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Ousseny Zerbo
Pertussis cases most commonly appear among age-matched vaccines, suggesting that the efficacy of suboptimal DTaP vaccine plays a major role in epidemics, according to a retrospective cohort study published in Pediatrics.
"The discovery that most cases of whooping cough occur in highly vaccinated children suggests that decreased immunization immunity has played an important role in recent cases of whooping cough," Ousseny Zerbo, PhD, researcher at the Kaiser Permanente Research Division Vaccine Studies Center in Northern California, Infectious Diseases in Children. "Although immunity to pertussis vaccine is decreasing, it is important that children continue to be vaccinated according to the CDC recommendation for immunization. The pertussis vaccine is effective in preventing whooping cough but for a short time. If a child is not vaccinated or under-vaccinated, his risk is much higher than that of a fully vaccinated child. "
The researchers tracked children born at Kaiser Permanente Northern California between 1999 and 2016, limiting their badysis to children who received only the acellular pertussis vaccine, introduced in the 1990s. They clbadified the children as fully vaccinated. if they had received the expected number of doses of DTaP no later than one month after [Advisory Committee on Immunization Practices]Recommended age, they wrote. Children were defined as not being under-vaccinated if they received fewer doses than expected for their age, while children with a dose of more than expected at that age were clbadified as fully vaccinated plus one dose.
Researchers identified 738 cases of pertussis among 469,982 children aged 3 to 11, of whom 99 were unvaccinated, 515 fully vaccinated and 88 vaccinated plus one dose, according to the study.
The risk of whooping cough was 13-fold higher in unvaccinated children (adjusted HR = 13.53, 95% CI, 10.64-17.21) compared to fully immunized children and 1.9-fold higher ( HR = 1.86, 95% CI, 1.32-2.63), in unvaccinated children. the researchers wrote. These findings are "broadly consistent" with two previous case-control studies, one from 2013 and the other from 2017, the researchers said.
Among vaccinated children aged 19 to less than 84 months, the risk was five times higher (aHR = 5.04, 95% CI, 1.84-13.8) in 3 years or more compared to less than one year after vaccination. Children aged 84 to 132 months were at twice the risk (HR = 2.32, 95% CI: 0.97-5.59) at age 6 or older compared to less than 3 years after vaccination.
"Our results reveal that the decline in DTaP immunity was a major cause of whooping cough in children. [older than] 18 months that have a longer interval between recommended doses, "wrote Zerbo and colleagues. "By the age of 19 months, almost all children had received at least one dose of DTaP, and children who had been vaccinated according to age [more than] 95% of follow-up. "
Kathryn M. Edwards
In a related editorial, Infectious Diseases in Children Member of the Editorial Board Kathryn M. Edwards, MD, Professor of Pediatrics at Vanderbilt University School of Medicine wrote: "Given the significant increase in the risk of whooping cough in unvaccinated and under-immunized children, universal vaccination with DTaP should be strongly recommended" .
Second, she stated that "the addition of maternal anti-TB vaccination administered during pregnancy has significantly reduced childhood illnesses before primary vaccination and should remain the norm".
However, Edwards added that addressing the decreasing immunity of DTaP vaccination was more problematic, suggesting that more in-depth safety studies in younger children would be needed before that potential options – including a live attenuated pertussis vaccine administered intranasally or the addition of other antigens to current vaccines – can be implemented. – by Joe Gramigna
References:
Edwards KM et al. Pediatr. 2019; doi: 10.1542 / peds.2018-3466.
Glanz JM. JAMA Pediatr. 2013; doi: 10.1001 / jamapediatrics.2013.2353 .
Huang WT, et al. Hum Vaccine Immunother. 2017 doi: 10.1080 / 21645515.2016.1249552.
Zerbo O, et al. Pediatrics. 2019; doi: 10.1542 / peds.2018-3466.
Disclosures: Zerbo does not report any relevant financial information. Please consult the study for the relevant financial information of all other authors.
