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Pertussis Vaccine Effectiveness


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Pediatr Infect Dis J. 2001 Dec;20(12):1108-12. Related Articles, Links
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Pertussis outbreak in an elementary school with high vaccination coverage.

Khetsuriani N, Bisgard K, Prevots DR, Brennan M, Wharton M, Pandya S, Poppe A, Flora K, Dameron G, Quinlisk P.

National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

BACKGROUND: An outbreak of pertussis in a US elementary school with high vaccination coverage was investigated to evaluate vaccine effectiveness and to identify potential contributing factors. METHODS: Survey and cohort study of all 215 students of an elementary school (including 36 case patients) and 16 secondary cases among contacts. RESULTS: Fifty-two pertussis cases were identified (attack rate among students, 17%). Receipt of <3 doses of pertussis-containing-vaccine compared with receipt of complete vaccination series was a significant risk factor for pertussis [relative risk, 5.1; 95% confidence interval (CI), 3 to 8.6]. The effectiveness of the complete vaccination series was 80% (95% CI 66 to 88). No evidence of waning immunity among students was found. The following contributing factors for the outbreak were identified: multiple introductions of pertussis from the community; delays in identification and treatment of early cases; and high contact rates among students. Antimicrobial treatment initiated >14 days after cough onset was associated with increased risk of further transmission of pertussis (relative risk, 10.1; 95% CI 1.5 to 70.3) compared with treatment within 14 days of onset. CONCLUSIONS: This investigation demonstrated the potential for pertussis outbreaks to occur in well-vaccinated elementary school populations. Aggressive efforts to identify cases and contacts and timely antimicrobial treatment can limit spread of pertussis in similar settings. High vaccination coverage should be maintained, because vaccination significantly reduces the risk of the disease throughout the elementary school years, and to ensure timely diagnosis and treatment health care providers should maintain a high index of suspicion for pertussis among elementary school age children.

PMID: 11740314 [PubMed - indexed for MEDLINE]

J Infect Dis. 1993 Feb;167(2):483-6. Related Articles, Links

Erratum in:
  • J Infect Dis 1993 Mar;167(3):788.

Efficacy of acellular pertussis vaccine in young infants.

Aoyama T, Iwata T, Iwai H, Murase Y, Saito T, Akamatsu T.

Department of Pediatrics, Kawasaki Municipal Hospital, Japan.

A prospective study of a pertussis outbreak in a residential facility was done. Among 19 residents aged < or = 2 years, 10 children were unimmunized and 9 were immunized with acellular pertussis vaccines. Of the 10 unimmunized children, 7 acquired laboratory-confirmed pertussis (four-fold titer rise, positive culture, or both); of these, 6 developed typical symptoms. Eight of the 9 immunized children acquired laboratory-confirmed infections, and 1 of these developed typical symptoms. No difference in infection was noted between the unimmunized and immunized groups (7/10 vs. 8/9, respectively), but a significant difference was observed in the development of symptoms (6/10 vs. 1/9, P < .05). Also, the isolation rate of Bordetella pertussis seemed to differ between the two groups (6/10 vs. 2/9, P = .12). In this population, acellular pertussis vaccine did not prevent infection with B. pertussis but protected most young infants from the onset of clinical symptoms.

PMID: 8421187 [PubMed - indexed for MEDLINE]

          Comment:  Is pertussis spread by asymptomatic infection?
Arch Dis Child. 1991 Jul;66(7):854-7. Related Articles, Links

Vaccine efficacy and control measures in pertussis.

Palmer SR.

PHLS Communicable Disease Surveillance Centre, Welsh Unit, Roath, Cardiff.

An outbreak of pertussis in primary school-children in the St David's area of Pembrokeshire provided the opportunity to estimate pertussis vaccine efficacy. The estimate of efficacy was 88% when notified cases were used, but this fell to 68% when all children with bouts of coughing for two or more weeks were included. Notified cases were significantly less likely to have been vaccinated than other cases with similar symptoms. Therefore vaccine efficacy estimates based upon notified cases are likely to be biased. However, even the lower estimates suggest that pertussis immunisation is highly desirable and efforts to improve coverage should be increased.

PMID: 1863099 [PubMed - indexed for MEDLINE]

Kansenshogaku Zasshi. 1990 May;64(5):564-9. Related Articles, Links

[Efficacy of acellular pertussis vaccine]

[Article in Japanese]

Saito T, Akamatsu T, Aoyama T, Iwai H, Gonda T, Murase Y, Yamshita N, Iwata T.

Azabu Nyujiin, Tokyo, Japan.

An outbreak of pertussis occurred in one room of a residential facility where 19 children aged 5 to 36 months were residing. They were prospectively surveyed to estimate the efficacy of acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular DTP vaccine and 10 were unimmunized. The spread of pertussis was surveyed bacteriologically and serologically for 2 months. Among the 9 immunized, 7 children acquired the laboratory-confirmed pertussis and 1 of the 7 developed the typical symptoms (whooping or paroxysmal coughing attack lasting for 14 days or more). Among the 10 unimmunized, 7 children acquired the laboratory-confirmed pertussis and 6 of the 7 developed the typical symptoms. There was no difference in the rate of secondary infection (7/9:7/10), but there was a significant difference in the rate of development of the typical symptoms (1/7:6/7 p less than 0.05). The point estimate of protective efficacy of the acellular DTP vaccine against typical pertussis was (6/10 - 1/9)/(6/10) x 100 = 81%. It was concluded from these findings that acellular DTP vaccine could not prevent the infection of Bordetella pertussis, but could prevent the development of the typical symptoms.

PMID: 2212750 [PubMed - indexed for MEDLINE]


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