Efficacy of whole-cell pertussis vaccine in preschool children in the United States
I. M. Onorato, S. G. Wassilak and B. Meade
Division of Immunization, Centers for Disease Control, Atlanta, GA 30333.
OBJECTIVE--To evaluate the efficacy of currently used whole-cell pertussis
vaccines. DESIGN--Active surveillance to detect pertussis cases in
Baltimore, Md, Denver, Colo, and Milwaukee, Wis, and investigation of
secondary attack rates in 347 household contacts, aged 1 through 4 years,
to estimate vaccine efficacy. OUTCOME MEASURE--Vaccine efficacy was
estimated using different case definitions for pertussis. RESULTS--Vaccine
efficacy was 64%, 81%, and 95% for case definitions of mild cough,
paroxysmal cough, and severe clinical illness, respectively. Requiring
laboratory confirmation increased efficacy to 95% to 98% for
culture-positive children and to 77% to 95% for culture- or
serology-confirmed cases, depending on disease severity. Vaccine efficacy
for typical paroxysmal cough increased from 44% for one diphtheria,
tetanus, and pertussis vaccine dose to 80% for four or more doses.
CONCLUSIONS--The trend toward increasing vaccine efficacy with different
case definitions may be due to improved efficacy in preventing severe
illness and to case definitions that are more specific for pertussis.
Whole-cell pertussis vaccine was highly effective in preventing pertussis
in preschool children exposed to infection within their households. Direct
side-by-side efficacy studies of whole-cell vaccine and the recently
licensed acellular vaccine will be necessary to assure that comparable
protection is afforded by the new vaccines if they are to be used for
immunization of infants.
Pertussis Vaccine Effectiveness Among Children 6 to 59 Months of Age in the United States, 1998-2001
Bisgard et al.
Pediatrics 2005;116:e285-e294.
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Molecular Pathogenesis, Epidemiology, and Clinical Manifestations of Respiratory Infections Due to Bordetella pertussis and Other Bordetella Subspecies
Mattoo and Cherry
Clin. Microbiol. Rev. 2005;18:326-382.
ABSTRACT
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Trends in Pertussis Among Infants in the United States, 1980-1999
Tanaka et al.
JAMA 2003;290:2968-2975.
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Active Immunization in the United States: Developments over the Past Decade
Dennehy
Clin. Microbiol. Rev. 2001;14:872-908.
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Economic Evaluation of Use of Diphtheria, Tetanus, and Acellular Pertussis Vaccine or Diphtheria, Tetanus, and Whole-Cell Pertussis Vaccine in the United States, 1997
Ekwueme et al.
Arch Pediatr Adolesc Med 2000;154:797-803.
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An Evaluation of the Safety and Immunogenicity of a Five-Component Acellular Pertussis, Diphtheria, and Tetanus Toxoid Vaccine (DTaP) When Combined With a Haemophilus influenzae Type b-Tetanus Toxoid Conjugate Vaccine (PRP-T) in Taiwanese Infants
Lee et al.
Pediatrics 1999;103:25-30.
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Comparative Efficacy of the Lederle/Takeda Acellular Pertussis Component DTP (DTaP) Vaccine and Lederle Whole-Cell Component DTP Vaccine in German Children After Household Exposure
Heininger et al.
Pediatrics 1998;102:546-553.
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Physician Concerns About Vaccine Adverse Effects and Potential Litigation
Zimmerman et al.
Arch Pediatr Adolesc Med 1998;152:12-19.
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Acellular Pertussis Vaccine: Recommendations for Use as the Initial Series in Infants and Children
Committee on Infectious Diseases
Pediatrics 1997;99:282-288.
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A Controlled Trial of Two Acellular Vaccines and One Whole-Cell Vaccine against Pertussis
Greco et al.
NEJM 1996;334:341-349.
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The 1993 Pertussis Epidemic in Cincinnati
Hardy et al.
NEJM 1994;331:1455-1456.
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The 1993 Epidemic of Pertussis in Cincinnati -- Resurgence of Disease in a Highly Immunized Population of Children
Christie et al.
NEJM 1994;331:16-21.
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