Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010
Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010
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DOI：
10.1001/jama.2012.14939
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发表时间：
2012-11-28
影响因子：
120.7
通讯作者：
Martin, Stacey W.
中科院分区：
文献类型：
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作者：
Misegades, Lara K.;Winter, Kathleen;Martin, Stacey W.
2010年，加州经历了60多年来最大的百日咳疫情；尽管白喉、破伤风和无细胞百日咳疫苗（DTaP）的覆盖率很高，但7至10岁年龄组的疾病负担仍然很大，这表明保护作用可能减弱。目的探讨百日咳与接种5剂百日咳的关系，以时间为单位进行分析。设计、环境和参与者在加利福尼亚15个县进行病例对照评价。病例（n=682）均为2010年1月至12月14日报告的4至10岁儿童百日咳疑似、可能和确诊病例；对照组（n=2016）是同一年龄组的儿童，他们接受了报告病例的临床医生的护理。每个病例选择三个对照。从医疗记录和免疫登记中获得疫苗接种史。主要结局指标主要结局是(1)百日咳与接受5剂DTaP系列之间的比值比（or）和(2)百日咳与完成5剂DTaP系列后（= 60个月）的时间之间的比值比（or）。采用Logistic回归计算ORs，考虑县和临床医生的聚类，疫苗有效性（VE）估计为（1-OR） x 100%。结果病例中53例（7.8%）未接种百日咳疫苗，对照组19例（0.9%）未接种百日咳疫苗。与对照组相比，百日咳患儿接受全部5剂DTaP的几率较低（OR, 0.11; 95% CI, 0.06-0.21[估计VE， 88.7%; 95% CI, 79.4%-93.8%]）。当儿童按完成DTaP系列后的时间进行分类时，使用未接种疫苗的参照组，与对照组相比，百日咳儿童在前12个月内接受第五剂疫苗的可能性更低（分别为19[2.8%]对354 [17.6%]；OR, 0.02; 95% CI, 0.01-0.04[估计VE， 98.1%; 95% CI, 96.1%-99.1%]）。这种关联随着接种疫苗时间的延长而明显，从第五次接种开始，ORs随着时间的增加而增加。在60个月或更长时间（n=231例[33.9%]和n=288例对照[14.3%]），or为0.29 （95% CI, 0.15-0.54[估计VE， 71.2%; 95% CI, 45.8%-84.8%]）。因此，在接种了第五剂百白破疫苗后，估计的VE每年都在下降。结论：在加州15个县的儿童中，与对照组相比，百日咳儿童接受5剂DTaP系列疫苗的几率较低；随着最后一次DTaP剂量的增加，几率增加，这与百日咳疫苗最后一次剂量后每年估计疫苗有效性的逐渐降低是一致的。《美国医学协会杂志》上。2012年;308 (20): 2126 - 2132 www.jama.com
Context In 2010, California experienced its largest pertussis epidemic in more than 60 years; a substantial burden of disease was noted in the 7- to 10-year-old age group despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage, indicating the possibility of waning protection.Objective To evaluate the association between pertussis and receipt of 5 DTaP doses by time since fifth DTaP dose.Design, Setting, and Participants Case-control evaluation conducted in 15 California counties. Cases (n=682) were all suspected, probable, and confirmed pertussis cases among children aged 4 to 10 years reported from January through December 14, 2010; controls (n=2016) were children in the same age group who received care from the clinicians reporting the cases. Three controls were selected per case. Vaccination histories were obtained from medical records and immunization registries.Main Outcome Measures Primary outcomes were (1) odds ratios (ORs) for the association between pertussis and receipt of the 5-dose DTaP series and (2) ORs for the association between pertussis and time since completion (= 60 months) of the 5-dose DTaP series. Logistic regression was used to calculate ORs, accounting for clustering by county and clinician, and vaccine effectiveness (VE) was estimated as (1-OR) x 100%.Results Among cases and controls, 53 (7.8%) and 19 (0.9%) had not received any pertussis-containing vaccines, respectively. Compared with controls, children with pertussis had a lower odds of having received all 5 doses of DTaP (OR, 0.11; 95% CI, 0.06-0.21 [estimated VE, 88.7%; 95% CI, 79.4%-93.8%]). When children were categorized by time since completion of the DTaP series, using an unvaccinated reference group, children with pertussis compared with controls were less likely to have received their fifth dose within the prior 12 months (19 [2.8%] vs 354 [17.6%], respectively; OR, 0.02; 95% CI, 0.01-0.04 [estimated VE, 98.1%; 95% CI, 96.1%-99.1%]). This association was evident with longer time since vaccination, with ORs increasing with time since the fifth dose. At 60 months or longer (n=231 cases [33.9%] and n=288 controls [14.3%]), the OR was 0.29 (95% CI, 0.15-0.54 [estimated VE, 71.2%; 95% CI, 45.8%-84.8%]). Accordingly, the estimated VE declined each year after receipt of the fifth dose of DTaP.Conclusion Among children in 15 California counties, children with pertussis, compared with controls, had lower odds of having received the 5-dose DTaP series; as time since last DTaP dose increased, the odds increased, which is consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of pertussis vaccine. JAMA. 2012;308(20):2126-2132 www.jama.com