Winter et al1Winter K. Harriman K. Zipprich J. Schechter R. Talarico J. Watt J. et al.California Pertussis Epidemic, 2010.J Pediatr. 2012; 161: 1091-1096Abstract Full Text Full Text PDF PubMed Scopus (199) Google Scholar describe the clinical and epidemiologic characteristics of the 2010 California pertussis epidemic. They illustrate high disease burden and mortality in Hispanic patients, especially among infants, despite comparable vaccination coverage. The authors speculate that the high burden of disease in Hispanic patients might be caused by having larger households and possibly more contacts. Because the inference of a causal relationship between household size and high pertussis burden among Hispanics was not supported by data in this study, it would be beneficial if the authors considered doing an ecologic analysis by geocoding cases to census tract, aggregating case count by census tract, then using the census tract economic and housing data to understand factors that could further explain the high burden of disease as demonstrated in a similar study in which the authors used county-wide coverage levels.2Duffy E, Shea K. Poster No 499: Effect of County-level Pertussis Vaccine Coverage on County-level Pertussis Incidence Rates in California During the 2010 Pertussis Epidemic. ID Week San Diego, California 2012. https://idsa.confex.com/idsa/2012/webprogram/Paper35961.html. Accessed February 12, 2013.Google Scholar Previous investigators have demonstrated that occupational exposures to pertussis occur frequently in pediatric health care settings3Kuncio D, Middleton M, Cooney M, Ramos M, Coffin S, Feemster K. Poster 458: Healthcare Worker Pertussis Exposure and Potential Transmission to Vulnerable Patients Missed Opportunities for Prevention. ID Week. San Diego, California 2012. https://idsa.confex.com/idsa/2012/webprogram/Paper37014.html. Accessed February 12, 2013.Google Scholar and that vaccination of health care personnel (HCP) is cost effective.4Greer A.L. Fisman D.N. Use of models to identify cost-effective interventions: pertussis vaccination for pediatric health care workers.Pediatrics. 2011; 128: e591-e599PubMed Google Scholar The authors did not discuss the role that HCP might have played in the epidemic because they usually are the first to come in contact with infants, and infected HCP may be a source of infection. Previous authors have demonstrated the presence of other Bordetella species in outbreaks5Rodgers L. Martin S.W. Cohn A. Budd J. Marcon M. Terranella A. et al.Epidemiologic and laboratory features of a large outbreak of pertussis-like illnesses associated with co-circulating Bordetella holmesii and Bordetella pertussis—Ohio, 2010–2011.Clin Infect Dis. 2012; 56: 322-331Crossref PubMed Scopus (112) Google Scholar and that Bordetella parapertussis infections may contribute to cases thought to be vaccine failures.6Cherry J.D. Seaton B.L. Patterns of Bordetella parapertussis respiratory illnesses: 2008–2010.Clin Infect Dis. 2012; 54: 534-537Crossref PubMed Scopus (56) Google Scholar Of the confirmed cases in this outbreak, 82% were laboratory-confirmed by polymerase chain reaction testing. Because this was a large outbreak with several thousands of cases, epidemiologic and clinical distribution of cases by species type would add to the growing body of literature and help readers understand whether there are changes in the spectrum of diseases caused by other Bordetella species. California Pertussis Epidemic, 2010The Journal of PediatricsVol. 161Issue 6PreviewIn 2010, California experienced the highest number of pertussis cases in >60 years, with >9000 cases, 809 hospitalizations, and 10 deaths. This report provides a descriptive epidemiologic analysis of this epidemic and describes public health mitigation strategies that were used, including expanded pertussis vaccine recommendations. Full-Text PDF