The nurse depicted in this 2006 image was administering an intramuscular vaccination in the left shoulder muscle to a young girl. The nurse immobilized the girl’s arm by clutching it tightly, while the girl held up her sleeve in order to facilitate the procedure. CDC/ Judy Schmidt

Two deadly childhood illnesses are back in the news. The Centers for Disease Control (CDC) raised all sorts of flags over the number of measles cases in the United States last year. The number of pertussis cases, also called whooping cough, is also rising rapidly across the nation.

The CDC publishes the Morbidity and Mortality Weekly Report every week. In that report is the data from the National Notifiable Diseases Surveillance System. The latest report is for week 16, ending April 21, 2012.
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Look at any state or local website run by a public health authority and you will see information, glaring warnings, about the the dangers of West Nile virus. West Nile is an illness transmitted by mosquitoes that has been seen in humans in the United States for about 12 years. It’s an import, from overseas.

While searching for information about whooping cough, pertussis, case numbers on various sites I began to notice the “West Nile panic“. Lots of information about West Nile but far less about illnesses, serious illnesses with much larger case numbers.

Here are some case number examples from the CDC MMWR week 35 report for September 5, 2010.

In 2007, Michigan reported 392 cases of AIDS, 4,191 cases of Chickenpox, 292 cases of Whooping Cough and 17 of West Nile.

For that same year, New York State, including New York City, reported 3,984 cases of AIDS, did not report chickenpox and 22 cases of West Nile.

Massachusetts reported, for 2007, 602 new cases of HIV, 1,178 cases of Whooping Cough and six cases of West Nile.

Is the allocation of scarce public health resources to massive West Nile educational campaigns a wise choice? Looking at the case numbers for Chlamydia and Gonorrhea in the table suggest at least one place where educational dollars might be better used. The outbreaks of Whooping Cough and Mumps in 2009 and 2010 certainly could have been reduced with funding for more immunizations clinics.

Do public health agencies serve the interests of the taxpayers? Billions of dollars have been spent on illnesses such as SARS, bird flu, anthrax and smallpox, and are now being spent on West Nile. Is that protecting the public?

Map showing states with over 100 whooping cough cases. Click for a larger image.

It has been clear for some weeks now that the whooping cough outbreaks this year are geographically related. There appear to be two clusters, a Midwest one and one that includes California and a couple of bordering states.

Texas, with the second highest number of cases of whooping cough, does not seem to have infected its neighbors.

This map uses the data from the Centers for Disease Control (CDC) MMWR report for week 31, ending August 7, 2010.

The data is provisional for several reasons. Updated data from the various states for any given week will be included in the cumulative totals as received, but not reflected in the weekly case counts. In addition, in the cases of California and Massachusetts, the CDC has told us by e-mail that the states are not reporting all their cases every week. Both states are said to be overwhelmed with the numbers of cases to be reported and have chosen to fall behind in various ways.

Further information about whooping cough / pertussis can be found at this link.

The United States Centers for Disease Control (CDC) function as the national public health authority. Within the Centers is the Division of Vector Borne Infectious Diseases (DVBID). Its mission is to provide, at the national level, surveillance, research, diagnostic testing and assistance to state, local and foreign governments with regard to vector borne diseases. Those are illnesses carried by mosquitoes, ticks, fleas and other animals that can be transmitted to humans.

The budget for the DVBID in 2010 was $26.7 million. That line has been defunded in the Administration’s 2011 proposal, with $18.9 million added to the emerging infectious diseases area…

The American Society for Tropical Medicine and Hygiene (ASTMH) has called for restoration of the funding for DVBID. Edward T. Ryan, M.D., President of the ASTMH, spoke with me recently about this issue.

This is the division that works on dengue fever, malaria, Lyme disease, West Nile virus, spotted fever and all the other illnesses we get from bug bites.

More at Budget cuts at CDC threaten efforts on bug borne diseases

Whooping cough, or pertussis, continues to spread in many areas of the country. In other areas, the case counts are down dramatically from 2009. The best count, using both the data provided in the Centers for Disease Control (CDC) MMWR Week 27 report (as of July 10, 2010) and a press release from the California California Department of Public Health (CDPH), seems to be 7,174 cases in 2010, and 7,440 cases for 2009 through the same date.

The CDPH press release is cited for a reason. Just over half of all the cases of whooping cough in California have not been reported to the CDC. I have been following with the CDC on this issue and they forwarded to me this response from California, that had been forwarded to them:

We are counting cases that are coming from CDMS and from the raw file you are exporting. It is my understanding that only cases for which we’ve received a Case History Form are sent to CDC from CDMS. Many counties are extremely behind in submitting the form since they are overwhelmed with case investigation for the ongoing outbreak. We’ve been maintaining our in-state total to release to the media which we know doesn’t match up with what is being sent to CDC. Our total count of Pertussis cases reported Jan-June 2010 is 1,337.

The press released linked has increased that June 30 total to 1,496. Here is a graph illustrating the difference in reported numbers. Click on the graph for a larger image.

The inability of California to report its cases of whooping cough in a timely manner means that Federal public health officials cannot react in a timely manner to changes in the case counts. It should worry neighboring states, as well, since they, too, cannot know how severe the epidemic may be.

Here are the states, in decreasing order of 2010 pertussis cases, that make up 2/3 of all the cases of whooping cough in the United States.

The states in deep red are up at least 150% over 2009. The cases in salmon are up between 100% and 150% over last year. Despite their totals, Texas and Ohio are only up 8% over 2009. Arizona, however, is up 86% and upstate New York (everything outside New York City) is up 98% over 2009 at this time. Click on the graph for a larger image.

These nine states have seen 2/3 of the cases of pertussis. Only California is seeing a dramatic increase in case numbers, year over year. Upstate New York has gone to 190 cases in 2010 from 96 cases in 2009, for example. The public health authorities in California called it an epidemic, and the case number increase bears out that declaration.

While those states are seeing significant increases in cases of whooping cough for 2010 over last year, others have significant decreases. Here are the states with over 150 cases in 2009 and with reductions in cases year over year.

For more information about whooping cough:

Pertussis (Whooping Cough) – What You Need To Know from the CDC

Pertussis (Whooping Cough) from CDPH