0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Association Between Undervaccination With Diphtheria, Tetanus Toxoids, and Acellular Pertussis (DTaP) Vaccine and Risk of Pertussis Infection in Children 3 to 36 Months of Age

Jason M. Glanz, PhD1,2; Komal J. Narwaney, MD, PhD1; Sophia R. Newcomer, MPH1; Matthew F. Daley, MD1,3; Simon J. Hambidge, MD, PhD1,2,3,4; Ali Rowhani-Rahbar, MD, PhD5; Grace M. Lee, MD, MPH6; Jennifer C. Nelson, PhD7; Allison L. Naleway, PhD8; James D. Nordin, MD, MPH9; Marlene M. Lugg, DrPH10; Eric S. Weintraub, MPH11
[+] Author Affiliations
1Institute for Health Research, Kaiser Permanente Colorado, Denver
2Department of Epidemiology, Colorado School of Public Health, Aurora
3Department of Pediatrics, University of Colorado, Aurora
4Community Health Services, Denver Health, Colorado
5Kaiser Permanente Vaccine Study Center, Oakland, California
6Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
7Group Health Cooperative, Seattle, Washington
8Kaiser Permanente Northwest, Portland, Oregon
9HealthPartners Research Foundation, Minneapolis, Minnesota
10Department of Research and Evaluation, Southern California Kaiser Permanente, Pasadena
11Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Pediatr. 2013;167(11):1060-1064. doi:10.1001/jamapediatrics.2013.2353.
Text Size: A A A
Published online

Importance  Undervaccination is an increasing trend that potentially places children and their communities at an increased risk for serious infectious diseases.

Objective  To examine the association between undervaccination and pertussis in children 3 to 36 months of age.

Design  Matched case-control study with conditional logistic regression analysis.

Setting  Eight managed care organizations of the Vaccine Safety Datalink between 2004 and 2010.

Participants  Each laboratory-confirmed case of pertussis (72 patients) was matched to 4 randomly selected controls (for a total of 288 controls). The case patients were matched to controls by managed care organization site, sex, and age at the index date. The index date was defined as the date of pertussis diagnosis for the case patients.

Exposure  Undervaccination for the diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine. Undervaccination was defined as the number of doses of DTaP vaccine that was either missing or delayed by the index date. Case patients and controls could be undervaccinated by 0, 1, 2, 3, or 4 doses of DTaP vaccine. Children undervaccinated by 0 doses were considered age-appropriately vaccinated by the index date.

Main Outcome and Measure  Pertussis.

Results  Of the 72 case patients with pertussis, 12 (16.67%) were hospitalized, and 34 (47.22%) were undervaccinated for DTaP vaccine by the date of pertussis diagnosis. Of the 288 matched controls, 64 (22.22%) were undervaccinated for DTaP vaccine. Undervaccination was strongly associated with pertussis. Children undervaccinated for 3 or 4 doses of DTaP vaccine were 18.56 (95% CI, 4.92-69.95) and 28.38 (95% CI, 3.19-252.63) times more likely, respectively, to have received a diagnosis of pertussis than children who were age-appropriately vaccinated.

Conclusions and Relevance  Undervaccination with DTaP vaccine increases the risk of pertussis among children 3 to 36 months of age.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();