Skip to main content Accessibility help
×
Home

Risk factors for pertussis in adults and teenagers in England

  • A. WENSLEY (a1), G. J. HUGHES (a1), H. CAMPBELL (a2), G. AMIRTHALINGAM (a2), N. ANDREWS (a3), N. YOUNG (a4) and L. COOLE (a1)...

Summary

Pertussis is a vaccine-preventable respiratory infection caused by Bordetella pertussis which can be fatal in infants. Although high vaccine coverage led to prolonged disease control in England, a national outbreak of pertussis in 2011 led to the largest increase in over two decades, including a marked increase in cases aged ⩾15 years. A case-control study in four regions of England was undertaken to investigate risk factors for pertussis in adolescents and adults, specifically employment type and professional and household contact with children. Pertussis cases were laboratory-confirmed and aged ⩾15 years. Controls were recruited through general practitioner nomination. Demographic and risk factor information were collected using an online survey. Multivariable logistic regression was used to estimate independent associations with outcome. Two hundred and thirty-one cases and 190 controls were recruited. None of the four employment variables (social care, education, health sector, patient contact) were significantly associated with pertussis. Professional contact with children aged < 1 year was associated with a significantly reduced odds of pertussis [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·08–0·78, P = 0·017]. Household contact with ⩾1 child aged 10–14 years was associated with significantly increased odds of pertussis (OR 2·61, 95% CI 1·47–4·64, P = 0·001). Occupational contact with very young children was associated with reduced odds of pertussis, probably due to immune boosting by low-level exposures to B. pertussis. Sharing a household with a young adolescent was a significant risk factor for pertussis in adults and older teenagers. The primary focus of the childhood pertussis vaccination programmes is to prevent infant disease. Although evidence is emerging that adolescent vaccination does not provide indirect protection to infants, our results highlight the importance of children aged 10–14 years in pertussis transmission to older adolescents and adults.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Risk factors for pertussis in adults and teenagers in England
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Risk factors for pertussis in adults and teenagers in England
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Risk factors for pertussis in adults and teenagers in England
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Dr L. Coole, Field Epidemiology Service, National Infections Service, Public Health England, Blenheim House, West One, Duncombe Street, Leeds LS1 4PL, UK. (Email: louise.coole@phe.gov.uk).

Footnotes

Hide All
† These authors contributed equally to this work.

