Skip to main content Accessibility help

Two Nosocomial Pertussis Outbreaks and Their Associated Costs—King County, Washington, 2004

  • Henry C. Baggett (a1) (a2) (a3), Jeffrey S. Duchin (a1) (a4), William Shelton (a4), Danielle M. Zerr (a4) (a5), Joan Heath (a5), Ismael R. Ortega-Sanchez (a6) and Tejpratap Tiwari (a6)...



Pertussis outbreaks in healthcare settings result in resource-intensive control activities, but studies have rarely evaluated the associated costs. We describe and estimate costs associated with 2 nosocomial pertussis outbreaks in King County, Washington, during the period from July 25 to September 15, 2004. One outbreak occurred at a 500-bed tertiary care hospital (hospital A), and the other occurred at a 250-bed pediatric hospital (hospital B).


We estimated the costs of each outbreak from the hospitals' perspective through standardized interviews with hospital staff and review of contact tracing logs. Direct costs included personnel time and laboratory and medication costs, whereas indirect costs were those resulting from hospital staff furloughs.


Hospital A incurred direct costs of $195,342 and indirect costs of $68,015; hospital B incurred direct costs of $71,130 and indirect costs of $50,000. Cost differences resulted primarily from higher personnel costs at hospital A ($134,536), compared with hospital B ($21,645). Total cost per pertussis case was $43,893 for hospital A (6 cases) and $30,282 for hospital B (4 cases). Total cost per person exposed to a pertussis patient were $357 for hospital A (738 exposures) and $164 for hospital B (737 exposures).


Nosocomial pertussis outbreaks result in substantial costs to hospitals, even when the number of pertussis cases is low. The cost-effectiveness of strategies to prevent nosocomial pertussis outbreaks, including vaccination of healthcare workers, should be evaluated.


Corresponding author

Division of Global Migration and Quarantine, CDC, 1600 Clifton Rd. NE MS E03, Atlanta, GA 30333 (


Hide All
1. Tanaka, M, Vitek, CR, Pascual, FB, Bisgard, KM, Tate, JE, Murphy, T. Trends in pertussis among infants in the United States, 1980-1999. JAMA 2003;290:29682975.
2. De Serres, G, Shadmani, R, Duval, B, Boulianne, N, Dery, P, Douville, FM. Morbidity of pertussis in adolescents and adults. J Infect Dis 2000;182:174179.
3. Edwards, KE, Decker, MD. Pertussis vaccine. In: Plotkin, SA, Orenstein, WA, eds. Vaccines. Philadelphia, PA: WB Saunders, 2004:471528.
4. Centers for Disease Control and Prevention. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other control measures: recommendations of the Immunization Practices Advisory committee (ACIP). MMWR Morb Mort Wkly Rep 1991;40(RR-10):128.
5. Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Morb Mort Wkly Rep 2004;53(RR-3):136.
6. Centers for Disease Control and Prevention. Guidelines for the control of pertussis outbreaks. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2006. Available at: Accessed on March 20, 2006.
7. Ward, A, Caro, J, Bassinet, L, Housset, B, O'Brien, JA, Guiso, N. Health and economic consequences of an outbreak of pertussis among healthcare workers in a hospital in France. Infect Control Hosp Epidemiol 2005;26:288292.
8. Calugar, A, Ortega-Sanchez, I, Tiwari, T, Oakes, L, Jahre, JA, Murphy, T. Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers. Clin Infect Dis 2006;42:981988.
9. Christie, CD, Glover, AM, Willke, MJ, Marx, ML, Reising, SF, Hutchinson, NM. Containment of pertussis in the regional pediatric hospital during the Greater Cincinnati epidemic of 1993. Infect Control Hosp Epidemiol 1995;16:556563.
10. Zivna, I, Bergin, D, Casavant, J, et al. Bordetella pertussis exposure in a Massachusetts tertiary care medical system, FY 2004 [abstract 191]. In: Program and abstracts of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (Los Angeles, California):108.
11. Council of State and Territorial Epidemiologists (CSTE). 1997 Position Statements. CSTE National Meeting, Saratoga Springs, NY: CSTE. Position statement 9. Available at: Accessed on March 20, 2006.
12. Muller, FM, Hoppe, JE, Wirsing von Konig, CH. Laboratory diagnosis of pertussis: state of the art in 1997. J Clin Microbiol 1997;35:24352443.
13. Jenkinson, D. Duration of effectiveness of pertussis vaccine: evidence from a 10 year community study. Br Med J (Clin Res Ed) 1988;296:612614.
14. He, Q, Viljanen, MK, Nikkari, S, Lyytikainen, R, Mertsola, J. Outcomes of Bordetella pertussis infection in different age groups of an immunized population. J Infect Dis 1994;170:873877.
15. Wright, SW, Edwards, KM, Decker, MD, Zeldin, MH. Pertussis infection in adults with persistent cough. JAMA 1995;273:10441046.
16. Nennig, ME, Shinefield, HR, Edwards, KM, Black, SB, Fireman, BH. Prevalence and incidence of adult pertussis in an urban population. JAMA 1996;275:16721674.
17. Bolyard, EA, Talban, OC, Williams, WW, Pearson, ML, Shapiro, CN, Deitchman, SD, and The Hospital Infection Control Practices Advisory Committee. Guideline for infection control in health care personnel, 1998. Infect Control Hosp Epidemiol 1998;19:407463.
18. Tiwari, T, Murphy, TV, Moran J;National Immunization Program, CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis:2005 CDC Guidelines. MMWR Recomm Rep 2005;54:116.
19. Centers for Disease Control and Prevention. ACIP votes to recommend use of combined tetanus, diphtheria and pertussis (Tdap) vaccine for adults (Updated March 3, 2006). Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: Accessed on March 20, 2006.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed