While it’s sometimes easier to identify public health failures than successes, data released this week provide strong evidence that efforts to curb whooping cough deaths in children in California and to prevent amputations among US patients with diabetes have been successful.
Public health officials in California have worked for years to combat high rates of whooping cough, which rose from just 249 reported cases in 1991 to 9000 in 2010, according to the California Department of Public Health (CDPH). Whooping cough, or pertussis, a highly contagious respiratory infection caused by Bordetella pertussis or Bordetella parapertussis, can be life threatening for young infants.
To combat this epidemic, California public health authorities launched campaigns to promote vaccination against pertussis for infants and made vaccinations freely available for parents of newborns to prevent them from exposing their children. They also promoted booster vaccinations for adolescents, who don’t become seriously ill from infection but are believed to play an important role in spreading pertussis. And these efforts appear to be making a substantial difference: On Tuesday, Ron Chapman, MD, MPH, director of CDPH, reported that the state had no pertussis-related deaths in 2011, although 3000 cases were reported that year. The announcement marked the first time in 2 decades that no infants in the state died as a result of pertussis and marked a striking decline in deaths since 2010 when 10 infants died.
“Greater awareness of the disease, more rapid diagnosis and treatment, and increased vaccination rates contributed to saving the lives of infants,” Chapman said.
The US Centers for Disease Control and Prevention (CDC) also reported a public health win this week when it published a study on Tuesday in the journal Diabetes Care that documented a 65% decrease in leg and foot amputations among patients with diabetes who are 40 years or older. Complications of diabetes make the feet vulnerable to ulcers, and if such ulcers develop and don’t heal properly, tissue and bone damage may necessitate amputation of a toe, foot, or part of a leg. However, proper management of diabetes and scrupulous foot care can help prevent diabetes-related foot ulcers.
Such diabetes-related amputations declined from a rate of 11.2 per 1000 patients with diabetes in 1996 to 3.9 per 1000 in 2008, according to the CDC. The study authors credit improvements in diabetes management and reductions in cardiovascular disease for improved outcomes overall. However, they noted, substantial disparities in diabetes amputation persist, with higher rates occurring among blacks and men.
“The significant drop in rates of nontraumatic lower-limb amputations among US adults with diagnosed diabetes is certainly encouraging, but more work is needed to reduce the disparities among certain populations,” said CDC epidemiologist Nilka Ríos Burrows, MPH, one of the study’s authors, in a statement.