Ousseny Zerbo1, Joan Bartlett2, Kristin Goddard2, Bruce Fireman2, Edwin Lewis2, Nicola P Klein2. 1. Division of Research, Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California ousseny.x.zerbo@kp.org. 2. Division of Research, Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California.
Abstract
OBJECTIVES: To determine pertussis risk by diphtheria-tetanus-acellular pertussis (DTaP) vaccination status and time since last DTaP dose. METHODS: Children born at Kaiser Permanente Northern California between 1999 and 2016 were followed from 3 months of age until they tested positive for pertussis; disenrolled from Kaiser Permanente Northern California; received the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed vaccine; turned 11 years of age, or the end of the study period. DTaP vaccination status was categorized on the basis of the number of doses received in relation to the number of doses expected according to the Advisory Committee on Immunization Practice-recommended ages. RESULTS: Among 469 982 children ages 3 months to 11 years, we identified 738 pertussis cases. A total of 99 cases were unvaccinated, 36 were undervaccinated, 515 were fully vaccinated, and 88 were fully vaccinated plus 1 dose. Pertussis risk was 13 times higher among unvaccinated (adjusted hazard ratio [aHR] = 13.53; 95% confidence interval [CI] 10.64-17.21) compared with fully vaccinated children and 1.9 times higher (aHR = 1.86; 95% CI 1.32-2.63) among undervaccinated children. Among vaccinated children ages 19 to <84 months, pertussis risk was 5 times higher (aHR = 5.04; 95% CI 1.84-13.80) ≥3 years vs <1 year after vaccination. Among children ages 84 to 132 months, risk was 2 times higher (aHR = 2.32; 95% CI 0.97-5.59) ≥6 years vs <3 years after vaccination. CONCLUSIONS: Undervaccinated and especially unvaccinated children were at greater risk of pertussis. However, most pertussis cases occurred among children age-appropriately vaccinated who were further away from their last DTaP dose, suggesting that suboptimal vaccine effectiveness played a major role in recent pertussis epidemics.
OBJECTIVES: To determine pertussis risk by diphtheria-tetanus-acellular pertussis (DTaP) vaccination status and time since last DTaP dose. METHODS:Children born at Kaiser Permanente Northern California between 1999 and 2016 were followed from 3 months of age until they tested positive for pertussis; disenrolled from Kaiser Permanente Northern California; received the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed vaccine; turned 11 years of age, or the end of the study period. DTaP vaccination status was categorized on the basis of the number of doses received in relation to the number of doses expected according to the Advisory Committee on Immunization Practice-recommended ages. RESULTS: Among 469 982 children ages 3 months to 11 years, we identified 738 pertussis cases. A total of 99 cases were unvaccinated, 36 were undervaccinated, 515 were fully vaccinated, and 88 were fully vaccinated plus 1 dose. Pertussis risk was 13 times higher among unvaccinated (adjusted hazard ratio [aHR] = 13.53; 95% confidence interval [CI] 10.64-17.21) compared with fully vaccinated children and 1.9 times higher (aHR = 1.86; 95% CI 1.32-2.63) among undervaccinated children. Among vaccinated children ages 19 to <84 months, pertussis risk was 5 times higher (aHR = 5.04; 95% CI 1.84-13.80) ≥3 years vs <1 year after vaccination. Among children ages 84 to 132 months, risk was 2 times higher (aHR = 2.32; 95% CI 0.97-5.59) ≥6 years vs <3 years after vaccination. CONCLUSIONS: Undervaccinated and especially unvaccinated children were at greater risk of pertussis. However, most pertussis cases occurred among children age-appropriately vaccinated who were further away from their last DTaP dose, suggesting that suboptimal vaccine effectiveness played a major role in recent pertussis epidemics.
Authors: Jessica E Atwell; Josh Van Otterloo; Jennifer Zipprich; Kathleen Winter; Kathleen Harriman; Daniel A Salmon; Neal A Halsey; Saad B Omer Journal: Pediatrics Date: 2013-09-30 Impact factor: 7.124
Authors: Nicola P Klein; Joan Bartlett; Bruce Fireman; Laurie Aukes; Philip O Buck; Girishanthy Krishnarajah; Roger Baxter Journal: Vaccine Date: 2017-05-12 Impact factor: 3.641
Authors: Saad B Omer; Kyle S Enger; Lawrence H Moulton; Neal A Halsey; Shannon Stokley; Daniel A Salmon Journal: Am J Epidemiol Date: 2008-10-15 Impact factor: 4.897
Authors: Jason M Glanz; Sophia R Newcomer; Komal J Narwaney; Simon J Hambidge; Matthew F Daley; Nicole M Wagner; David L McClure; Stan Xu; Ali Rowhani-Rahbar; Grace M Lee; Jennifer C Nelson; James G Donahue; Allison L Naleway; James D Nordin; Marlene M Lugg; Eric S Weintraub Journal: JAMA Pediatr Date: 2013-03-01 Impact factor: 16.193
Authors: Karen R Broder; Margaret M Cortese; John K Iskander; Katrina Kretsinger; Barbara A Slade; Kristin H Brown; Christina M Mijalski; Tejpratap Tiwari; Emily J Weston; Amanda C Cohn; Pamela U Srivastava; John S Moran; Benjamin Schwartz; Trudy V Murphy Journal: MMWR Recomm Rep Date: 2006-03-24
Authors: F Heath Damron; Mariette Barbier; Purnima Dubey; Kathryn M Edwards; Xin-Xing Gu; Nicola P Klein; Kristina Lu; Kingston H G Mills; Marcela F Pasetti; Robert C Read; Pejman Rohani; Peter Sebo; Eric T Harvill Journal: J Immunol Date: 2020-08-15 Impact factor: 5.422
Authors: Ricardo da Silva Antunes; Ferran Soldevila; Mikhail Pomaznoy; Mariana Babor; Jason Bennett; Yuan Tian; Natalie Khalil; Yu Qian; Aishwarya Mandava; Richard H Scheuermann; Mario Cortese; Bali Pulendran; Christopher D Petro; Adrienne P Gilkes; Lisa A Purcell; Alessandro Sette; Bjoern Peters Journal: JCI Insight Date: 2021-04-08