Effectiveness of pertussis vaccination and duration of immunity

Schwartz, Kevin L; Kwong, Jeffrey C.; Deeks, Shelley L.; Campitelli, Michael A.; Jamieson, Frances; Marchand-Austin, Alex; Stukel, Thérèse A.; Rosella, Laura; Daneman, Nick; Bolotin, Shelly; Drews, Steven J.; Rilkoff, Heather; Crowcroft, Natasha S.

doi:10.1503/cmaj.160193

Cited by 111 publications

(64 citation statements)

References 34 publications

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“…Although the goal of vaccination is to establish durable, lifelong immunity, it has become clear that for a number of infectious diseases, vaccine-induced host protective immunity wanes over time (4)(5)(6)(7)(8)(9)(10). Participants in an NIAID-sponsored workshop, "Waning Immunity and Microbial Vaccines," reviewed research on six representative vaccines and assessed the issue of waning immunity and possible approaches to generate long-term protection.…”

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Waning Immunity and Microbial Vaccines—Workshop of the National Institute of Allergy and Infectious Diseases

Plotkin

Edwards

et al. 2017

Clin Vaccine Immunol

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Since the middle of the 20th century, vaccines have made a significant public health impact by controlling infectious diseases globally. Although long-term protection has been achieved with some vaccines, immunity wanes over time with others, resulting in outbreaks or epidemics of infectious diseases. Long-term protection against infectious agents that have a complex life cycle and antigenic variation remains a key challenge. Novel strategies to characterize the short-and long-term immune responses to vaccines and to induce immune responses that mimic natural infection have recently emerged. New technologies and approaches in vaccinology, such as adjuvants, delivery systems, and antigen formulations, have the potential to elicit more durable protection and fewer adverse reactions; together with in vitro systems, these technologies have the capacity to model and accelerate vaccine development. The National Institute of Allergy and Infectious Diseases (NIAID) held a workshop on 19 September 2016 that focused on waning immunity to selected vaccines (for Bordetella pertussis, Salmonella enterica serovar Typhi, Neisseria meningitidis, influenza, mumps, and malaria), with an emphasis on identifying knowledge gaps, future research needs, and how this information can inform development of more effective vaccines for infectious diseases.

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confidence: 99%

Waning Immunity and Microbial Vaccines—Workshop of the National Institute of Allergy and Infectious Diseases

Plotkin

Edwards

et al. 2017

Clin Vaccine Immunol

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“…The aP is the result of decades of research into the immunological properties of B. pertussis and its virulence factors using animal models and in vitro experiments to characterize B. pertussis's mode of infection and pathophysiological effects (6)(7)(8). In the context of large and frequent B. pertussis outbreaks and decreasing vaccine effectiveness since the introduction of the aP (albeit to various degrees in different regions), additional research has been conducted to examine how vaccination may be influencing the evolution of B. pertussis and the long-term impact on the effectiveness of B. pertussis vaccines (9)(10)(11)(12)(13)(14).…”

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Short-Read Whole-Genome Sequencing for Laboratory-Based Surveillance of Bordetella pertussis

et al. 2017

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Bordetella pertussis is a Gram-negative bacterium that causes respiratory infections in humans. Ongoing molecular surveillance of B. pertussis acellular vaccine (aP) antigens is critical for understanding the interaction between evolutionary pressures, disease pathogenesis, and vaccine effectiveness. Methods currently used to characterize aP components are relatively labor-intensive and low throughput. To address this challenge, we sought to derive aP antigen genotypes from minimally processed short-read whole-genome sequencing data generated from 40 clinical B. pertussis isolates and analyzed using the SRST2 bioinformatic package. SRST2 was able to identify aP antigen genotypes for all antigens with the exception of pertactin, possibly due to low read coverage in GC-rich low-complexity regions of variation. Two main genotypes were observed in addition to a singular third genotype that contained an 84-bp deletion that was identified by SRST2 despite the issues in allele calling. This method has the potential to generate large pools of B. pertussis molecular data that can be linked to clinical and epidemiological information to facilitate research of vaccine effectiveness and disease severity in the context of emerging vaccine antigen-deficient strains.KEYWORDS Bordetella pertussis, DNA sequencing, immunization, molecular methods, surveillance studies B ordetella pertussis is a Gram-negative aerobic bacterium that causes respiratory illness in humans and is commonly referred to as whooping cough. Vaccination is the primary recommended preventative public health intervention, and since the end of the 20th century, vaccination programs in most high-income countries have incorporated acellular component vaccines (aP) as replacements for whole-cell vaccines that have been used for over 60 years, largely due to an improved safety profile (1-5). The aP is the result of decades of research into the immunological properties of B. pertussis and its virulence factors using animal models and in vitro experiments to characterize B. pertussis's mode of infection and pathophysiological effects (6-8). In the context of large and frequent B. pertussis outbreaks and decreasing vaccine effectiveness since the introduction of the aP (albeit to various degrees in different regions), additional research has been conducted to examine how vaccination may be influencing the evolution of B. pertussis and the long-term impact on the effectiveness of B. pertussis vaccines (9-14).Allele typing using select virulence factors has been useful in describing changes across larger evolutionary scales and has been a key tool for associating changes in the B. pertussis population with the introduction of aPs (15-17). The virulence factor typing

