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Duration of Immunity and Effectiveness of Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children.
JAMA Pediatr. 2019 06 01; 173(6):588-594.JP

Abstract

Importance

The United States has experienced a nationwide resurgence of pertussis since the mid-1970s, despite high estimated vaccine coverage. Short-lived immunity induced by diphtheria-tetanus-acellular pertussis (DTaP) vaccines in young children is widely believed to be responsible for this growing burden, but the duration of protection conferred by DTaP vaccines remains incompletely quantified.

Objective

To assess the duration of immunity and the effectiveness of DTaP vaccines in US children.

Design, Setting, and Participants

A mathematical, age-structured model of pertussis transmission, previously validated empirically on incidence data in Massachusetts, was used in this simulation study to assess the duration of DTaP immunity most consistent with the empirical values of the relative increase in the odds of acquiring pertussis from recent epidemiologic studies in the United States. The study included 5 simulated cohorts of children born between January 1, 2001, and December 31, 2005, followed up between the ages of 5 and 9 years (study period, January 1, 2006, to December 31, 2014). Statistical analysis was performed from May 1 to December 1, 2017.

Interventions

Vaccination with DTaP according to the US immunization schedule, with a range of assumptions regarding the degree of waning immunity.

Main Outcomes and Measures

Vaccine effectiveness and relative change in the odds of acquiring pertussis (odds ratio) in children aged 5 to 9 years, duration of DTaP immunity, and vaccine population-level impact.

Results

This study found a marked association between the degree of waning immunity, vaccine effectiveness, and the odds ratio. Counterintuitively, the odds ratio was positively associated with vaccine effectiveness, as a consequence of nonlinear, age-assortative transmission dynamics. Based on the empirical odds ratios (1.33; 95% CI, 1.23-1.43), it was estimated that vaccine effectiveness exceeded 75% in children aged 5 to 9 years and that more than 65% of children remained immune to pertussis 5 years after the last DTaP dose.

Conclusions and Relevance

The results of this study suggest that temporal trends in the odds of acquiring pertussis are an unreliable measure of the durability of vaccine-induced protection. They further demonstrate that DTaP vaccines confer imperfect, but long-lived protection. Control strategies should be based on the best available estimates of vaccine properties and the age structure of the transmission network.

Authors+Show Affiliations

Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases Unit, Institut Pasteur, Inserm U1181, University of Versailles St-Quentin-en-Yvelines, Versailles, France.Odum School of Ecology, University of Georgia, Athens. Department of Infectious Diseases, University of Georgia, Athens. Center for the Ecology of Infectious Diseases, University of Georgia, Athens.Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor. Department of Mathematics, University of Michigan, Ann Arbor. Center for the Study of Complex Systems, University of Michigan, Ann Arbor.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31009031

Citation

Domenech de Cellès, Matthieu, et al. "Duration of Immunity and Effectiveness of Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children." JAMA Pediatrics, vol. 173, no. 6, 2019, pp. 588-594.
Domenech de Cellès M, Rohani P, King AA. Duration of Immunity and Effectiveness of Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children. JAMA Pediatr. 2019;173(6):588-594.
Domenech de Cellès, M., Rohani, P., & King, A. A. (2019). Duration of Immunity and Effectiveness of Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children. JAMA Pediatrics, 173(6), 588-594. https://doi.org/10.1001/jamapediatrics.2019.0711
Domenech de Cellès M, Rohani P, King AA. Duration of Immunity and Effectiveness of Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children. JAMA Pediatr. 2019 06 1;173(6):588-594. PubMed PMID: 31009031.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duration of Immunity and Effectiveness of Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children. AU - Domenech de Cellès,Matthieu, AU - Rohani,Pejman, AU - King,Aaron A, PY - 2019/4/23/pubmed PY - 2020/2/23/medline PY - 2019/4/23/entrez SP - 588 EP - 594 JF - JAMA pediatrics JO - JAMA Pediatr VL - 173 IS - 6 N2 - Importance: The United States has experienced a nationwide resurgence of pertussis since the mid-1970s, despite high estimated vaccine coverage. Short-lived immunity induced by diphtheria-tetanus-acellular pertussis (DTaP) vaccines in young children is widely believed to be responsible for this growing burden, but the duration of protection conferred by DTaP vaccines remains incompletely quantified. Objective: To assess the duration of immunity and the effectiveness of DTaP vaccines in US children. Design, Setting, and Participants: A mathematical, age-structured model of pertussis transmission, previously validated empirically on incidence data in Massachusetts, was used in this simulation study to assess the duration of DTaP immunity most consistent with the empirical values of the relative increase in the odds of acquiring pertussis from recent epidemiologic studies in the United States. The study included 5 simulated cohorts of children born between January 1, 2001, and December 31, 2005, followed up between the ages of 5 and 9 years (study period, January 1, 2006, to December 31, 2014). Statistical analysis was performed from May 1 to December 1, 2017. Interventions: Vaccination with DTaP according to the US immunization schedule, with a range of assumptions regarding the degree of waning immunity. Main Outcomes and Measures: Vaccine effectiveness and relative change in the odds of acquiring pertussis (odds ratio) in children aged 5 to 9 years, duration of DTaP immunity, and vaccine population-level impact. Results: This study found a marked association between the degree of waning immunity, vaccine effectiveness, and the odds ratio. Counterintuitively, the odds ratio was positively associated with vaccine effectiveness, as a consequence of nonlinear, age-assortative transmission dynamics. Based on the empirical odds ratios (1.33; 95% CI, 1.23-1.43), it was estimated that vaccine effectiveness exceeded 75% in children aged 5 to 9 years and that more than 65% of children remained immune to pertussis 5 years after the last DTaP dose. Conclusions and Relevance: The results of this study suggest that temporal trends in the odds of acquiring pertussis are an unreliable measure of the durability of vaccine-induced protection. They further demonstrate that DTaP vaccines confer imperfect, but long-lived protection. Control strategies should be based on the best available estimates of vaccine properties and the age structure of the transmission network. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/31009031/Duration_of_Immunity_and_Effectiveness_of_Diphtheria_Tetanus_Acellular_Pertussis_Vaccines_in_Children_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2019.0711 DB - PRIME DP - Unbound Medicine ER -