First Pertussis Vaccine Dose and Prevention of Infant Mortality

BACKGROUND: American infants are at highest risk of severe pertussis and death. We investigated the role of >= 1 pertussis vaccinations in preventing pertussis-related deaths and risk markers for death among infants aged < 42 days. METHODS: We analyzed characteristics of fatal and nonfatal infant pertussis cases reported nationally during 1991-2008. Infants were categorized into 2 age groups on the basis of eligibility to receive a first pertussis vaccine dose at age 6 weeks; dose 1 was considered valid if given >= 14 days before illness onset. Multivariable logistic regression was used to estimate the effect of >= 1 pertussis vaccine doses on outcome and risk markers. RESULTS: Pertussis-related deaths occurred among 258 of 45 404 cases. Fatal and nonfatal cases were confirmed by culture (54% vs 49%) and polymerase chain reaction (31% vs 27%). All deaths occurred before age 34 weeks at illness onset; 64% occurred before age 6 weeks. Among infants aged >= 42 days, receiving >= 1 doses of vaccine protected against death (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11-0.74), hospitalization (aOR: 0.69; 95% CI: 0.63-0.77), and pneumonia (aOR: 0.80; 95% CI: 0.68-0.95). Risk was elevated for Hispanic ethnicity (aOR: 2.28; 95% CI: 1.36-3.83) and American Indian/Alaska Native race (aOR: 5.15; 95% CI: 2.37-11.2) and lower for recommended antibiotic treatment (aOR: 0.28; 95% CI: 0.16-0.47). Among infants aged,42 days, risk was elevated for Hispanic ethnicity and lower with recommended antibiotic use. CONCLUSIONS: The first pertussis vaccine dose and antibiotic treatment protect against death, hospitalization, and pneumonia.