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Research

Effectiveness of pertussis vaccination and duration of immunity

Kevin L. Schwartz, Jeffrey C. Kwong, Shelley L. Deeks, Michael A. Campitelli, Frances B. Jamieson, Alex Marchand-Austin, Therese A. Stukel, Laura Rosella, Nick Daneman, Shelly Bolotin, Steven J. Drews, Heather Rilkoff and Natasha S. Crowcroft
CMAJ November 01, 2016 188 (16) E399-E406; DOI: https://doi.org/10.1503/cmaj.160193
Kevin L. Schwartz
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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  • For correspondence: kevin.schwartz@oahpp.ca
Jeffrey C. Kwong
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Shelley L. Deeks
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Michael A. Campitelli
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Frances B. Jamieson
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Alex Marchand-Austin
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Therese A. Stukel
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Laura Rosella
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Nick Daneman
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Shelly Bolotin
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Steven J. Drews
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Heather Rilkoff
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Natasha S. Crowcroft
Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
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Abstract

Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming.

Methods: We used the test-negative design, a nested case–control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 – OR) × 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine.

Results: Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15–364 days, 84% (95% CI 77% to 89%) at 1–3 years, 62% (95% CI 42% to 75%) at 4–7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57).

Interpretation: We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent.

  • Accepted May 30, 2016.
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Canadian Medical Association Journal: 188 (16)
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Effectiveness of pertussis vaccination and duration of immunity
Kevin L. Schwartz, Jeffrey C. Kwong, Shelley L. Deeks, Michael A. Campitelli, Frances B. Jamieson, Alex Marchand-Austin, Therese A. Stukel, Laura Rosella, Nick Daneman, Shelly Bolotin, Steven J. Drews, Heather Rilkoff, Natasha S. Crowcroft
CMAJ Nov 2016, 188 (16) E399-E406; DOI: 10.1503/cmaj.160193

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Effectiveness of pertussis vaccination and duration of immunity
Kevin L. Schwartz, Jeffrey C. Kwong, Shelley L. Deeks, Michael A. Campitelli, Frances B. Jamieson, Alex Marchand-Austin, Therese A. Stukel, Laura Rosella, Nick Daneman, Shelly Bolotin, Steven J. Drews, Heather Rilkoff, Natasha S. Crowcroft
CMAJ Nov 2016, 188 (16) E399-E406; DOI: 10.1503/cmaj.160193
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