Communicable Disease Services, Multnomah County Health Department, Portland, Oregon.
Clin Infect Dis. 2014 Jun;58(11):1523-9. doi: 10.1093/cid/ciu156. Epub 2014 Mar 14.
Bordetella pertussis causes severe respiratory illness among infants and adolescents. High proportions of breakthrough infection have been observed. To understand the effect of vaccination in the era of acellular pertussis vaccines (DTaP and Tdap), we assessed if vaccination status is associated with disease severity and duration.
The Multnomah County Health Department conducts enhanced pertussis surveillance for 1.7 million residents in the Portland, Oregon, metropolitan area. Surveillance activities include ascertaining demographics, clinical presentation, cough duration, vaccination history, and other health outcomes. Utilizing Advisory Committee on Immunization Practices (ACIP) routine vaccination recommendations, we analyzed a cohort of persons aged 6 weeks to 18 years with confirmed pertussis to assess illness severity and duration by vaccination status. Analysis was conducted using both logistic regression (disease severity) and survival analysis (cough duration).
During 2010-2012, 98.7% (n = 624) of patients with confirmed pertussis in our cohort had vaccination, treatment, demographic, and outcome information. Among these patients, 45% (n = 286) were ACIP up to date with vaccinations. Ever-vaccinated cases were significantly less likely to be hospitalized or develop severe illness (adjusted odds ratio [aOR], 0.2; 95% confidence interval [CI], .1-.8 and aOR, 0.4; 95% CI, .2-.9, respectively). ACIP up-to-date patients stopped coughing significantly more rapidly than unvaccinated patients (adjusted hazard ratio, 1.7; 95% CI, 1.3-2.2).
Patients with pertussis vaccination had decreased morbidity characterized by less severe illness and significantly reduced illness duration. Therefore, vaccination is recommended among at-risk individuals, and research into the nature of the residual vaccine immunity is warranted.
百日咳博德特氏菌可导致婴儿和青少年发生严重呼吸道疾病。突破性感染的比例较高。为了了解无细胞百日咳疫苗（DTaP 和 Tdap）时代疫苗接种的效果，我们评估了疫苗接种状况是否与疾病严重程度和持续时间有关。
摩特诺玛县卫生部门对俄勒冈州波特兰市大都市区的 170 万居民进行强化百日咳监测。监测活动包括确定人口统计学、临床表现、咳嗽持续时间、疫苗接种史和其他健康结果。利用免疫实践咨询委员会（ACIP）常规疫苗接种建议，我们分析了一组年龄在 6 周至 18 岁的确诊百日咳患者，以评估疫苗接种状况与疾病严重程度和持续时间的关系。使用逻辑回归（疾病严重程度）和生存分析（咳嗽持续时间）进行分析。
在 2010 年至 2012 年期间，我们队列中 98.7%（n=624）的确诊百日咳患者有疫苗接种、治疗、人口统计学和结局信息。在这些患者中，45%（n=286）符合 ACIP 的疫苗接种要求。曾经接种过疫苗的病例住院或发生严重疾病的可能性显著降低（调整后的优势比[OR]，0.2；95%置信区间[CI]，0.1-0.8 和调整后的 OR，0.4；95% CI，0.2-0.9）。ACIP 最新的患者咳嗽停止的速度明显快于未接种疫苗的患者（调整后的危险比，1.7；95% CI，1.3-2.2）。
接种百日咳疫苗的患者发病率降低，疾病严重程度较轻，且疾病持续时间明显缩短。因此，建议高危人群接种疫苗，有必要对残留疫苗免疫力的性质进行研究。
