Published on in Vaccine Update for Healthcare Providers
Regarding the acellular pertussis vaccine contained in DTaP, there is good news and bad news.
Recently, researchers from the Kaiser Permanente Northern California group evaluated the incidence of pertussis in 469,982 children starting at 3 months of age who were followed between 1999 and 2016 (Zerbo O, et al. Acellular pertussis vaccine effectiveness over time. Pediatrics. 2019 Jul;144(1)). Researchers identified 738 children with pertussis.
The good news is that vaccination works. The risk of pertussis risk was 13 times greater among unvaccinated children than fully vaccinated children. Further, the risk of pertussis was 1.9 times greater among undervaccinated children when compared with fully vaccinated children.
The bad news was that 515 of the 738 cases of pertussis occurred in children who were fully vaccinated. Among fully vaccinated children, the risk of pertussis was five times greater three years after vaccination than within one year of vaccination. In other words, pertussis immunity fades — and fairly quickly.
The authors concluded, “Undervaccinated and especially unvaccinated children were at greater risk of pertussis. However, most pertussis cases occurred among children age-appropriately vaccinated, who were further away from their last DTaP dose, suggesting that suboptimal vaccine effectiveness played a major role in recent pertussis epidemics.”
In an accompanying editorial, Dr. Kathryn Edwards from Vanderbilt University School of Medicine discussed the future of pertussis vaccines, focusing on recent studies in adults using a live attenuated nasal spray pertussis vaccine that would induce better (and hopefully) longer-lasting immunity (Edwards KM. Challenges to pertussis control. Pediatrics. 2019 Jul;144(1)).
While it’s currently the best tool that we have, we could benefit from a more effective and longer-lasting pertussis vaccine.
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