title: Societal costs and morbidity of pertussis in adolescents and adults.
abstract: BACKGROUND
  Since the 1980s, the reported incidence of pertussis among adolescents and adults has been steadily increasing. To understand whether the benefits of an acellular pertussis vaccine formulated for adolescents and adults might offset its costs, policy makers will need information about morbidity and societal (medical and nonmedical) costs of pertussis.
  
  
  METHODS
  Adolescents (age, 10-17 years) and adults (age, >or=18 years) with confirmed pertussis illness were identified by the Massachusetts enhanced pertussis surveillance system. We evaluated medical costs in a cohort of patients who had confirmed pertussis during the period of January 1998 through December 2000; nonmedical costs, by means of prospective interviews, in a cohort of patients who had confirmed pertussis during the period of December 2001 through January 2003; and morbidity in both cohorts. Our main outcome measures were mean costs per case, in 2002 US dollars.
  
  
  RESULTS
  In the analysis of medical costs, 1679 adolescents and 936 adults were found to have mean costs of 242 dollars and 326 dollars, respectively (P<.05). In interviews with 314 adolescents and 203 adults, adults had significantly higher nonmedical costs (447 dollars) than those of adolescents (155 dollars). A total of 83% of adolescents missed a mean of 5.5 days from school (range, 0.4-32 days), and 61% of adults missed a mean of 9.8 days from work (range, 0.1-180 days) because of pertussis. Thirty-eight percent of adolescents and 61% of adults were still coughing at the time of the interview, which occurred an average of 106 days and 94 days, respectively, after cough onset.
  
  
  CONCLUSIONS
  Pertussis causes significant morbidity in and costs for adolescents and adults, with time losses comprising the largest proportion of the cost. Societal costs should be considered when making decisions about potential vaccine use in the future.
authors.affiliation: Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA 02215, USA. grace_lee@hphc.org
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
authors.forename: Susan
authors.initials: S
authors.lastname: Lett
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schauer
authors.forename: Charles
authors.initials: C
authors.lastname: LeBaron
authors.forename: Trudy V
authors.initials: TV
authors.lastname: Murphy
authors.forename: Donna
authors.initials: D
authors.lastname: Rusinak
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012961:Sociology; D014917:Whooping Cough / Q000150:complications* / Q000191:economics*