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On individual and community-level determinants of pertussis incidence and vaccination

Year: 2015
Type: dissertation
Study design: Observational Study
Abstract: The association between vaccination and vaccine-preventable infectious diseases is well established. Vaccines are often highly effective at preventing disease not only in an individual, but also in a community. Despite the overall high coverage of vaccination in the United States, there has been a recent resurgence of new and existing infectious diseases. In particular, incident pertussis (whooping cough) has dramatically increased over the last decade, both nationally and locally in Philadelphia, where 2012 saw a doubling of the number of cases compared to the prior year. Possible causative agents include waning immunity from the Diphtheria, Tetanus, and acellular Pertussis vaccine and an increase in vaccination exemptions. This dissertation examined the recent increase in pediatric pertussis in Philadelphia through three aims. In the first aim, we examined risk factors for pertussis at both individual and contextual (neighborhood) levels, and hypothesized neighborhoods with a greater number of day cares would report more cases of pertussis. In the second aim, we challenged the traditional notion of vaccination uptake defined by the up-to-date status of an individual, and instead propose using the number of doses as a better predictor in etiologic analyses. In the third aim, we quantified misclassification of pertussis as a result of the changing case definition in 2014 (addition of infant apnea) and demonstrated that in vaccine effectiveness studies, the measure of association is likely attenuated when the investigator does not re-case classify reported cases or consider underreporting of the disease.
DOI: 10.17918/etd-6408
Language: English
Subfield: Microbiology
Open Access status: gold
OpenAlex ID: W2519035191
Cites: 68
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Related to: 10