Effectiveness of pertussis vaccination and duration of immunity
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. We used the test-...
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| Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2016-11, Vol.188 (16), p.E399-E406 |
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| creator | Schwartz, Kevin L Kwong, Jeffrey C Deeks, Shelley L Campitelli, Michael A Jamieson, Frances B Marchand-Austin, Alex Stukel, Therese A Rosella, Laura Daneman, Nick Bolotin, Shelly Drews, Steven J Rilkoff, Heather Crowcroft, Natasha S |
| description | 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.
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.
Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive 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).
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. |
| doi_str_mv | 10.1503/cmaj.160193 |
| format | Article |
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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.
Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive 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).
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.</description><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.160193</identifier><identifier>PMID: 27672225</identifier><identifier>CODEN: CMAJAX</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Adolescent ; Age ; Ambulatory care ; Case-Control Studies ; Child ; Child, Preschool ; Disease Outbreaks - prevention & control ; Female ; Health care policy ; Humans ; Immune response ; Immunity, Active ; Immunization Schedule ; Incidence ; Infant ; Influenza ; Laboratories ; Logistic Models ; Male ; Mortality ; Multivariate Analysis ; Odds Ratio ; Ontario - epidemiology ; Pertussis Vaccine - therapeutic use ; Polymerase chain reaction ; Population ; Prevention ; Public health ; Sensitivity analysis ; Systematic review ; Teenagers ; Testing ; Vaccines ; Whooping cough ; Whooping Cough - epidemiology ; Whooping Cough - prevention & control ; Young Adult</subject><ispartof>Canadian Medical Association journal (CMAJ), 2016-11, Vol.188 (16), p.E399-E406</ispartof><rights>2016 Canadian Medical Association or its licensors.</rights><rights>COPYRIGHT 2016 Joule Inc.</rights><rights>Copyright 8872147 Canada Inc. Nov 1, 2016</rights><rights>2016 Joule Inc. or its licensors 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c710t-489ece6ba6e81cbb2b2292354e4d996348fcd57affa56d50198d48eac9e4bf233</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088088/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088088/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27672225$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schwartz, Kevin L</creatorcontrib><creatorcontrib>Kwong, Jeffrey C</creatorcontrib><creatorcontrib>Deeks, Shelley L</creatorcontrib><creatorcontrib>Campitelli, Michael A</creatorcontrib><creatorcontrib>Jamieson, Frances B</creatorcontrib><creatorcontrib>Marchand-Austin, Alex</creatorcontrib><creatorcontrib>Stukel, Therese A</creatorcontrib><creatorcontrib>Rosella, Laura</creatorcontrib><creatorcontrib>Daneman, Nick</creatorcontrib><creatorcontrib>Bolotin, Shelly</creatorcontrib><creatorcontrib>Drews, Steven J</creatorcontrib><creatorcontrib>Rilkoff, Heather</creatorcontrib><creatorcontrib>Crowcroft, Natasha S</creatorcontrib><title>Effectiveness of pertussis vaccination and duration of immunity</title><title>Canadian Medical Association journal (CMAJ)</title><addtitle>CMAJ</addtitle><description>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.
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.
Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive 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).
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.</description><subject>Adolescent</subject><subject>Age</subject><subject>Ambulatory care</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Outbreaks - prevention & control</subject><subject>Female</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Immune response</subject><subject>Immunity, Active</subject><subject>Immunization Schedule</subject><subject>Incidence</subject><subject>Infant</subject><subject>Influenza</subject><subject>Laboratories</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Ontario - epidemiology</subject><subject>Pertussis Vaccine - therapeutic use</subject><subject>Polymerase chain reaction</subject><subject>Population</subject><subject>Prevention</subject><subject>Public health</subject><subject>Sensitivity analysis</subject><subject>Systematic review</subject><subject>Teenagers</subject><subject>Testing</subject><subject>Vaccines</subject><subject>Whooping cough</subject><subject>Whooping Cough - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Medical Association journal (CMAJ)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schwartz, Kevin L</au><au>Kwong, Jeffrey C</au><au>Deeks, Shelley L</au><au>Campitelli, Michael A</au><au>Jamieson, Frances B</au><au>Marchand-Austin, Alex</au><au>Stukel, Therese A</au><au>Rosella, Laura</au><au>Daneman, Nick</au><au>Bolotin, Shelly</au><au>Drews, Steven J</au><au>Rilkoff, Heather</au><au>Crowcroft, Natasha S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of pertussis vaccination and duration of immunity</atitle><jtitle>Canadian Medical Association journal (CMAJ)</jtitle><addtitle>CMAJ</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>188</volume><issue>16</issue><spage>E399</spage><epage>E406</epage><pages>E399-E406</pages><issn>0820-3946</issn><eissn>1488-2329</eissn><coden>CMAJAX</coden><abstract>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.
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.
Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive 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).
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.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>27672225</pmid><doi>10.1503/cmaj.160193</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Journals@Ovid Complete; PubMed Central; Alma/SFX Local Collection |
| subjects | Adolescent Age Ambulatory care Case-Control Studies Child Child, Preschool Disease Outbreaks - prevention & control Female Health care policy Humans Immune response Immunity, Active Immunization Schedule Incidence Infant Influenza Laboratories Logistic Models Male Mortality Multivariate Analysis Odds Ratio Ontario - epidemiology Pertussis Vaccine - therapeutic use Polymerase chain reaction Population Prevention Public health Sensitivity analysis Systematic review Teenagers Testing Vaccines Whooping cough Whooping Cough - epidemiology Whooping Cough - prevention & control Young Adult |
| title | Effectiveness of pertussis vaccination and duration of immunity |
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