Pertussis immunity wanes over time in vaccinated children

  • Zerbo O et al
  • Pediatrics
  • 10 Jun 2019

  • International Clinical Digest
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Takeaway

  • Under-, unvaccinated children have elevated pertussis risk vs fully diphtheria-tetanus-acellular pertussis (DTaP)-vaccinated children.
  • Both un/under and fully vaccinated children are at increased risk during pertussis epidemics, the latter due to waning immunity and subpar vaccine efficacy (VE).

Why this matters

  • Ensure that pediatric patients are current on DTaP vaccines.
  • Administer Tdap (tetanus-diphtheria-pertussis) vaccine in adolescents ages 11-12 years or catch up at next clinical visit in ages 13-18 years.

Key results

  • 469,982 children, 2,138,835 person-years:
  • 738 PCR-confirmed pertussis cases, 13% (n=99), 5% (36), 70% (515), 12% (88) unvaccinated, undervaccinated, fully vaccinated, and fully vaccinated plus 1 dose children, respectively.
  • Pertussis risk 13 times higher in unvaccinated (adjusted HR [aHR], 13.53; 95% CI, 10.64-17.21), 1.9 times higher in undervaccinated (aHR, 1.86; 95% CI, 1.32-2.63) vs fully vaccinated children.
  • Children (19 to
  • Children >84 to 132 months, risk was >4 times higher ≥6 years post-last DTaP dose vs

Study design

  • Retrospective cohort study to determine pertussis risk by DTaP vaccination status, time since last DTaP in children born between 1999 and 2016.
  • Funding: Kaiser Permanente Northern California, NIH.

Limitations

  • Reduced precision estimates.
  • Missed cases.
  • Misclassification bias.

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