Do More Vaccinated or Unvaccinated Kids Get Pertussis?

While this seems like a simple question, the answer is a bit more complicated than most people imagine.

Do More Vaccinated or Unvaccinated Kids Get Pertussis?

For anti-vaccine folks, the answer is clear – more vaccinated kids get pertussis. They put all of the blame for pertussis outbreaks on waning immunity. Of course, that’s not the whole story.

While it might technically be true that more vaccinated kids get pertussis in the average outbreak, that’s only because there are many more vaccinated kids!

A more accurate and useful answer, taking into account attack rates, makes it clear that a higher percentage of unvaccinated kids get pertussis in these outbreaks.

“In conclusion we have described a school-based outbreak of pertussis that may have been fueled by moderate vaccine effectiveness combined with a failure to vaccinate.”

Terrenella et al on Vaccine effectiveness of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine during a pertussis outbreak in Maine

In a pertussis outbreak in Maine, attack rates were much higher in unvaccinated kids, even though more vaccinated kids got pertussis. While 29 of 214 vaccinated kids got pertussis, a much higher percentage of unvaccinated kids got sick – 6 of 28.

That means your risk of getting pertussis was much higher if you were unvaccinated.

A 2013 pertussis outbreak in Florida is a good example that even with all the bad press it gets, the DTaP and Tdap vaccines work too. This outbreak was started by an unvaccinated child at a charter school with high rates of unvaccinated kids. About 30% of unvaccinated kids got sick, while there was only one case “in a person who reported having received any vaccination against pertussis.”

In another 2013 pertussis outbreak in Florida, this time in a preschool, although most of the kids were vaccinated, the outbreak started with “a 1-year-old vaccine-exempt preschool student.” And the classroom with the highest attack rate, was “one in which a teacher with a laboratory-confirmed case of pertussis who had not received a Tdap booster vaccination, worked throughout her illness.”

Why do so many unvaccinated kids get pertussis these days?

“We found evidence of an increase in exemption rates, spatial clustering of nonmedical exemptions, and space-time clustering of pertussis in Michigan. There was considerable overlap between the clusters of exemptions and the clusters of pertussis cases.”

Omer et al on Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis

Besides the fact that they are unvaccinated and unprotected?

“Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. Herd immunity does not seem to completely protect unvaccinated children from pertussis.”

Glanz et al on Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

They can’t get away with hiding in the herd.

Another important consideration – in addition to the fact that more unvaccinated kids get pertussis, when they get pertussis, it is more severe than those who are vaccinated.

“Serious pertussis symptoms and complications are less common among age-appropriate number of pertussis vaccines (AAV) pertussis patients, demonstrating that the positive impact of pertussis vaccination extends beyond decreasing risk of disease.”

McNamara et al on Reduced Severity of Pertussis in Persons With Age-Appropriate Pertussis Vaccination-United States, 2010-2012.

Still thinking of skipping or delaying your child’s pertussis vaccine?

More on Do More Vaccinated or Unvaccinated Kids Get Pertussis?

• VAXOPEDIA – Do More Vaccinated or Unvaccinated Kids Get Sick in Outbreaks?
• VAXOPEDIA – Can Vaccinated Children Be Asymptomatic Carriers of Pertussis?
• VAXOPEDIA – What to Do If Your Child Is Exposed to Pertussis
• VAXOPEDIA – What Causes Non-Stop Crying After DTaP Vaccines?
• VAXOPEDIA – Do Pertussis Vaccines Work Against Pertactin-Negative Pertussis Bacteria?
• VAXOPEDIA – A Shot at the Dark – DPT vs DTaP
• CDC – Pertussis Surveillance and Reporting
• CDC – 2017 Provisional Pertussis Surveillance Report
• CDC – Introduction to Epidemiology
• WHO – Basic Epidemiology
• WHO – Epidemiology of the Unimmunized Child
• Epidemiology: Solve the Outbreak
• Exponential Outbreaks: The Mathematics of Epidemics
• Why Do So Many Vaccinated People Get the Mumps During an Outbreak?
• Of Maths and Measles
• The Simple Math of Herd Immunity
• Hey antivaccination gang–it’s really simple math
• Study – Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis
• Study – Effectiveness of Prenatal Tetanus, Diphtheria, and Acellular Pertussis Vaccination on Pertussis Severity in Infants.
• Study – Reduced Severity of Pertussis in Persons With Age-Appropriate Pertussis Vaccination-United States, 2010-2012.
• Study – Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.
• CDC – Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013
• Study – Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA
• Study – Reduced Severity of Pertussis in Persons With Age-Appropriate Pertussis Vaccination—United States, 2010–2012
• Study – Vaccine effectiveness of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine during a pertussis outbreak in Maine.
• Study – Pertussis Outbreak in an Amish Community — Kent County, Delaware, September 2004–February 2005
• Study – School-Associated Pertussis Outbreak — Yavapai County, Arizona, September 2002–February 2003