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Whole-cell and acellular pertussis vaccination programs and rates of pertussis among infants and young children

From the Department of Applied Research (Vickers [at the time of submission]), College of Medicine, University of Saskatchewan; the Saskatoon Regional Health Authority (Ross, Neudorf); the Department of Community Health and Epidemiology (Ross, Shah), College of Medicine, University of Saskatchewan; and the Department of Microbiology (Mainar-Jaime), Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Sask.

Correspondence to: David Vickers, Department of Applied Research, Royal University Hospital, University of Saskatchewan, Saskatoon SK S7N 0W8; fax 306 966-8774; david.vickers{at}usask.ca

Background: The transition from a whole-cell to a 5-component acellular pertussis vaccine provided a unique opportunity to compare the effect that each type of vaccine had on the incidence of pertussis, under routine conditions, among children less than 10 years of age.

Methods: Analyses were based on passive surveillance data collected between 1995 and 2005. The incidence of pertussis by year and birth cohort was compiled according to age during the surveillance period. We determined the association between vaccine type (whole-cell, acellular or a combination of both) and the incidence of pertussis using Poisson regression analysis after controlling for age (< 1 year, 1–4 years and 5–9 years) and vaccination history (i.e., partial or complete).

Results: During 7 of the 11 years surveyed, infants (< 1 year of age) had the highest incidence of pertussis. Among children born after 1997, when acellular vaccines were introduced, the rates of pertussis were highest among infants and preschool children (1–4 years of age). Poisson regression analysis revealed that, in the group given either the whole-cell vaccine or a combination of both vaccines, the incidence of pertussis was lower among infants and preschool children than among school-aged children (5–9 years). The reverse was true in the group given only an acellular vaccine, with a higher incidence among infants and preschool children than among school-aged children.

Interpretation: These results suggest that current immunization practices may not be adequate in protecting infants and children less than 5 years of age against pertussis. Altering available acellular formulations or adopting immunization practices used in some European countries may increase the clinical effectiveness of routine pertussis vaccination programs among infants and preschool children.

This article has been cited by other articles:

				S. A. Halperin and G. De Serres Has the change to acellular pertussis vaccine improved or worsened pertussis control? Can. Med. Assoc. J., November 7, 2006; 175(10): 1227 - 1227. [Full Text] [PDF]

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