Journal Article

Effectiveness of Adolescent and Adult Tetanus, Reduced-Dose Diphtheria, and Acellular Pertussis Vaccine against Pertussis

Stanley C. Wei, Kathleen Tatti, Kimberly Cushing, Jennifer Rosen, Kristin Brown, Pamela Cassiday, Thomas Clark, Richard Olans, Lucia Pawloski, Monte Martin, Maria Lucia Tondella and Stacey W. Martin

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 3, pages 315-321
Published in print August 2010 | ISSN: 1058-4838
Published online August 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/653938
Effectiveness of Adolescent and Adult Tetanus, Reduced-Dose Diphtheria, and Acellular Pertussis Vaccine against Pertussis

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Background. Pertussis is among the most poorly controlled bacterial vaccine-preventable diseases in the United States. In 2006, a tetanus, reduced-dose diphtheria, and acellular pertussis (Tdap) booster was recommended for adolescents and adults. Tdap vaccines were licensed on the basis of antibody response without vaccine effectiveness data.

Methods. From 30 September 2007 through 19 December 2007, a pertussis outbreak occurred at a nursery through twelfth grade school on St. Croix, US Virgin Islands. We screened all students for cough and collected clinical history, including Tdap receipt. Coughing students were offered diagnostic testing. We defined clinical case patients as students with cough ⩾14 days in duration plus either whoop, paroxysms, or post-tussive vomiting, and we defined confirmed case patients as students with any cough with isolation of Bordetella pertussis or those with clinical cases and polymerase chain reaction or serological evidence of pertussis; other clinical cases were classified as probable.

Results. There were 51 confirmed or probable cases among 499 students (attack rate, 10%). Disease clustered in grades 6–12, with a peak attack rate of 38% among 10th graders. Of 266 students aged ⩾11 years with complete data, 31 (12%) had received Tdap. Forty-one unvaccinated students (18%) had confirmed or probable pertussis, compared with 2 (6%) of the vaccinated students (relative risk, 2.9); vaccine effectiveness was 65.6% (95% confidence interval, −35.8% to 91.3%; P = .092).

Conclusions. This first evaluation of Tdap vaccine effectiveness in the outbreak setting suggests that Tdap provides protection against pertussis. Increased coverage is needed to realize the full benefit of the vaccine program. Serological testing was an important tool for case identification and should be considered for inclusion in the Council of State and Territorial Epidemiologists case definition.

Journal Article.  3974 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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