Pertussis Vaccine Effectiveness in the Setting of Pertactin-Deficient Pertussis

BACKGROUND: In the United States, the proportion of Bordetella pertussis isolates lacking pertactin, a component of acellular pertussis vaccines, increased from 14% in 2010 to 85% in 2012. The impact on vaccine effectiveness (VE) is unknown.

METHODS: We conducted 2 matched case-control evaluations in Vermont to assess VE of the 5-dose diphtheria, tetanus, and acellular pertussis vaccine (DTaP) series among 4- to 10-year-olds, and tetanus, diphtheria, and acellular pertussis vaccine (Tdap) among 11- to 19-year-olds. Cases reported during 2011 to 2013 were included. Three controls were matched to each case by medical home, and additionally by birth year for the Tdap evaluation. Vaccination history was obtained from medical records and parent interviews. Odds ratios (OR) were calculated by using conditional logistic regression; VE was estimated as (1-OR) × 100%. Pertactin status was determined for cases with available isolates.

RESULTS: Overall DTaP VE was 84% (95% confidence interval [CI] 58%–94%). VE within 12 months of dose 5 was 90% (95% CI 71%–97%), declining to 68% (95% CI 10%–88%) by 5–7 years post-vaccination. Overall Tdap VE was 70% (95% CI 54%–81%). Within 12 months of Tdap vaccination, VE was 76% (95% CI 60%–85%), declining to 56% (95% CI 16%–77%) by 2–4 years post-vaccination. Of cases with available isolates, >90% were pertactin-deficient.

CONCLUSIONS: Our DTaP and Tdap VE estimates remain similar to those found in other settings, despite high prevalence of pertactin deficiency in Vermont, suggesting these vaccines continue to be protective against reported pertussis disease.