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Infant pertussis and maternal immunity: The curious case of Canada
Natasha S Crowcroft1, Shelly Bolotin2, Ye Li3
1Dalla Lana School of Public Health, University of Toronto, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Canada; ICES, Toronto, Canada.
Insights
Past pertussis outbreaks in children may lower infant risk when those children become parents. As these cohorts age, Canada
Area of Science:
- Epidemiology
- Immunology
- Public Health
Background:
- The United Kingdom (UK) and Canada utilize the same acellular pertussis vaccine.
- Both nations experienced significant pertussis (whooping cough) outbreaks historically.
- Despite similar vaccines and past outbreaks, current pertussis epidemiology differs between the UK and Canada.
Purpose of the Study:
- To investigate the hypothesis that childhood pertussis outbreaks influence future pertussis risk in the same individuals when they reach reproductive age.
Main Methods:
- Ecological birth cohort analysis of women of childbearing age in England and Wales, and Canada.
- Comparison of the relative risk of pertussis infection at baseline (1992) and two subsequent time points (2002, 2012).
- Forecasting pertussis risk trends in Canada to 2022, assuming stable incidence.
Main Results:
- In Canada, the cumulative risk of pertussis remained similar in 2002 and 2012, and was higher than in 1992.
- In England and Wales, cumulative pertussis risk decreased significantly between 1992 and 2012.
- Projected 2022 data suggests Canada's pertussis risk pattern may increasingly resemble that of England and Wales.
Conclusions:
- Widespread childhood pertussis outbreaks may confer reduced risk of infection for infants born to parents who experienced these outbreaks.
- The precise mechanism requires further investigation.
- As cohorts exposed to past outbreaks age out of their childbearing years, Canada may see an increased pertussis burden in infants, mirroring UK trends.
Background:
The United Kingdom (UK) and Canada use the same acellular pertussis vaccine and both experienced large pertussis outbreaks in the past, occurring in the 1980s in the UK and 1990s in Canada, yet current epidemiology differs. A national outbreak with infant deaths occurred in the UK in 2012, yet outbreaks remain localized and death from pertussis rare in Canada.
Aim:
We explored whether past outbreaks in children may influence future risk when those children become parents.
Methods:
We conducted an ecological within-country birth cohort analysis in women of childbearing age of the relative risk of ever having pertussis infection by two points in time, 2002 and 2012, comparing with 1992 as the baseline. We used notified cases of pertussis in England and Wales and Canada to compare trends in relative risk. We projected forward to 2022 in Canada assuming incidence remained stable.
Results:
In Canada, the cumulative risk of previous pertussis was similar in 2002 and 2012 and, in both periods, was higher than in 1992. In England and Wales, the cumulative risk of pertussis fell stepwise from 1992 to 2012. Projecting forwards, the pattern of risk in Canada becomes similar to England and Wales in 2022.
Conclusions:
Widespread pertussis outbreaks in children may reduce the risk of pertussis in infants when those children become parents. Further research is needed to determine the mechanism. As birth cohorts that experienced outbreaks grow past childbearing age, pertussis burden in infants in Canada may increase, following trends observed in England and Wales.
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