Ousseny Zerbo
Pertussis cases most commonly appear among age-matched vaccines, suggesting that the efficacy of suboptimal DTaP vaccine plays a major role in epidemics, according to a retrospective cohort study published in Pediatrics.
"The discovery that most cases of whooping cough occur in highly vaccinated children suggests that decreased immunization immunity has played an important role in recent cases of whooping cough," Ousseny Zerbo, PhD, researcher at the Kaiser Permanente Research Division Vaccine Studies Center in Northern California, Infectious Diseases in Children. "Although immunity to pertussis vaccine is decreasing, it is important that children continue to be vaccinated according to the CDC recommendation for immunization. The pertussis vaccine is effective in preventing whooping cough but for a short time. If a child is not vaccinated or under-vaccinated, his risk is much higher than that of a fully vaccinated child. "
The researchers tracked children born at Kaiser Permanente Northern California between 1999 and 2016, limiting their badysis to children who received only the acellular pertussis vaccine, introduced in the 1990s. They clbadified the children as fully vaccinated. if they had received the expected number of doses of DTaP no later than one month after [Advisory Committee on Immunization Practices]Recommended age, they wrote. Children were defined as not being under-vaccinated if they received fewer doses than expected for their age, while children with a dose of more than expected at that age were clbadified as fully vaccinated plus one dose.
Researchers identified 738 cases of pertussis among 469,982 children aged 3 to 11, of whom 99 were unvaccinated, 515 fully vaccinated and 88 vaccinated plus one dose, according to the study.
The risk of whooping cough was 13-fold higher in unvaccinated children (adjusted HR = 13.53, 95% CI, 10.64-17.21) compared to fully immunized children and 1.9-fold higher ( HR = 1.86, 95% CI, 1.32-2.63), in unvaccinated children. the researchers wrote. These findings are "broadly consistent" with two previous case-control studies, one from 2013 and the other from 2017, the researchers said.
Among vaccinated children aged 19 to less than 84 months, the risk was five times higher (aHR = 5.04, 95% CI, 1.84-13.8) in 3 years or more compared to less than one year after vaccination. Children aged 84 to 132 months were at twice the risk (HR = 2.32, 95% CI: 0.97-5.59) at age 6 or older compared to less than 3 years after vaccination.
"Our results reveal that the decline in DTaP immunity was a major cause of whooping cough in children. [older than] 18 months that have a longer interval between recommended doses, "wrote Zerbo and colleagues. "By the age of 19 months, almost all children had received at least one dose of DTaP, and children who had been vaccinated according to age [more than] 95% of follow-up. "
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Kathryn M. Edwards
In a related editorial, Infectious Diseases in Children Member of the Editorial Board Kathryn M. Edwards, MD, Professor of Pediatrics at Vanderbilt University School of Medicine wrote: "Given the significant increase in the risk of whooping cough in unvaccinated and under-immunized children, universal vaccination with DTaP should be strongly recommended" .
Second, she stated that "the addition of maternal anti-TB vaccination administered during pregnancy has significantly reduced childhood illnesses before primary vaccination and should remain the norm".
However, Edwards added that addressing the decreasing immunity of DTaP vaccination was more problematic, suggesting that more in-depth safety studies in younger children would be needed before that potential options – including a live attenuated pertussis vaccine administered intranasally or the addition of other antigens to current vaccines – can be implemented. – by Joe Gramigna
References:
Edwards KM et al. Pediatr. 2019; doi: 10.1542 / peds.2018-3466.
Glanz JM. JAMA Pediatr. 2013; doi: 10.1001 / jamapediatrics.2013.2353 .
Huang WT, et al. Hum Vaccine Immunother. 2017 doi: 10.1080 / 21645515.2016.1249552.
Zerbo O, et al. Pediatrics. 2019; doi: 10.1542 / peds.2018-3466.
Disclosures: Zerbo does not report any relevant financial information. Please consult the study for the relevant financial information of all other authors.
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