Effectiveness of Acellular Pertussis Vaccine in Older Adults: Nested Matched Case-control Study

Author:

Liu Bette C1ORCID,He Wen-Qiang1,Newall Anthony T1,Quinn Helen E23,Bartlett Mark4,Hayen Andrew5,Sheppeard Vicky6,Rose Nectarios6,Macintyre C Raina7,Mcintyre Peter28

Affiliation:

1. School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

2. National Centre for Immunisation Research and Surveillance and University of Sydney, Australia

3. Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

4. Sax Institute, Sydney, Australia

5. University of Technology, Sydney, Australia

6. Health Protection, New South Wales Ministry of Health, Sydney, New South Wales, Australia

7. Kirby Institute, University of New South Wales, Sydney New South Wales,, Australia

8. Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand

Abstract

Abstract Background Despite recommendations that older adults receive acellular pertussis vaccines, data on direct effectiveness in adults aged over 50 years are sparse. Methods A case-control study nested within an adult cohort. Cases were identified from linked pertussis notifications and each matched to 3 controls on age, sex, and cohort recruitment date. Cases and controls were invited to complete a questionnaire, with verification of vaccination status by their primary care provider. Vaccine effectiveness (VE) was estimated by conditional logistic regression, with adjustment for reported contact with children and area of residence. Results Of 1112 notified cases in the cohort, we had complete data for 333 cases and 506 controls. Among 172 PCR-diagnosed cases (mean age, 61 years), 11.2% versus 19.5% of controls had provider-verified pertussis vaccination, on average, 3.2 years earlier. Adjusted VE against PCR-diagnosed pertussis was 52% (95% CI, 15–73%), nonsignificantly higher if vaccinated within 2 years (63%; −5–87%). Adjusted VE was similar in adults born before 1950, presumed primed by natural infection (51%; −8–77%) versus those born 1950 or later who may have received whole-cell pertussis vaccine (53%; −11–80%) (P-heterogeneity = 0.9). Among 156 cases identified by single-point serology, adjusted VE was −55% (−177–13%). Conclusions We found modest protection against PCR-confirmed pertussis among older adults (mean age, 61 years; range, 46–81 years) within 5 years after acellular vaccine. The most likely explanation for the markedly divergent VE estimate from cases identified by single-titer serology is misclassification arising from limited diagnostic specificity in our setting.

Funder

National Health and Medical Research Council

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Reference34 articles.

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2. Australian vaccine preventable disease epidemiological review series: pertussis, 2006-2012;Pillsbury;Commun Dis Intell Q Rep,2014

3. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP);Liang;MMWR Recomm Rep,2018

4. Morbidity of pertussis in adolescents and adults;De Serres;J Infect Dis,2000

5. Survey of pertussis morbidity in adults in western Sydney;Thomas;Med J Aust,2000

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