title: Long-term follow-up of Swedish children vaccinated with acellular pertussis vaccines at 3, 5, and 12 months of age indicates the need for a booster dose at 5 to 7 years of age.
abstract: OBJECTIVE
  The purpose of this work was to evaluate the long-term effectiveness of vaccination with acellular pertussis vaccines at 3, 5, and 12 months of age.
  
  
  METHODS
  Clinical follow-up of reported culture- and polymerase chain reaction-confirmed cases of pertussis was initiated during October 1997 in most of Sweden (except Gothenburg and environs). The study population included 90% of Swedish children born during 1996 or later (ie, who received diphtheria-tetanus-acellular pertussis vaccines at 3, 5, and 12 months of age) and children who had participated in a large pertussis vaccine trial in 1993-1996. Age-specific incidences were estimated using reported culture- or polymerase chain reaction-confirmed pertussis from October 1997 to September 2004 in areas covered by enhanced surveillance. In addition, annual overall and age-specific incidences of pertussis throughout Sweden before and after introduction of acellular pertussis vaccines were estimated.
  
  
  RESULTS
  The overall incidence of notified culture- and polymerase chain reaction-confirmed pertussis dropped from 113 to 150 per 100,000 during 1992-1995 to 11 to 16 per 100,000 during 2001-2004. In areas of enhanced surveillance, the incidence of pertussis was 31 per 100,000 person-years after 2 doses and 19 per 100,000 person-years after the third dose at 12 months of age. The age-specific incidence remained low for approximately 5 years after the third dose but increased in children aged 6 to 8 years, becoming 32 and 48 per 100,000 person-years, respectively. The highest incidence occurred among infants who were unvaccinated or had received only 1 dose of diphtheria-tetanus-acellular pertussis vaccine.
  
  
  CONCLUSIONS
  The increased incidence among 7- to 8-year-olds (ie, mainly acellular pertussis vaccine-vaccinated children) suggests waning of vaccine-induced protection from pertussis. Along with a concomitant increase in incidence among infants, most likely infected by older siblings, these data suggest a booster dose of acellular pertussis vaccine is warranted from 5 to 7 years of age.
authors.affiliation: Swedish Institute for Infectious Disease Control, SE 171 82 Solna, Sweden. patrick.olin@smi.ki.se.
authors.forename: Lennart
authors.initials: L
authors.lastname: Gustafsson
authors.forename: Luc
authors.initials: L
authors.lastname: Hessel
authors.forename: Jann
authors.initials: J
authors.lastname: Storsaeter
authors.forename: Patrick
authors.initials: P
authors.lastname: Olin
mesh_terms: D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary; D015994:Incidence; D007223:Infant; D008297:Male; D010567:Pertussis Vaccine / Q000008:administration & dosage*; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D013548:Sweden / Q000453:epidemiology; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D004269:DNA, Bacterial; D010567:Pertussis Vaccine