to pandemic (H1N1) 2009: lessons identified. Canberra: Commonwealth of Australia, 2011. http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/review-2011/$File/lessons%20identified-oct11.pdf (accessed May 2013).
  • 19. Bonacruz-Kazzi G, McIntyre P, Hanlon M, Menzies R. Diagnostic testing and discharge coding for whooping cough in a children’s hospital. J Paediatr Child Health 2003; 39: 586-590.
  • 20. Zepp F, Heininger U, Mertsola J, et al. Rationale for pertussis booster vaccination throughout life in Europe. Lancet Infect Dis 2011; 11: 557-570.
  • 21. Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013; 131: e1047-e1052.
  • 22. Sheridan SL, Ware RS, Grimwood K, Lambert SB. Number and order of whole cell pertussis vaccines in infancy and disease protection. JAMA 2012; 308: 454-456.
  • 23. Witt MA, Katz PH, Witt DJ. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak. Clin Infect Dis 2012; 54: 1730-1735.
  • 24. Vickers D, Ross AG, Mainar-Jaime RC, et al. Whole-cell and acellular pertussis vaccination programs and rates of pertussis among infants and young children. CMAJ 2006; 175: 1213-1217.
  • 25. Quinn HE, Mahajan D, Hueston L, et al. The seroepidemiology of pertussis in NSW: fluctuating immunity profiles related to changes in vaccination schedules. N S W Public Health Bull 2011; 22: 224-229.
  • 26. Octavia S, Sintchenko V, Gilbert GL, et al. Newly emerging clones of Bordetella pertussis carrying prn2 and ptxP3 alleles implicated in Australian pertussis epidemic in 2008-2010. J Infect Dis 2012; 205: 1220-1224.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.