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In this issue of Pediatrics Acosta et al1 present a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) vaccine effectiveness study in adolescents in Washington State during the first 6 months of 2012. Their findings support the previous Tdap effectiveness data from Wisconsin.2 The duration of Tdap effectiveness is disappointing, particularly because case-control studies tend to inflate efficacy.3
In 4 recent publications (including 1 article in Pediatrics) I have discussed epidemic pertussis and why vaccines fail.4–7 Before discussing why Tdap vaccine effectiveness wanes so rapidly, it seems worthwhile to discuss how rapidly protection wanes after a natural infection in the pre-Tdap era and to take a realistic look at the resurgence of pertussis.
The resurgence of pertussis is often attributed to the switch from whole-cell pertussis vaccines to acellular products. However, the increase in reported pertussis began ∼14 years before the universal use of diphtheria-tetanus-acellular pertussis (DTaP) vaccines in childhood commenced. The 2 greatest contributors to the resurgence of pertussis are greater awareness and more sensitive diagnosis (the routine use …
Address correspondence to James D. Cherry, MD, MSc, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, MDCC 22-442, Los Angeles, CA 90095-1972. E-mail: jcherry{at}medent.ucla.edu
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