Acellular pertussis vaccine effectiveness for children during the 2009–2010 pertussis epidemic in Queensland

Sarah L Sheridan, Bradley J McCall, Craig A Davis, Jennifer M B Robson, Brynley P Hull, Christine E Selvey, Robert S Ware, Keith Grimwood and Stephen B Lambert
Med J Aust 2014; 200 (6): 334-338. || doi: 10.5694/mja13.11069


Objectives: To assess the effectiveness of three, four and five doses of acellular pertussis vaccine against pertussis notification for children aged 1 – < 4 years and 5 – < 12 years, and the effectiveness of three doses of acellular pertussis vaccine against pertussis hospitalisation for children aged 1 – < 4 years.

Design, setting and participants: A population-based retrospective study of children aged 1 – < 12 years residing in Queensland, Australia, during 2009 and 2010. Routinely collected notification, hospitalisation, testing and vaccination data were used to describe notification rates and testing patterns and to assess vaccine effectiveness (VE) by the screening method.

Main outcome measures: VE against pertussis notification for children aged 1 – < 4 years and 5 – < 12 years, by birth year, and VE against pertussis hospitalisation for children aged 1 – < 4 years.

Results: 1961 notifications and 29 hospitalisations were included in the VE calculations. VE point estimates against pertussis notification and hospitalisation in children aged 1 – < 4 years were similar in 2009 and 2010, and ranged between 83.5% and 89.4%. VE point estimates against notification among children aged 5 – < 12 years were between 71.2% and 87.7% in 2009, and between 34.7% and 70.3% in 2010. The numbers of pertussis tests performed for children, particularly polymerase chain reaction (PCR) tests, increased between 2009 and 2010.

Conclusions: Acellular pertussis vaccine provided good protection within the first years of priming, but this waned as age increased. Changes in pertussis testing behaviour, because of increases in PCR use and awareness, may have contributed to increased pertussis notification rates and lower estimates of VE against notification owing to identification of milder disease.

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  • Sarah L Sheridan1,2
  • Bradley J McCall3
  • Craig A Davis4
  • Jennifer M B Robson5
  • Brynley P Hull6
  • Christine E Selvey7
  • Robert S Ware1,2
  • Keith Grimwood1
  • Stephen B Lambert1,4

  • 1 Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, QLD.
  • 2 School of Population Health, University of Queensland, Brisbane, QLD.
  • 3 Metro South Public Health Unit, Brisbane, QLD.
  • 4 Communicable Diseases Unit, Queensland Health, Brisbane, QLD.
  • 5 Microbiology Department, Sullivan Nicolaides Pathology, Brisbane, QLD.
  • 6 National Centre for Immunisation Research and Surveillance, Sydney, NSW.
  • 7 Health Protection NSW, NSW Health, Sydney, NSW.



We thank Angela Wakefield and Nancy Tran, of the Communicable Diseases Unit, Queensland Health, and Jason Christiansen, of Metro South Public Health Unit, for their assistance in data extraction; and Karen Peterson and Vicki Bryant, of the Queensland Health Immunisation Program, for describing the vaccination program, schedule and register. Sarah Sheridan is supported by a National Health and Medical Research Council (NHMRC) postgraduate scholarship and a Children’s Health Foundation (CHF) clinical PhD scholarship. Stephen Lambert is supported by an NHMRC early career fellowship and a CHF People Support Fellowship, which helped support the study. Keith Grimwood receives funding from the NHMRC.

Competing interests:

Keith Grimwood has served on the GlaxoSmithKline advisory board for pneumococcal conjugate vaccines.

