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American Academy of Pediatrics
Article

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

Nicola P. Klein, Joan Bartlett, Bruce Fireman, Ali Rowhani-Rahbar and Roger Baxter
Pediatrics June 2013, 131 (6) e1716-e1722; DOI: https://doi.org/10.1542/peds.2012-3836
Nicola P. Klein
Northern California Kaiser Permanente Vaccine Study Center, Oakland, California
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Joan Bartlett
Northern California Kaiser Permanente Vaccine Study Center, Oakland, California
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Bruce Fireman
Northern California Kaiser Permanente Vaccine Study Center, Oakland, California
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Ali Rowhani-Rahbar
Northern California Kaiser Permanente Vaccine Study Center, Oakland, California
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Roger Baxter
Northern California Kaiser Permanente Vaccine Study Center, Oakland, California
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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.

  • pertussis infection
  • whole cell pertussis vaccine
  • acellular pertussis vaccine
  • teenagers
  • Abbreviations:
    CI —
    confidence interval
    DTwP —
    diphtheria, tetanus toxoids, whole-cell pertussis
    DTaP —
    diphtheria, tetanus toxoids, acellular pertussis
    KPNC —
    Kaiser Permanente Northern California
    OR —
    odds ratio
    PCR —
    polymerase chain reaction
    PY —
    person-years
    Tdap —
    reduced antigen content acellular pertussis
    • Accepted February 22, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 6
    1 Jun 2013
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    Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers
    Nicola P. Klein, Joan Bartlett, Bruce Fireman, Ali Rowhani-Rahbar, Roger Baxter
    Pediatrics Jun 2013, 131 (6) e1716-e1722; DOI: 10.1542/peds.2012-3836

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    Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers
    Nicola P. Klein, Joan Bartlett, Bruce Fireman, Ali Rowhani-Rahbar, Roger Baxter
    Pediatrics Jun 2013, 131 (6) e1716-e1722; DOI: 10.1542/peds.2012-3836
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    • Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review
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    • Comparison of Three Whole-Cell Pertussis Vaccines in the Baboon Model of Pertussis
    • Identification of Pertussis-Specific Effector Memory T Cells in Preschool Children
    • Antibody Responses to Bordetella pertussis Fim2 or Fim3 following Immunization with a Whole-Cell, Two-Component, or Five-Component Acellular Pertussis Vaccine and following Pertussis Disease in Children in Sweden in 1997 and 2007
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    Subjects

    • Infectious Disease
      • Infectious Disease
      • Influenza
      • Vaccine/Immunization

    Keywords

    • pertussis infection
    • whole cell pertussis vaccine
    • acellular pertussis vaccine
    • teenagers
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