Effectiveness of pertussis vaccines for adolescents and adults: case-control study

Baxter, Roger; Bartlett, Joan; Rowhani-Rahbar, Ali; Fireman, Bruce; Klein, Nicola P.

doi:10.1136/bmj.f4249

Cited by 73 publications

(70 citation statements)

References 24 publications

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“…However, uptake of these recommendations as measured by pertussis vaccine coverage in Ontario and Canada has been about 70% among adolescents and only 7% among adults. [30][31][32][33] Given our data, combined with reports from others, 10,11 it is unsurprising that we are witnessing a resurgence of pertussis in adolescents and adults. 2,11 The presence of a large susceptible population puts young infants, in whom virtually all of the morbidity and mortality is observed, at risk of acquiring infection.…”

Section: Discussionmentioning

confidence: 83%

“…[30][31][32][33] Given our data, combined with reports from others, 10,11 it is unsurprising that we are witnessing a resurgence of pertussis in adolescents and adults. 2,11 The presence of a large susceptible population puts young infants, in whom virtually all of the morbidity and mortality is observed, at risk of acquiring infection. 1 Our findings suggest the need to reconsider our strategy for pertussis vaccination.…”

Section: Discussionmentioning

confidence: 83%

“…10,11,[26][27][28] Our analysis, which is stratified by time since last vaccination and adjusted for age, suggests that the low estimates of vaccine effectiveness beyond 4 years from last vaccination are attributable to waning immunity. A recent metaanalysis identified an increased odds of pertussis of 33% for each year following the DTaP dose.…”

Section: Discussionmentioning

confidence: 99%

“…6 Other jurisdictions in Canada, the United States and Australia have reported lower effectiveness with the acellular product and rapidly waning immunity. [7][8][9][10][11] Canada has a unique history of using a whole-cell vaccine with lower effectiveness, and also has different secular trends in pertussis incidence and vaccination coverage, necessitating local evaluation of the effectiveness of the pertussis vaccine to inform vaccination policy. Our objective was to study the effectiveness of the pertussis vaccine in Ontario while characterizing the effect of waning immunity and whole-cell vaccine priming.…”

mentioning

confidence: 99%

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Effectiveness of pertussis vaccination and duration of immunity

Schwartz

Kwong

Deeks

et al. 2016

CMAJ

111

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Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming. Methods:We used the test-negative design, a nested case-control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 -OR) × 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine.Results : Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 testpositive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15-364 days, 84% (95% CI 77% to 89%) at 1-3 years, 62% (95% CI 42% to 75%) at 4-7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57). Interpretation:We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent. AbstractSee also www.cmaj.ca/lookup

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of pertussis vaccination and duration of immunity

Schwartz

Kwong

Deeks

et al. 2016

CMAJ

111

View full text Add to dashboard Cite

show abstract

“…Effectiveness was 53% and 64% when the two control groups (negative [polymerase chain reaction] PCR and KPNC) were considered, thus suggesting moderate effectiveness of dTap immunization in preventing cases of PCR-confirmed pertussis in adolescents and adults. 66 KPNC was also used to verify whether there are any differences in the risk of pertussis in subjects aged 10-17 years who receive whole-cell or acellular vaccines. After the epidemic outbreak that occurred in California in 2010-2011, young people (10-17-y-old) immunized with cellular vaccine resulted to have greater protection than those who received acellular vaccine.…”

mentioning

confidence: 99%