By Andrew M. Seaman, NEW YORK | Fri Sep 13, 2013 1:33pm EDT
(Reuters Health) - Children who are not vaccinated according to the schedule recommended by U.S. health officials are at an increased risk of catching whooping cough, according to a new study.
Researchers found kids who fell significantly behind on their diphtheria, tetanus and acellular pertussis (DTaP) shots were between 19 and 28 times more likely to be diagnosed with whooping cough, also known as pertussis, than children who were vaccinated on time.
"What we found - not surprisingly - was that kids who were not vaccinated on time were at a greater risk of pertussis, compared to those who were vaccinated on time," Jason Glanz, the study's lead author from the Kaiser Permanente Colorado Institute for Health Research in Denver, said.
Studies have shown pertussis cases have been on the rise across the U.S.
Researchers suspect that's due to the use of a new type of pertussis vaccine - which has fewer side effects, but is less effective over the long run - and to more children missing or delaying vaccination (see Reuters Health story of May 20, 2013 here: reut.rs/18aYu17.)
Although parents sometimes believe delaying their children's vaccines and following alternative schedules is safer, Glanz said there is no evidence that they are "any safer in terms of adverse events than what's typical."
For the new study, he and his colleagues compared the vaccination records of 72 children who were diagnosed with pertussis in one of eight healthcare systems between 2004 and 2010 and 288 similar kids who didn't get the disease. All of the children were between the ages of three and 36 months.
The Centers for Disease Control and Prevention recommends children receive doses of the DTaP vaccine at two, four and six months of age, another dose between 15 and 18 months and a booster shot when they're four to six years old.
The researchers found that about 47 percent of children diagnosed with pertussis were not vaccinated according to that recommended schedule, versus about 22 percent of kids in the comparison group.
"Just over a third of the cases could have been prevented had they been vaccinated on time," Glanz said.
His team also found that the longer parents delayed getting their children vaccinated, the higher the kids' risks of catching pertussis climbed.
Those who were three doses behind, for example, were 19 times more likely to get whooping cough than kids who were caught up on their shots, and those who were four doses behind had 28 times the risk.
"I think the nice thing about this study is that it quantifies the risk," Dr. Mary Healy, director of vaccinology and maternal immunization for the Center for Vaccine Awareness and Research at Texas Children's Hospital in Houston, said.
"Pertussis is a particularly serious disease. The difficulty with pertussis is that it's very often underappreciated how serious it can be," Healy, who was not involved with the study, said.
In an ongoing pertussis outbreak in Texas, about 2,000 cases have been reported in the state this year. So far, two infants, who were too young to receive the DTaP vaccine, have died (see Reuters story of September 5, 2013 here: reut.rs/1dWKX3J.)
Healy told Reuters Health it's also important for adults including pregnant women in their third trimester to get booster shots of the vaccine to protect young children and those with weakened immune systems.
Glanz said common side effects of the vaccine include fever, discomfort and a sore arm. Serious side effects are rare, he said, adding that parents should understand that delaying their kids' vaccines puts the children at a greater risk of catching pertussis.
"The purpose isn't to demonize parents or marginalize them. We're doing this not because we're pro-vaccine but because we're pro-child," he said.
SOURCE: bit.ly/14Pft6k JAMA Pediatrics, online September 9, 2013.
Fonte: http://www.reuters.com/article/2013/09/13/us-delayed-vaccines-cough-idUSBRE98C0SG20130913
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Fonte: http://archpedi.jamanetwork.com/article.aspx?articleid=1735653
Original Investigation | September 09, 2013
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 ONLINE FIRST
JAMA Pediatr. Published online September 09, 2013. doi:10.1001/jamapediatrics.2013.2353
ABSTRACT
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.
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Più dati in: http://www.cdc.gov/mmwr/pdf/wk/mm6236.pdf
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