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Pediatrics. 2015 Jun;135(6):990-9. doi: 10.1542/peds.2014-2291. Epub 2015 May 4.

First pertussis vaccine dose and prevention of infant mortality.

Author information

  • 1Meningitis and Bacterial Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and tit2@cdc.gov.
  • 2Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • 3Meningitis and Bacterial Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and.

Abstract

BACKGROUND:

American infants are at highest risk of severe pertussis and death. We investigated the role of ≥1 pertussis vaccinations in preventing pertussis-related deaths and risk markers for death among infants aged <42 days.

METHODS:

We analyzed characteristics of fatal and nonfatal infant pertussis cases reported nationally during 1991-2008. Infants were categorized into 2 age groups on the basis of eligibility to receive a first pertussis vaccine dose at age 6 weeks; dose 1 was considered valid if given ≥14 days before illness onset. Multivariable logistic regression was used to estimate the effect of ≥1 pertussis vaccine doses on outcome and risk markers.

RESULTS:

Pertussis-related deaths occurred among 258 of 45 404 cases. Fatal and nonfatal cases were confirmed by culture (54% vs 49%) and polymerase chain reaction (31% vs 27%). All deaths occurred before age 34 weeks at illness onset; 64% occurred before age 6 weeks. Among infants aged ≥42 days, receiving ≥1 doses of vaccine protected against death (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11-0.74), hospitalization (aOR: 0.69; 95% CI: 0.63-0.77), and pneumonia (aOR: 0.80; 95% CI: 0.68-0.95). Risk was elevated for Hispanic ethnicity (aOR: 2.28; 95% CI: 1.36-3.83) and American Indian/Alaska Native race (aOR: 5.15; 95% CI: 2.37-11.2) and lower for recommended antibiotic treatment (aOR: 0.28; 95% CI: 0.16-0.47). Among infants aged <42 days, risk was elevated for Hispanic ethnicity and lower with recommended antibiotic use.

CONCLUSIONS:

The first pertussis vaccine dose and antibiotic treatment protect against death, hospitalization, and pneumonia.

Copyright © 2015 by the American Academy of Pediatrics.

PMID:
25941302
[PubMed - indexed for MEDLINE]
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