  • 1. Winter K, Harriman K, Zipprich J, et al. California pertussis epidemic, 2010. J Pediatr 2012; 161: 1091-1096.
  • 2. Sheridan SL, Ware RS, Grimwood K, Lambert SB. Number and order of whole cell pertussis vaccines in infancy and disease protection. JAMA 2012; 308: 454-456.
  • 3. Witt MA, Katz PH, Witt DJ. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak. Clin Infect Dis 2012; 54: 1730-1735.
  • 4. Klein NP, Bartlett J, Rowhani-Rahbar A, et al. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med 2012; 367: 1012-1019.
  • 5. Misegades LK, Winter K, Harriman K, et al. Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010. JAMA 2012; 308: 2126-2132.
  • 6. Witt MA, Arias L, Katz PH, et al. Reduced risk of pertussis among persons ever vaccinated with whole cell pertussis vaccine compared to recipients of acellular pertussis vaccines in a large US cohort. Clin Infect Dis 2013; 56: 1248-1254.
  • 7. Liko J, Robison SG, Cieslak PR. Priming with whole-cell versus acellular pertussis vaccine. N Engl J Med 2013; 368: 581-582.
  • 8. Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook. 10th ed. Canberra: Australian Government Department of Health, 2013. (accessed Jul 2013).
  • 9. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997; 46: 1-25.
  • 10. Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013; 131: e1047-e1052.
  • 11. Vickers D, Mainar-Jaime RC, Pahwa P. Pertussis in rural populations of Saskatchewan (1995 to 2003): incidence, seasonality, and differences among cases. Can J Public Health 2006; 97: 459-464.
  • 12. Gold M, Kempe A, Osbourn M. A comparison of serious adverse reactions to whole cell and acellular pertussis vaccines in South Australia. Med J Aust 1999; 171: 331-332.
  • 13. Cherry JD. Epidemic pertussis in 2012-the resurgence of a vaccine-preventable disease. N Engl J Med 2012; 367: 785-787.
  • 14. Communicable Diseases Network Australia. Australian national notifiable diseases case definitions: pertussis case definition. Australian Government Department of Health, 2004. nsf/Content/cda-surveil-nndss-casedefs-cd_pertus.htm (accessed Feb 2013).
  • 15. Data Collections Unit, Queensland Health. 2009–2010 Queensland hospital admitted patient data collection (QHAPDC): manual of instructions and procedures for the reporting of QHAPDC data. Brisbane: Queensland Health, 2009. (accessed Feb 2013).
  • 16. Farrington CP. Estimation of vaccine effectiveness using the screening method. Int J Epidemiol 1993; 22: 742-746.
  • 17. Hull BP, Lawrence GL, MacIntyre CR, McIntyre PB. Estimating immunisation coverage: is the ‘third dose assumption’ still valid? Commun Dis Intell Q Rep 2003; 27: 357-361.
  • 18. Torvaldsen S, Simpson JM, McIntyre PB. Effectiveness of pertussis vaccination in New South Wales, Australia, 1996–1998. Eur J Epidemiol 2003; 18: 63-69.
  • 19. Hull BP, Deeks SL, McIntyre PB. The Australian Childhood Immunisation Register — a model for universal immunisation registers? Vaccine 2009; 27: 5054-5060.
  • 20. Hull BP, Lawrence GL, MacIntyre C, McIntyre PB. Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register. Aust N Z J Public Health 2003; 27: 533-538.
  • 21. Orenstein WA, Bernier RH, Dondero TJ, et al. Field evaluation of vaccine efficacy. Bull World Health Organ 1985; 63: 1055-1068.
  • 22. Octavia S, Sintchenko V, Gilbert GL, et al. Newly emerging clones of Bordetella pertussis carrying prn2 and ptxP3 alleles implicated in Australian pertussis epidemic in 2008-2010. J Infect Dis 2012; 205: 1220-1224.
  • 23. Kaczmarek MC, Valenti L, Kelly HA, et al. Sevenfold increase in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000–2011. Med J Aust 2013; 198: 624-628. <MJA full text>
  • 24. Cherry JD. Why do pertussis vaccines fail? Pediatrics 2012; 129: 968-970.


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