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In 2000, acellular pertussis vaccines (DTaP) replaced whole-cell vaccines, and in 2005, booster vaccination with Tdap was recommended for adolescents and adults. Despite high vaccination rates, pertussis outbreaks continue throughout the U.S. Infants too young to be vaccinated experience the most severe disease, and older unvaccinated children can also have significant disease. Because the vaccine is not completely protective, immunity wanes and leads to breakthrough disease in previously vaccinated children. Investigators in Oregon examined disease severity in patients with breakthrough disease among 633 cases of pertussis in children (age, <19 years) during a 2-year period (2010–2012).
Vaccination rates for kindergarteners were high (despi…