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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA retrospective, single-center chart review of the 2010 Bordetella pertussis outbreak in California, USA found that a time interval greater than 3 year since vaccination with acellular pertussis correlated with increased risk for acquiring the disease.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EViral Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELower Respiratory Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EClinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVaccinations\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBacterial Infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA retrospective, single-center chart review of the 2010 \u003Cem\u003EBordetella pertussis\u003C\/em\u003E outbreak in California found that a time interval greater than 3 year since vaccination with acellular pertussis (aP) correlated with increased risk for acquiring the disease. Research assistant Maxwell Witt, Kaiser Permanente Medical Center, San Rafael, California, USA, reported that children between 8 and 12 years had higher attack rates and reduced vaccine effectiveness compared with children aged 2 to 7 and 13 to 18 years, possibly a reflection of greater time since their last aP dose.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESince the replacement of whole-cell pertussis vaccine with the better-tolerated aP version in 2002, questions regarding its efficacy and durability have lingered [Zhang L et al. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E 2011]. Researchers at San Rafael Kaiser Permanente (KP) Medical Center, led by David Witt, MD, saw the California outbreak as an opportunity to observe aP vaccine performance by age, time since last vaccine, and vaccine status.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EBetween March and October 2010, patients who presented to the San Rafael KP pediatrics department with a severe cough for greater than 1 week and a positive PCR for \u003Cem\u003EB. pertussis\u003C\/em\u003E were considered infected and included in the review. Electronic medical records were examined for demographic information and vaccine status.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn all, 132 patients \u0026lt;18 years were included. Vaccination status among children aged \u226412 years at presentation revealed that 85% were fully vaccinated, 7% was under vaccinated, and 8% was unvaccinated (never vaccinated). \u003Cem\u003EB. pertussis\u003C\/em\u003E attack rates were shown to be highest among 8- to 12-year olds, compared with 2- to 7- and 13- to 18-year olds (p=0.002, one sample t-test; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Among children \u0026lt;12 years, a trend toward lower attack rates among fully immunized children versus under- or never-immunized children was observed, but the difference was not statistically significant. In contrast, children aged 13 to 18 years who were not fully immunized had significantly higher attack rates compared with other age groups (p=0.009). No patients in the cohort were hospitalized or died from their illness.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12440\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12440\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12440\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EPeak Attack Rates Observed Among 8- to 12-Year Olds.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EVaccine effectiveness, a metric of the field performance of the vaccine, was calculated by comparing attack rates between under- and never-immunized versus fully immunized patient groups (of note, \u003Cem\u003Eeffectiveness\u003C\/em\u003E should not be confused with \u003Cem\u003Eefficacy\u003C\/em\u003E, which reflects performance in a prospective placebo-controlled trial). The effectiveness of aP varied by age group: 41% (95% CI, 21% to 54%) and 79% (95% CI, 73% to 84%) within the 2- to 7- and 13- to 18-year olds, respectively, possibly reflecting more recent immunization, but only 24% (95% CI, 0% to 40%) in the 8- to 12- year old age group.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe authors concluded that aP is highly effective within 3 years of administration after which its protection may diminish. Should larger studies confirm these findings, additional scheduled dosing or targeted vaccine programs during outbreaks may be proposed. One attendee, however, challenged the relevance of the findings including the use of the phrase \u201cvaccine failure,\u201d arguing that strict case definitions had not been used. In Dr. Witt\u0027s opinion, \u003Cem\u003EB. pertussis\u003C\/em\u003E carriage in the face of a viral illness had not been ruled out and therefore, these results cannot be used to question the efficacy of the vaccine.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/12\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmx5d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmx5d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}