Footnotes

References

Hide All
1. Warfel, JM, Edwards, KM. Pertussis vaccines and the challenge of inducing durable immunity. Current Opinion in Immunology 2015; 35: 4854.
2. van Hoek, AJ, et al. The burden of disease and health care use among pertussis cases in school aged children and adults in England and Wales; a patient survey. PLoS ONE 2014; 9: e111807.
3. Schellekens, J, von König, C-HW, Gardner, P. Pertussis sources of infection and routes of transmission in the vaccination era. Pediatric Infectious Disease Journal 2005; 24: S1924.
4. Campbell, H, et al. Accelerating control of pertussis in England and Wales. Emerging Infectious Diseases 2012; 18: 3847.
5. Miller, E. Overview of recent clinical trials of acellular pertussis vaccines. Biologicals 1999; 27: 7986.
6. Wendelboe, AM, et al. Duration of immunity against pertussis after natural infection or vaccination. Pediatric Infectious Disease Journal 2005; 24: S5861.
7. Tartof, SY, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013; 131: e10471052.
8. Clark, TA. Changing pertussis epidemiology: everything old is new again. Journal of Infectious Diseases 2014; 209: 978981.
9. Skoff, TH, Martin, SW. Impact of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccinations on reported pertussis cases among those 11 to 18 years of age in an era of waning pertussis immunity: a follow-up analysis. JAMA Pediatrics 2016; 170: 453458.
10. World Health Organization. Pertussis vaccines: WHO position paper – August 2015. Weekly Epidemiological Record 2015; 90: 433460.
11. Warfel, JM, Zimmerman, LI, Merkel, TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proceedings of the National Academy of Sciences USA 2014; 111: 787792.
12. Amirthalingam, G, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014; 384: 15211528.
13. Dabrera, G, et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012–2013. Clinical Infectious Diseases 2015; 60: 333337.
14. Tan, T, Trindade, E, Skowronski, D. Epidemiology of pertussis. Pediatric Infectious Disease Journal 2005; 24: S1018.
15. Public Health England. Laboratory confirmed pertussis in England: data to end-August 2014. Health Protection Report 2014; 8: 25.
16. Wiley, KE, et al. Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy. Vaccine 2013; 31: 618625.
17. De, Serres G, et al. Morbidity of pertussis in adolescents and adults. Journal of Infectious Disease 2000; 182: 174179.
18. Pascual, FB, et al. Outbreak of pertussis among healthcare workers in a hospital surgical unit. Infection Control and Hospital Epidemiology 2006; 27: 546552.
19. Baugh, V, McCarthy, N. Outbreak of Bordetella pertussis among oncology nurse specialists. Occupational Medicine 2010; 60: 401405.
20. Bassinet, L, et al. Nosocomial pertussis outbreak among adult patients and healthcare workers. Infection Control and Hospital Epidemiology 2004; 25: 995997.
21. Wright, SW, Decker, MD, Edwards, KM. Incidence of pertussis infection in healthcare workers. Infection Control and Hospital Epidemiology 1999; 20: 120123.
22. Cunegundes, KSA, et al. Bordetella pertussis infection in paediatric healthcare workers. Journal of Hospital Infection 2015; 90: 163166.
23. Riffelmann, M, et al. Antibodies to pertussis antigens in pediatric health care workers. Pediatric Infectious Disease Journal 2002; 21: 381383.
24. Health Protection Agency. Public Health Management of Pertussis. London: Health Protection Agency, 2012.
25. Bechini, A, et al. Acellular pertussis vaccine use in risk groups (adolescents, pregnant women, newborns and health care workers): a review of evidences and recommendations. Vaccine 2012; 30: 51795190.
26. Hope, K, et al. Pertussis vaccination in child care workers: room for improvement in coverage, policy and practice. BMC Pediatrics 2012; 12: 98.
27. Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York: John Wiley & Sons, 2001.
28. Breslow, NE. Statistics in epidemiology: the case-control study. Journal of the American Statistical Association 1996; 91: 1428.
29. Lavine, JS, King, AA, Bjornstad, ON. Natural immune boosting in pertussis dynamics and the potential for long-term vaccine failure. Proceedings of the National Academy of Sciences USA 2011; 108: 72597264.
30. Bisgard, KM, et al. Infant pertussis. Pediatric Infectious Disease Journal 2004; 23: 985989.
31. Wendelboe, AM, et al. Transmission of Bordetella pertussis to young infants. Pediatric Infectious Disease Journal 2007; 26: 293299.
32. de Greeff, SC, et al. Pertussis disease burden in the household: how to protect young infants. Clinical Infectious Diseases 2010; 50: 13391345.
33. Sheridan, SL, et al. Waning vaccine immunity in teenagers primed with whole cell and acellular pertussis vaccine: recent epidemiology. Expert Review of Vaccines 2014; 13: 10811106.
34. Health Protection Agency. Laboratory-confirmed cases of pertussis reported to the enhanced pertussis surveillance programme (England and Wales). Health Protection Report 2012; 6: 47.
35. Lavine, JS, et al. Short-lived immunity against pertussis, age-specific routes of transmission, and the utility of a teenage booster vaccine. Vaccine 2012; 30: 544551.
36. Quinn, H, McIntyre, P. The impact of adolescent pertussis immunization, 2004–2009: lessons from Australia. Bulletin of the World Health Organization 2011; 89: 666674.

Keywords

Risk factors for pertussis in adults and teenagers in England

  • A. WENSLEY (a1), G. J. HUGHES (a1), H. CAMPBELL (a2), G. AMIRTHALINGAM (a2), N. ANDREWS (a3), N. YOUNG (a4) and L. COOLE (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed