Pertussis found to persist in UK children despite preschool booster vaccine

1. Roughly 1 in 5 UK children presenting with persistent cough were found to be infected with pertussis despite receiving the preschool booster vaccine.

2. Children who received the preschool booster vaccine 7 or more years prior to the study were four times more likely to have pertussis compared to children who had received the booster within 3 years of the study.

Evidence Rating Level: 2 (Good)

Study Rundown: This study investigates the prevalence and severity of pertussis (Whooping cough) in the adolescent population to inform policy decisions regarding the introduction of an adolescent pertussis booster. Looking at a population of n=279 from 2010 to 2012 in the UK, researchers identified laboratory confirmed pertussis in 56 study participants (20%, 95% CI: 16% to 25%) who presented to their local GP with persistent cough. Additionally, participants who received the preschool booster vaccine seven or more years prior to the study were over 4 times more likely to be diagnosed with pertussis compared to those who had received the preschool booster one to three years prior. These findings reveal that roughly one in five UK children and adolescents are infected with pertussis. Researchers argue that these findings support the decision to implement an adolescent pertussis booster to help curb rates of pertussis infection in adolescents and adults. This study is the largest of its kind, but it still enrolled less than 300 participants. Regardless, the findings are telling and the recommendations outlined in the article should be strongly considered by the UK Joint Committee on Vaccination and Immunisation.

Click to read the study in British Medical Journal

Relevant reading: Accelerating control of pertussis in England and Wales

In-Depth [study]: Over the last four years there has been a marked increase in the incidence of pertussis-related persistent cough presented in UK primary care offices. Although, the UK has very good population coverage for the primary pertussis vaccination (~90%) and good coverage for the preschool booster vaccination (80%) there remains a significant disease burden associated with pertussis. In the US and many other developed nations (not including the UK) there has been an adoption of an adolescent pertussis booster to help curb the spread of pertussis infection in adolescents and adults. In 2005 the US introduced the adolescent Tdap vaccination which provides tetanus, pertussis, and diphtheria immunizations to engage this specific issue.

This study was conducted in response to calls for research from the UK Joint Committee on Vaccination and Immunisation. In this study, researchers identified patients, ages 5-15, presenting in Thames Valley primary care offices with persistent cough lasting three weeks or longer. Upon presenting with cough, patients’ oral fluid was then tested to confirm pertussis infection serologically. A surprising finding from the study was that children who received the preschool booster vaccination 7 or more years prior to the beginning of the study were 4.23 times as likely (risk ratio 4.23, 95% CI: 1.84 to 9.70) to have laboratory confirmed pertussis, compared to those who had the booster within 1 to 3 years prior to the study. This finding reveals the potential for individuals to lose pertussis immunity over time, even after receiving the preschool booster.

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