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“…The adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71%-86%) at 15-364 days, 84% (95% CI 77%-89%) at one to three years, 62% (95% CI 42%-75%) at four to seven years and 41% (95% CI 0%-66%) at eight or more years since last vaccination. 4 Their results yielded good news (the acellular vaccine works) and bad (the effectiveness does not last forever).The group then exploited the presence of the two cohorts (pertussis positive and pertussis negative) to create a case-control study and compared those who had been "primed" or not with whole-cell vaccine. People who received only the acellular vaccine had a 2.2 times higher odds of pertussis than those primed with three doses of whole-cell pertussis vaccine, and a 1.82 times higher odds than those who had at least one priming dose of a whole-cell vaccine.…”

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“…However, the findings of a linked research paper show that there has been an increase in both outbreaks and sporadic disease, despite good vaccine coverage in Canada and globally. 3,4 In their study, Schwartz and colleagues 4 used linked databases from the public health laboratory and population-based health administrative data in Ontario to determine vaccine effectiveness over time. The adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71%-86%) at 15-364 days, 84% (95% CI 77%-89%) at one to three years, 62% (95% CI 42%-75%) at four to seven years and 41% (95% CI 0%-66%) at eight or more years since last vaccination.…”

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confidence: 99%

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Reining in the “100-day cough”: unfinished business

Saux

Gemmill

2016

CMAJ

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A lthough rare today, a shocking 1374 deaths due to pertussis occurred in Canada in 1923. 1 Vaccination played a pivotal role in decreasing cases of pertussis. The adverse-event profile of the whole-cell vaccine prompted a switch to the acellular vaccine in the late 1990s. Although still cyclical, the incidence of pertussis in children declined overall within a few years. 2 In the early 2000s, an increase in cases among teenagers prompted the recommendation for a booster dose in adolescents and, subsequently, in adults. However, the findings of a linked research paper show that there has been an increase in both outbreaks and sporadic disease, despite good vaccine coverage in Canada and globally. 3,4 In their study, Schwartz and colleagues 4 used linked databases from the public health laboratory and population-based health administrative data in Ontario to determine vaccine effectiveness over time. The adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71%-86%) at 15-364 days, 84% (95% CI 77%-89%) at one to three years, 62% (95% CI 42%-75%) at four to seven years and 41% (95% CI 0%-66%) at eight or more years since last vaccination. 4 Their results yielded good news (the acellular vaccine works) and bad (the effectiveness does not last forever).The group then exploited the presence of the two cohorts (pertussis positive and pertussis negative) to create a case-control study and compared those who had been "primed" or not with whole-cell vaccine. People who received only the acellular vaccine had a 2.2 times higher odds of pertussis than those primed with three doses of whole-cell pertussis vaccine, and a 1.82 times higher odds than those who had at least one priming dose of a whole-cell vaccine. This suggests that even one prior dose of whole-cell vaccine conferred added protection.After seeing success in decreasing disease, why are we witnessing a resurgence of pertussis that has apparently accelerated in a cohort that received only the acellular vaccine? This phenomenon is not completely understood, but these epidemiologic studies are critical in understanding the biology of prevention. Other factors, such as increased reporting and the discovery of pertactinnegative pertussis strains (or other genetic variants), could also be operating, but they appear to be of less importance currently.At the heart of the issue is the current pertussis vaccine. Both the acellular and whole-cell vaccines in human and animal models induce high, protective antibody titers to pertussis toxins and therefore confer protection against disease, at least in the short term.5 However, the antibody decay may be faster with the acellular vaccine than was seen with the whole-cell vaccine. Using epidemiologic modelling of disease incidence in the United States, investigators were able to show that even a small decrease in efficacy and duration of protection with the acellular vaccine compared with the whole-cell vaccine could account for the increased incidence of pertussis and the curious shifts in high incidence from...

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Effectiveness of pertussis vaccination and duration of immunity

Cited by 111 publications

References 34 publications

Waning Immunity and Microbial Vaccines—Workshop of the National Institute of Allergy and Infectious Diseases

Waning Immunity and Microbial Vaccines—Workshop of the National Institute of Allergy and Infectious Diseases

Short-Read Whole-Genome Sequencing for Laboratory-Based Surveillance of Bordetella pertussis

Reining in the “100-day cough”: unfinished business

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