Investigation of a pertussis outbreak and comparison of two acellular booster pertussis vaccines in a junior school in South East England, 2019

Abstract

In March 2019, a pertussis outbreak occurred in children in a junior school (7–11 years) in England who had been offered pertussis-containing booster vaccine at 40 months of age. In a case–control investigation, we assessed the extent of transmission and any difference in protection afforded to those who had previously received a booster 3- or 5-component acellular pertussis vaccine (aP). We took oral fluid specimens from the students to determine IgG antibodies against pertussis toxin (anti-PT). Parents of students attending the school were sent a questionnaire on pertussis symptoms and vaccination status was retrieved from general practitioner records for all students. Of 381 students, 134 (35.2%) were classified as pertussis cases, 133 by demonstration of significant anti-PT IgG titres and one clinically. There was no significant difference in the risk of pertussis between students receiving 3-component (33.7%) or 5-component (32.3%) aP boosters. However, pertussis infection differed significantly in school year 4, with 22.9%, 50.0%, 23.7% and 38.1% pertussis cases in years 3, 4, 5 and 6, respectively. The proportion of students with incomplete vaccinations recorded was higher than the proportion of those not covered according to the national reported coverage, possibly contributing to sustained transmission within the school.

The Present and Future Aspects of Life-Long Pertussis Prevention: Narrative Review with Regional Perspectives for Türkiye

“…In 2019, a pertussis outbreak was announced in an early-years school in England among 7-11-year-old students who had their last booster dose at the age of 40 months. Vaccination coverage was found to be lower than the national average in this school and considered to be the main reason for the high transmission [10].…”

Exploring the Ethical Dimensions of Mandatory Immunization Discourse for School Attendance in Indonesia

“…A study performed in Estonia also showed that low vaccination coverage played a pivotal role in the pertussis outbreak in schools (27). Not only is coverage among school children is important, but also proper vaccination in terms of completeness in primary and boosters were shown to be important to prevent sustained transmission within the school (31,32). Nevertheless, when outbreaks within schools happened, studies also show that vaccination, even a single dose that taken years ago, was able to protect children against severe cases of disease (33).…”

Comparing the pertussis antibody levels of healthy children immunized with four doses of DTap-IPV/Hib (Pentaxim) combination vaccine and DTaP vaccine in Quzhou, China

“…The reported number of pertussis cases increased from 6658 in 2015 to 30,027 in 2019, and the actual number of cases was estimated to be 16.22 times higher in China (4), which has generated great concern from many experts. In England, a pertussis outbreak occurred in a junior school (ages 7-11 years) in March 2019 wherein the children had been offered a pertussis-containing booster vaccine at 40 months of age (5). In the past few years, countries with a high DTaP coverage have experienced a "pertussis resurgence" in the form of pertussis epidemics and/or local outbreaks (6,7).…”