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Seroepidemiology of pertussis in China: A population-based, cross-sectional study
Zhujiazi Zhang1, Jingbin Pan1, Meng Chen1
1Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China.
Insights
Pertussis vaccination boosts antibodies, but immunity wanes by school age, increasing infection risk. A preschool booster may enhance protection against pertussis.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- Pertussis incidence increased in China (2013-2017) despite high vaccination rates.
- The Expanded Programme on Immunization (1978) initially reduced pertussis, but recent trends show resurgence.
Purpose of the Study:
- To evaluate the immune response to pertussis in vaccinated children in China.
- To assess antibody levels and infection rates in different age groups.
Main Methods:
- Recruited 2,144 healthy subjects for serum IgG antibody testing against pertussis toxin (anti-PT IgG) via ELISA.
- Calculated geometric mean concentration (GMC), seropositivity, and recent infection rates.
- Stratified analysis by vaccination schedule, age intervals, and vaccine type (DTaP vs. DTaP-IPV/PRP~T).
Main Results:
- Anti-PT IgG GMC in 0-6-year-olds was 5.99 IU/ml, declining after primary and booster doses, reaching a nadir at 6 years.
- GMCs were higher with DTaP-IPV/PRP~T compared to DTaP vaccines.
- In individuals >6 years, seropositivity increased from age 6, peaking at 9 years (10.3%).
Conclusions:
- Pertussis vaccination elicits anti-PT IgG, but immunity wanes over time.
- Sero-estimated pertussis infection rates rise from school age, peaking around 9 years.
- Results suggest a preschool booster dose of pertussis vaccine could be beneficial.
Background:
Despite high pertussis vaccination coverage and significant decrease of pertussis since the adoption of the Expanded Programme on Immunization (1978), increased pertussis incidence has been reported in China from 2013 to 2017. This study aimed at evaluating the immune response to pertussis among vaccinated children and beyond in China.
Methods:
The study recruited 2 144 healthy subjects. Serum IgG antibodies against pertussis toxin (anti-PT IgG) were measured by ELISA. Anti-PT IgG concentration (GMC), seropositivity rate (GMC ≥ 40 IU/ml), and recent infection rate (GMC > 100 IU/ml) were calculated. Participants ≤ 2 years-old were further stratified by vaccination schedule intervals and participants ≤ 6 years-old by vaccine used (Domestic DTaP or DTaP-IPV//PRP ~ T (Pentaxim, SP)).
Results:
Among 0-6-year-olds, the anti-PT IgG GMC was 5.99 IU/ml (95%CI 5.39-6.67). The GMC increased in accordance with the primary vaccination series (4-6 months) and the toddler booster (18-23 months), and continuously declined thereafter to its nadir at 6 years-old [3.72 IU/ml (95%CI 2.91-4.77)]. GMCs were markedly higher in those vaccinated with DTaP-IPV/PRP ~ T compared to DTaP. In individuals > 6 years-old, the GMC was 5.67 IU/ml (95%CI 5.36-6.00), the seropositivity rate was 6.7% (95%CI 5.5-7.9) and the recent infection rate was 1.2% (95%CI 0.7-1.7). The seropositivity rates increased from 6 years-old and peaked at 9 years-old (10.3% [95%CI 0.7-19.8]).
Conclusions:
Vaccination against pertussis increases anti-PT IgG, but wanes over time. The sero-estimated infection rates increase from school age and peak at about 9 years-old. These results support the addition of a booster of pertussis vaccine at preschool age.
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