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On the Role of Different Age Groups and Pertussis Vaccines During the 2012 Outbreak in Wisconsin.

ABSTRACT: There is limited information on the roles of different age groups in propagating pertussis outbreaks, and on the impact of vaccination on pertussis transmission in the community.The relative roles of different age groups in propagating the 2012 pertussis outbreak in Wisconsin were evaluated using the relative risk (RR) statistic that measures the change in the group's proportion among all detected cases before vs after the epidemic peak. The impact of vaccination in different age groups against infection (that is potentially different from the protective effect against detectable disease) was evaluated using the odds ratios (ORs), within each age group, for being vaccinated vs undervaccinated before vs after the outbreak's peak.The RR statistic suggests that children aged 13-14 years played the largest relative role during the outbreak's ascent (with estimates consistent across the 3 regions in Wisconsin that were studied), followed by children aged 7-8, 9-10, and 11-12 years. Young children and older teenagers and adults played more limited relative roles during the outbreak. Results of the vaccination status analysis for the fifth dose of DTaP (for children aged 7-8 years: OR, 0.44; 95% confidence interval [CI], 0.23-0.86; for children aged 9-10 years: OR, 0.51; 95% CI, 0.27-0.95); and for Tdap for children aged 13-14 years (OR, 0.38, 95% CI, 0.16-0.89) are consistent with protective effect against infection.While our epidemiological findings for the fifth dose of DTaP and for Tdap are consistent with protective effect against infection, further studies, including those estimating vaccine effectiveness against infection/transmission to others particularly for pertussis vaccines for adolescents, are needed to evaluate the impact of vaccination on the spread of pertussis in the community.

SUBMITTER: Goldstein E

PROVIDER: S-EPMC5961225 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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On the Role of Different Age Groups and Pertussis Vaccines During the 2012 Outbreak in Wisconsin.

Goldstein Edward E Worby Colin J CJ Lipsitch Marc M

Open forum infectious diseases 20180416 5

<h4>Background</h4>There is limited information on the roles of different age groups in propagating pertussis outbreaks, and on the impact of vaccination on pertussis transmission in the community.<h4>Methods</h4>The relative roles of different age groups in propagating the 2012 pertussis outbreak in Wisconsin were evaluated using the relative risk (RR) statistic that measures the change in the group's proportion among all detected cases before vs after the epidemic peak. The impact of vaccinati ...[more]

PMID: 29942818

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Project description:ObjectiveTo describe clinical and laboratory findings from the 2012 southeastern Minnesota pertussis outbreak.Patients and methodsPatients were selected for 2 parts of the study. In the first part, nasopharyngeal swabs from a convenience sample of 265 unique patients were used for both the clinician-requested polymerase chain reaction (PCR) test and culture. B pertussis isolates were tested for macrolide susceptibility and typed using whole genome sequencing and pulsed-field gel electrophoresis. Pertactin gene sequences were analyzed to identify pertactin-deficient B pertussis. In the second part, all patients seen at Mayo Clinic in Rochester, Minnesota, who had PCR results positive for Bordetella pertussis or Bordetella parapertussis between January 1, 2012, and December 31, 2012, were analyzed for patient demographic features and vaccination records.ResultsOne hundred sixty patients had results positive for B pertussis, and 21 patients had results positive for B parapertussis. Among the 265 swabs cultured, B pertussis was detected by both culture and PCR in 11. One swab was positive for B pertussis by culture alone, and 13 were positive by PCR alone. Polymerase chain reaction detected B pertussis more frequently than did culture (P=.001). No macrolide resistance was detected. All 12 isolates tested had an altered pertactin gene, including 9 with a signal sequence deletion, 2 with insertion sequence disruptions, and 1 with a premature stop codon. Nine and 3 isolates were pertactin types prn1 and prn2, respectively. Whole genome sequencing and pulsed-field gel electrophoresis detected the presence of multiple B pertussis strains. The mean age of patients with pertussis was younger than that of those without pertussis (15.6 and 25.5 years, respectively; P=.002). Compared with those whose test results were negative for B pertussis, fewer patients with positive results had received whole-cell pertussis vaccine (P=.02). In the subgroup who had received acellular vaccine exclusively, the time since the most recent pertussis vaccination in those with results positive for B pertussis was longer than that in those with negative results (1363 vs 1010 days; P=.004).ConclusionThe 2012 pertussis outbreak in southeastern Minnesota included multiple strains of B pertussis, all putatively lacking pertactin. Our findings may indicate decreased efficacy of (and waning immunity from) acellular vaccines as contributors to the outbreak.

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On the Role of Different Age Groups and Pertussis Vaccines During the 2012 Outbreak in Wisconsin.

Publications

On the Role of Different Age Groups and Pertussis Vaccines During the 2012 Outbreak in Wisconsin.

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