title: Pertussis outbreak in an elementary school with high vaccination coverage.
abstract: BACKGROUND
  An outbreak of pertussis in a US elementary school with high vaccination coverage was investigated to evaluate vaccine effectiveness and to identify potential contributing factors.
  
  
  METHODS
  Survey and cohort study of all 215 students of an elementary school (including 36 case patients) and 16 secondary cases among contacts.
  
  
  RESULTS
  Fifty-two pertussis cases were identified (attack rate among students, 17%). Receipt of <3 doses of pertussis-containing-vaccine compared with receipt of complete vaccination series was a significant risk factor for pertussis [relative risk, 5.1; 95% confidence interval (CI), 3 to 8.6]. The effectiveness of the complete vaccination series was 80% (95% CI 66 to 88). No evidence of waning immunity among students was found. The following contributing factors for the outbreak were identified: multiple introductions of pertussis from the community; delays in identification and treatment of early cases; and high contact rates among students. Antimicrobial treatment initiated >14 days after cough onset was associated with increased risk of further transmission of pertussis (relative risk, 10.1; 95% CI 1.5 to 70.3) compared with treatment within 14 days of onset.
  
  
  CONCLUSIONS
  This investigation demonstrated the potential for pertussis outbreaks to occur in well-vaccinated elementary school populations. Aggressive efforts to identify cases and contacts and timely antimicrobial treatment can limit spread of pertussis in similar settings. High vaccination coverage should be maintained, because vaccination significantly reduces the risk of the disease throughout the elementary school years, and to ensure timely diagnosis and treatment health care providers should maintain a high index of suspicion for pertussis among elementary school age children.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. nkhetsuriani@cdc.gov
authors.forename: N
authors.initials: N
authors.lastname: Khetsuriani
authors.forename: K
authors.initials: K
authors.lastname: Bisgard
authors.forename: D R
authors.initials: DR
authors.lastname: Prevots
authors.forename: M
authors.initials: M
authors.lastname: Brennan
authors.forename: M
authors.initials: M
authors.lastname: Wharton
authors.forename: S
authors.initials: S
authors.lastname: Pandya
authors.forename: A
authors.initials: A
authors.lastname: Poppe
authors.forename: K
authors.initials: K
authors.lastname: Flora
authors.forename: G
authors.initials: G
authors.lastname: Dameron
authors.forename: P
authors.initials: P
authors.lastname: Quinlisk
mesh_terms: D000328:Adult; D001886:Bordetella pertussis / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D006801:Humans; D008875:Middle Aged; D010567:Pertussis Vaccine / Q000008:administration & dosage* / Q000276:immunology; D012307:Risk Factors; D012574:Schools; D014611:Vaccination; D014917:Whooping Cough / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control
chemical_list: D010567:Pertussis Vaccine