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Association between pertussis vaccination in infancy and childhood asthma: A population-based record linkage cohort
Gladymar Pérez Chacón1,2, Parveen Fathima1,3, Mark Jones3
1Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
Insights
Whole-cell pertussis (wP) vaccines given in infancy did not show a protective effect against childhood asthma hospitalizations. This large study found no significant difference in asthma risk between wP and acellular pertussis (aP) vaccine recipients.
Area of Science:
- Pediatric Allergy and Immunology
- Vaccinology
- Epidemiology
Background:
- Asthma is a common childhood noncommunicable disease often co-occurring with atopic conditions.
- Prior research suggested whole-cell pertussis (wP) vaccines might reduce IgE-mediated food allergy risk compared to acellular pertussis (aP) vaccines.
- This led to the hypothesis that wP vaccination could protect against childhood atopic asthma.
Purpose of the Study:
- To investigate the potential protective association between early infancy whole-cell pertussis (wP) vaccination and the risk of atopic asthma in childhood.
- To compare asthma hospitalization rates in children who received wP versus aP vaccines as their first pertussis dose.
Main Methods:
- A retrospective record-linkage cohort study included over 274,000 children born between 1997 and 1999 in Australia.
- Children received either wP or aP vaccine as their primary pertussis immunization.
- Asthma hospitalizations (first and recurrent) were the primary outcomes, analyzed using Cox and Andersen and Gill models to compute hazard ratios (HRs).
Main Results:
- The study analyzed 274,405 children, with 5,905 asthma hospitalizations recorded.
- Incidence rates for first asthma hospitalization were similar between wP (1.5/1000 child-years) and aP (1.5/1000 child-years) vaccine groups.
- Adjusted HRs showed no significant difference: 1.02 (95% CI 0.94-1.12) for first hospitalizations and 1.07 (95% CI 0.95-1.2) for recurrent hospitalizations for wP versus aP.
Conclusions:
- No convincing clinical evidence supports an association between early infancy wP vaccination and reduced hospital presentations for childhood asthma.
- The findings do not support a protective role of wP vaccines against atopic asthma in childhood.
- Further research may be needed to explore other potential long-term effects of different pertussis vaccine types.
Background:
Asthma is among the commonest noncommunicable diseases of childhood and often occurs with other atopic comorbidities. A previous case-control study found evidence that compared to children who received acellular pertussis (aP) vaccines in early infancy, children who received one or more doses of whole-cell pertussis (wP) vaccine had lower risk of developing IgE-mediated food allergy. We hypothesized that wP vaccination in early infancy might protect against atopic asthma in childhood.
Methods:
Retrospective record-linkage cohort study of children between 5 and < 15 years old and born between January 1997, and December 1999, in the Australian states of Western Australia (WA) and New South Wales (NSW), receiving wP versus aP vaccine as the first pertussis vaccine dose. The main outcome and measures were first and recurrent hospitalizations for asthma; hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by means of Cox and Andersen and Gill models.
Results:
274,405 children aged between 5 and < 15 years old (78.4% NSW-born) received a first dose of either wP (67.8%) or aP vaccine before 4 months old. During the follow-up period, there were 5,905 hospitalizations for asthma among 3,955 children. The incidence rate for first hospitalization was 1.5 (95% CI 1.4-1.5) per 1,000 child-years among children receiving wP vaccine as a first dose, and 1.5 (95% CI 1.4-1.6) among those vaccinated with aP vaccine as a first dose. The adjusted HRs for those who received wP vaccine versus aP vaccine as the first dose were 1.02 (95% CI 0.94-1.12) for first hospitalizations and 1.07 (95% CI 0.95-1.2) for recurrent hospitalizations for asthma.
Conclusions:
We found no convincing evidence of a clinically relevant association between receipt of wP versus aP vaccines in early infancy and hospital presentations for asthma in childhood.
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