Research ArticleEpidemiology

The impact of past vaccination coverage and immunity on pertussis resurgence

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Science Translational Medicine  28 Mar 2018:
Vol. 10, Issue 434, eaaj1748
DOI: 10.1126/scitranslmed.aaj1748

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The problem of pertussis

The recent rise of pertussis in developed countries has generated controversy as to its cause. Domenech de Cellès et al. modeled pertussis transmission using incidence data from Massachusetts, United States. They found little evidence that the switch to the acellular vaccine contributed to the Massachusetts outbreaks. Instead, waning vaccine-conferred immunity, as opposed to vaccine failure to mount a full or even partial immune response, best explained the local rise in pertussis cases along with a historical gap in vaccination coverage. Simulations suggested that administering existing boosters to children may be an effective strategy to halt pertussis transmission.

Abstract

The resurgence of pertussis over the past decades has resulted in incidence levels not witnessed in the United States since the 1950s. The underlying causes have been the subject of much speculation, with particular attention paid to the shortcomings of the latest generation of vaccines. We formulated transmission models comprising competing hypotheses regarding vaccine failure and challenged them to explain 16 years of highly resolved incidence data from Massachusetts, United States. Our results suggest that the resurgence of pertussis is a predictable consequence of incomplete historical coverage with an imperfect vaccine that confers slowly waning immunity. We found evidence that the vaccine itself is effective at reducing overall transmission, yet that routine vaccination alone would be insufficient for elimination of the disease. Our results indicated that the core transmission group is schoolchildren. Therefore, efforts aimed at curtailing transmission in the population at large, and especially in vulnerable infants, are more likely to succeed if targeted at schoolchildren, rather than adults.

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