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Acellular Pertussis Vaccine Effectiveness Over Time

Ousseny Zerbo1, Joan Bartlett2, Kristin Goddard2

  • 1Division of Research, Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California ousseny.x.zerbo@kp.org.

Pediatrics
|June 12, 2019
PubMed

Insights

Unvaccinated children face 13 times higher pertussis risk. Most cases occur in fully vaccinated children who are further from their last diphtheria-tetanus-acellular pertussis (DTaP) vaccine dose, indicating waning immunity.

Area of Science:

  • Pediatric infectious diseases
  • Vaccinology
  • Epidemiology

Background:

  • Pertussis (whooping cough) remains a significant public health concern, with outbreaks occurring despite widespread vaccination efforts.
  • Understanding pertussis risk in relation to diphtheria-tetanus-acellular pertussis (DTaP) vaccination status and time since last dose is crucial for optimizing immunization strategies.

Purpose of the Study:

  • To assess the risk of pertussis infection among children based on their diphtheria-tetanus-acellular pertussis (DTaP) vaccination status.
  • To evaluate how the time elapsed since the last DTaP vaccination dose influences pertussis risk.

Main Methods:

  • A retrospective cohort study was conducted using data from Kaiser Permanente Northern California (1999-2016).
  • Children (3 months to 11 years) were followed to determine pertussis incidence based on DTaP vaccination status (unvaccinated, undervaccinated, fully vaccinated, fully vaccinated + 1 dose).
  • Time since last DTaP dose was analyzed as a factor in pertussis risk.

Main Results:

  • Among nearly 470,000 children, 738 pertussis cases were identified.
  • Unvaccinated children had a 13.5-fold higher risk of pertussis compared to fully vaccinated children (aHR=13.53).
  • Undervaccinated children had a 1.9-fold higher risk (aHR=1.86).
  • Among vaccinated children, pertussis risk increased significantly with longer intervals since the last DTaP dose (5x higher after ≥3 years vs. <1 year in younger children; 2x higher after ≥6 years vs. <3 years in older children).

Conclusions:

  • Children who are undervaccinated or unvaccinated face substantially greater pertussis risk.
  • The majority of pertussis cases occurred in age-appropriately vaccinated children, particularly those many years past their last DTaP dose.
  • Waning vaccine effectiveness over time is a significant factor contributing to pertussis incidence and epidemics.
Abstract

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