Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1446-1451 (doi:10.1542/peds.2008-2150)
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ARTICLE

Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children

Jason M. Glanz, PhDa,b, David L. McClure, PhDa, David J. Magid, MD, MPHa,b, Matthew F. Daley, MDa,c,d, Eric K. France, MD, MSPHe, Daniel A. Salmon, PhD, MPHf and Simon J. Hambidge, MD, PhDa,b,d,g

a Institute for Health Research
e Department of Prevention, Kaiser Permanente Colorado, Denver, Colorado; Departments of
b Preventive Medicine and Biometrics
d Pediatrics, University of Colorado, Denver, Colorado
c Department of Pediatrics, Children's Hospital, Denver, Colorado
f Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
g Community Health Services, Denver Health, Denver, Colorado

OBJECTIVE. The objective of this study was to determine if children who contracted pertussis infection were more likely to have parents who refused pertussis vaccinations than a similar group of children who did not develop pertussis infection.

METHODS. We conducted a case-control study of children enrolled in the Kaiser Permanente of Colorado health plan between 1996 and 2007. Each pertussis case was matched to 4 randomly selected controls. Pertussis case status and vaccination status were ascertained by medical chart review.

RESULTS. We identified 156 laboratory-confirmed pertussis cases and 595 matched controls. There were 18 (12%) pertussis vaccine refusers among the cases and 3 (0.5%) pertussis vaccine refusers among the controls. Children of parents who refused pertussis immunizations were at an increased risk for pertussis compared with children of parents who accepted vaccinations. In a secondary case-control analysis of children continuously enrolled in Kaiser Permanente of Colorado from 2 to 20 months of age, vaccine refusal was associated with a similarly increased risk of pertussis. In the entire Kaiser Permanente of Colorado pediatric population, 11% of all pertussis cases were attributed to parental vaccine refusal.

CONCLUSIONS. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. Herd immunity does not seem to completely protect unvaccinated children from pertussis. These findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively.

Key Words: immunizations • pertussis • vaccinations • vaccine refusal • epidemiology

Abbreviations: KPCO—Kaiser Permanente Colorado • PCR—polymerase chain reaction • OR—odds ratio • CI—confidence interval • URI—upper respiratory infection

Accepted Sep 23, 2008.


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