Whole-cell and acellular pertussis vaccination programs and rates of pertussis among infants and young children

Vickers, David; Ross, Allen G.; Jaime, R. C. M.; Neudorf, Cordell; Shah, Syed Sajid Hussain

doi:10.1503/cmaj.051637

Cited by 26 publications

(21 citation statements)

References 22 publications

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“…Observational data from Canada, Australia and the US have shown greater protection with whole-cell infant priming. [7][8][9] We were surprised to see a significant protective effect, given the estimated low effectiveness of this particular whole-cell vaccine of 49%-61%. [3][4][5] However, our results showed that receiving 1 or more doses of whole-cell vaccine as an infant provided significant protection from pertussis more than a decade later.…”

Section: Discussionmentioning

confidence: 99%

“…6 Other jurisdictions in Canada, the United States and Australia have reported lower effectiveness with the acellular product and rapidly waning immunity. [7][8][9][10][11] Canada has a unique history of using a whole-cell vaccine with lower effectiveness, and also has different secular trends in pertussis incidence and vaccination coverage, necessitating local evaluation of the effectiveness of the pertussis vaccine to inform vaccination policy. Our objective was to study the effectiveness of the pertussis vaccine in Ontario while characterizing the effect of waning immunity and whole-cell vaccine priming.…”

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confidence: 99%

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Effectiveness of pertussis vaccination and duration of immunity

Schwartz

Kwong

Deeks

et al. 2016

CMAJ

104

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Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming. Methods:We used the test-negative design, a nested case-control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 -OR) × 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine.Results : Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 testpositive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15-364 days, 84% (95% CI 77% to 89%) at 1-3 years, 62% (95% CI 42% to 75%) at 4-7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57). Interpretation:We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent. AbstractSee also www.cmaj.ca/lookup

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effectiveness of pertussis vaccination and duration of immunity

Schwartz

Kwong

Deeks

et al. 2016

CMAJ

104

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“…9 Another recent study in Australia also noted that children who had received 3 doses of DTaP had higher rates of pertussis in an outbreak than did children who had received 3 doses of DTwP. 11 It is well recognized that whole-cell and acellular pertussis vaccines trigger different immune responses in infants.…”

Section: Discussionmentioning

confidence: 99%

“…Early clinical trials comparing DTwP with DTaP reported that both vaccines induced high levels of specific antibody titers and provided good protection against pertussis for several years, 6-8 yet other studies have suggested that protection after DTaP is less enduring than after DTwP. [9][10][11] Although reasons for the recurrent pertussis outbreaks are likely to be complex, 5,12,13 waning protection after 5 doses of DTaP plays a central role, at least in recent epidemics. 14,15 Since 2005, the Advisory Committee on Immunization Practices has recommended boosting with reduced antigen content acellular pertussis (Tdap) vaccine for persons 11 years and older.…”

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confidence: 99%

Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers

et al. 2013

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BACKGROUND: During the 1990s, the United States switched from combined diphtheria, tetanus toxoids, whole-cell pertussis (DTwP) vaccines to combined acellular pertussis (DTaP) vaccines because of safety concerns. After a 2010–2011 pertussis outbreak, we sought to evaluate whether disease risk in 10 to 17 year olds differed between those who previously received DTwP from those who received DTaP. METHODS: A case-control study among individuals born from 1994 to 1999 who received 4 pertussis-containing vaccines during the first 2 years of life at Kaiser Permanente Northern California (KPNC). We separately compared pertussis polymerase chain reaction (PCR)-positive cases with PCR-negative and KPNC-matched controls. We assessed risk of pertussis relative to vaccine type in early childhood (4 DTwPs, mixed DTwP/DTaP, or 4 DTaPs) by using conditional logistic regression stratified for calendar time and adjusted for gender, race, medical clinic, and receipt of reduced antigen content acellular pertussis (Tdap) vaccine. RESULTS: We compared 138 PCR-positive cases with 899 PCR-negative and 54 339 KPNC-matched controls. Teenagers who had received 4 DTwPs were much less likely to be pertussis PCR-positive than those who had received 4 DTaPs (odds ratio 5.63, 95% confidence interval 2.55–12.46) or mixed DTwP/DTaP vaccines (odds ratio 3.77, 95% confidence interval 1.57–9.07). Decreasing number of DTwP doses was significantly associated with increased pertussis risk (P < .0001). CONCLUSIONS: Teenagers who received DTwP vaccines in childhood were more protected during a pertussis outbreak than were those who received DTaP vaccines.

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“…144 Furthermore, there is evidence to suggest that whole cell pertussis vaccine formulations used in Australia and overseas before the late 1990s provided longer lasting protection against B. pertussis infection than currently used acellular pertussis vaccines. 80,95,220,221 It has also been suggested that immunity levels are waning faster in some age cohorts due to changes in vaccination schedules, such as the removal of the 18 month booster dose. 9 In addition, recent analysis of B. pertussis isolates collected in Australia between 2008 and 2010 indicates that there has been increasing circulation of vaccine-mismatched strains.…”

Section: Methodsmentioning

confidence: 99%

The diagnosis and epidemiology of pertussis in Australia

Kaczmarek¹

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Pertussis, more commonly known as whooping cough, is one of the most common vaccine-preventable infections reported in Australia. In the last decade, pertussis incidence has increased in Australia and overseas, with large sustained epidemics occurring most notably in developed countries. Australia had a pertussis epidemic between 2009 and 2012, which peaked during 2011 with 38,602 notified cases. The role of improved diagnostic methods, particularly the use of polymerase chain reaction (PCR) testing, has been hypothesised to have led to improved case ascertainment and superior detection of disease activity. This Thesis is comprised of five distinct studies contributing to the investigation of this hypothesis.In Australia, the incidence of pertussis is predominantly monitored using notification data, with the case definition for notifications heavily reliant on laboratory confirmation. By analysing pertussis notifications between 1991 and 2013 by diagnostic test method, I was able to demonstrate that PCR quickly replaced all other laboratory methods for pertussis diagnosis from 2005 onwards, with the exception of persisting serology use in a proportion of adolescents and adults. In addition, a change in the age distribution of notifications was observed over time, with increasing pertussis incidence among older children and adolescents.As notification data can be biased by changes in testing practices, awareness, and definitions, my next study investigated pertussis testing trends in the general practice (GP, primary care) setting between 2000 and 2011 using data from the Bettering the Evaluation And Care of Health (BEACH) program. Among a stable set of GP encounters for respiratory illness, it was observed that the likelihood of individuals being tested for pertussis in 2010-2011 was seven times higher compared to ten years earlier. These findings, at least in part, suggest that notifications have been amplified due to increased testing.To gather more information about the contribution of increased testing to the pertussis epidemic, the incidence of severe pertussis cases admitted to intensive care units (ICUs) was reviewed, as the ICU setting is less likely to be biased by changes in diagnostic This Thesis makes an important and original contribution to understanding the recent resurgence of pertussis in Australia and overseas by addressing gaps in knowledge about changes in diagnostic testing. Although a true increase in pertussis incidence occurred in Australia, increasing PCR diagnosis allowed better case detection across all age groups and healthcare settings. Greater understanding of pertussis epidemiology as a result of PCR diagnosis should ultimately improve pertussis immunisation and control programs, through better identification of at-risk groups.iv

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Whole-cell and acellular pertussis vaccination programs and rates of pertussis among infants and young children

Cited by 26 publications

References 22 publications

Effectiveness of pertussis vaccination and duration of immunity

Effectiveness of pertussis vaccination and duration of immunity

Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers

The diagnosis and epidemiology of pertussis in Australia

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