31 mayo, 2013

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

Age-standardised disability-adjusted life year (DALY) rates from Pertussis by country (per 100,000 inhabitants). (Photo credit: Wikipedia)

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

Published online May 20, 2013 Pediatrics Vol. 131 No. 6 June 1, 2013

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pp. e1716 -e1722
(doi: 10.1542/peds.2012-3836)

Nicola P. Klein, MD, PhD,
Joan Bartlett, MPH, MPP,
Bruce Fireman, MA,
Ali Rowhani-Rahbar, MD, MPH, PhD, and
Roger Baxter, MD

+ Author Affiliations

Northern California Kaiser Permanente Vaccine Study Center, Oakland, California

Abstract

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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