title: Pertussis vaccination in infancy lowers the incidence of pertussis disease and the rate of hospitalisation after one and two doses: analyses of 10 years of pertussis surveillance.
abstract: OBJECTIVE
  Shortly after pertussis vaccination was reintroduced in Sweden in 1996, an intensified pertussis disease surveillance programme was set up. In this study, we report on in-depth analyses of age-dose-number-specific incidences and the rate of pertussis hospitalisation for children with no, 1 or 2 doses of an acellular pertussis vaccine before pertussis disease. Vaccine coverage, the timeliness of childhood vaccination and the effect of later than scheduled pertussis vaccination(s) are also examined.
  
  
  METHODS
  Children with notified laboratory-confirmed (culture or PCR) pertussis disease were evaluated among the surveillance population of about 1 million infants, born between 1996 and 2007 and followed for pertussis disease from October 1997 to December 2007, for nearly 6 million person-years. Birth and vaccination dates of the diseased children are known from the surveillance programme. To estimate denominators of the age-dose-number-specific pertussis incidences, we used birth and vaccination dates from a vaccine trial with more than 72,000 infants combined with national pertussis vaccine coverage data for children in the surveillance population.
  
  
  RESULTS
  For infants from 3 to <5 months of age, the incidence of pertussis disease with at least 14 days of cough decreased from 264/100,000 for unvaccinated infants to 155/100,000 for infants with one dose of a pertussis vaccine prior to onset of the disease. In the age range 5 to <12 months, the age-dose specific incidences were 526, 95, and 24/100,000 for infants with no, 1 and 2 doses, respectively. The rate of hospitalisation for infants with 1 dose of a pertussis vaccine prior to onset of the disease was significantly lower than for unvaccinated infants of the same age. For many infants, there is a delay in administration of the vaccine doses according to the regular 3-5-12 month schedule (which has been the case for many years). Hypothetically, if all infants had been vaccinated exactly on schedule, we would expect about 28% fewer pertussis cases with at least 14 days of cough and 38% fewer hospitalisations due to pertussis, of cases possible to influence by vaccinations on schedule.
  
  
  CONCLUSIONS
  Pertussis vaccination had a significant effect among infants already after the first dose. This is particularly important for premature infants and infants with severe respiratory and cardiac diseases. A moderate decrease in the incidence of pertussis disease in infants and rate of hospitalisation could be expected if primary vaccinations were carried out closer to the scheduled time than is currently the practice in Sweden.
authors.affiliation: Swedish Institute for Communicable Disease Control, 171 82 Solna, Sweden. Lennart.Nilsson@smi.se
authors.forename: Lennart
authors.initials: L
authors.lastname: Nilsson
authors.forename: Tiia
authors.initials: T
authors.lastname: Lepp
authors.forename: Kerstin
authors.initials: K
authors.lastname: von Segebaden
authors.forename: Hans
authors.initials: H
authors.lastname: Hallander
authors.forename: Lennart
authors.initials: L
authors.lastname: Gustafsson
mesh_terms: D002648:Child; D002675:Child, Preschool; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D010567:Pertussis Vaccine / Q000008:administration & dosage / Q000276:immunology*; D013548:Sweden / Q000453:epidemiology; D014611:Vaccination / Q000379:methods; D014917:Whooping Cough / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*
chemical_list: D010567:Pertussis Vaccine