Pertussis immunity after Dtap

Recent article in Pediatrics (see pertussis immunity waning peds 2013 in dropbox), with large cohort of kids (400K) who had complete immunizations with Dtap (5 shots, last dose between 4-6 years old) and looked at cases of pertusis in relation to timing of last shot.  Looked at 2 states (Minnesotta and Oregon).  1 year after the last Dtap, the rate of pertussis/100K kids was 15.6 in minnesota and 6.2 in oregon.  6 years after, it was 138.4 and 24.4, respectively, in those states.
 
This is consistent with the new recommendation by cdc to give pertussis vaccine (eg Tdap) to all women late in pregnacy for each pregnancy (they cite that there is sufficient decrease in antibody titer within months of immunization that passive placental transfer to the newborns might be insufficient if given too early). There are differences in the dosages of detoxified pertussis toxin between the kid and adult formulations (DtaP for kids has 10 mcg of pertussis toxin, Tdap for adults has 2.5 mcg), and if the issue with adults is rapid decrease in immunity, it does raise the question about the cdc recommendation to give a single dose of Tdap to adults, independent of their age.  I expect that this recommendation may change.... Esp in light of the large numbers of pertussis outbreaks reported regularly in MMWR.

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