Document Detail

Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010.
MedLine Citation:
PMID:  23188029     Owner:  NLM     Status:  MEDLINE    
CONTEXT: In 2010, California experienced its largest pertussis epidemic in more than 60 years; a substantial burden of disease was noted in the 7- to 10-year-old age group despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage, indicating the possibility of waning protection.
OBJECTIVE: To evaluate the association between pertussis and receipt of 5 DTaP doses by time since fifth DTaP dose.
DESIGN, SETTING, AND PARTICIPANTS: Case-control evaluation conducted in 15 California counties. Cases (n = 682) were all suspected, probable, and confirmed pertussis cases among children aged 4 to 10 years reported from January through December 14, 2010; controls (n = 2016) were children in the same age group who received care from the clinicians reporting the cases. Three controls were selected per case. Vaccination histories were obtained from medical records and immunization registries.
MAIN OUTCOME MEASURES: Primary outcomes were (1) odds ratios (ORs) for the association between pertussis and receipt of the 5-dose DTaP series and (2) ORs for the association between pertussis and time since completion (<12, 12-23, 24-35, 36-47, 48-59, or ≥60 months) of the 5-dose DTaP series. Logistic regression was used to calculate ORs, accounting for clustering by county and clinician, and vaccine effectiveness (VE) was estimated as (1 - OR) × 100%.
RESULTS: Among cases and controls, 53 (7.8%) and 19 (0.9%) had not received any pertussis-containing vaccines, respectively. Compared with controls, children with pertussis had a lower odds of having received all 5 doses of DTaP (OR, 0.11; 95% CI, 0.06-0.21 [estimated VE, 88.7%; 95% CI, 79.4%-93.8%]). When children were categorized by time since completion of the DTaP series, using an unvaccinated reference group, children with pertussis compared with controls were less likely to have received their fifth dose within the prior 12 months (19 [2.8%] vs 354 [17.6%], respectively; OR, 0.02; 95% CI, 0.01-0.04 [estimated VE, 98.1%; 95% CI, 96.1%-99.1%]). This association was evident with longer time since vaccination, with ORs increasing with time since the fifth dose. At 60 months or longer (n = 231 cases [33.9%] and n = 288 controls [14.3%]), the OR was 0.29 (95% CI, 0.15-0.54 [estimated VE, 71.2%; 95% CI, 45.8%-84.8%]). Accordingly, the estimated VE declined each year after receipt of the fifth dose of DTaP.
CONCLUSION: Among children in 15 California counties, children with pertussis, compared with controls, had lower odds of having received the 5-dose DTaP series; as time since last DTaP dose increased, the odds increased, which is consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of pertussis vaccine.
Lara K Misegades; Kathleen Winter; Kathleen Harriman; John Talarico; Nancy E Messonnier; Thomas A Clark; Stacey W Martin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JAMA     Volume:  308     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-28     Completed Date:  2012-12-03     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2126-32     Citation Subset:  AIM; IM    
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MeSH Terms
California / epidemiology
Case-Control Studies
Child, Preschool
Diphtheria-Tetanus-acellular Pertussis Vaccines / administration & dosage*,  standards
Disease Outbreaks*
Immunization Schedule*
Logistic Models
Odds Ratio
Time Factors
Whooping Cough / epidemiology*,  prevention & control*
Reg. No./Substance:
0/Diphtheria-Tetanus-acellular Pertussis Vaccines
Comment In:
JAMA. 2012 Nov 28;308(20):2149-50   [PMID:  23188034 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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