Asthma and lower airway disease
Increased risk of pertussis in patients with asthma

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Background

The recent pertussis outbreak in California highlights the effect of pertussis on public health. In 2004, a pertussis outbreak occurred in Olmsted County, Minnesota, despite a high vaccine uptake. This outbreak provided a natural experiment to assess the relationship between asthma and pertussis.

Objective

We sought to determine whether asthmatic subjects have a higher risk of pertussis than nonasthmatic subjects.

Methods

We conducted a population-based case-control study. There were 223 pertussis cases identified by means of PCR in 2004 and 2005. We identified age- and sex-matched control subjects from 5537 patients with negative test results for pertussis. We conducted a comprehensive medical record review and applied predetermined criteria to ascertain asthma status. Conditional logistic regression was fit to assess the effect of asthma status on the risk of pertussis.

Results

Of the 223 subjects, 164 were eligible for the study, and 328 matched control subjects (1:2 matching) were enrolled. Of these 164 subjects, 50% were male, and 82% were white. The median age at the index date of pertussis was 14 years. Sixty-two (38%) of the 164 cases had asthma before the index date of pertussis compared with 85 (26%) of the 328 control subjects (odds ratio, 1.73; 95% CI, 1.12-2.67; P = .013). The population attributable risk percentage of asthma for risk of pertussis was 17%.

Conclusions

Given the high prevalence of asthma and the ongoing risk of pertussis throughout the United States, consideration of defining asthmatic subjects as a target group for pertussis vaccination (eg, replacing decennial tetanus-diphtheria booster with tetanus, diphtheria, and acellular pertussis vaccine for adolescents and adults) should be given.

Section snippets

Methods

The study was approved by the Institutional Review Boards at both Mayo Clinic and Olmsted County Medical Center. This is a retrospective, population-based case-control study of 164 eligible children and adults who had pertussis and 328 age- and sex-matched control subjects during the outbreak of B pertussis infection in Olmsted County, Minnesota, between January 1, 2004, and December 31, 2005. The study compared a history of asthma between pertussis cases and matched control subjects.

Study subjects

The characteristics of the subjects are summarized in Table II.32 Of the 223 reported pertussis cases, 164 were eligible, and 59 were excluded (47 were due to non–Olmsted County residency, and 12 were due to no research authorization). From the pool of eligible control subjects, 328 were matched (2:1) to cases within a median of 34 days from the index date of pertussis (ie, PCR test date for cases). Of the 164 cases, 50.0% were male, and 82% were white. The median age at the index date of

Discussion

Our study results show that asthma is associated with an increased risk of pertussis. The results were still significant after adjusting for the potential covariates and confounders. Our study findings are unlikely to be due to detection bias, which occurs when exposure (asthma status) affects detection of outcome (pertussis). For example, if detection bias significantly affects our study, we might expect to observe a stronger association between a physician’s diagnosis of asthma and the risk

References (68)

  • D.I. Grove et al.

    Humoral and cellular immunity in asthma

    J Allergy Clin Immunol

    (1975)
  • S. Krassilnikova et al.

    Changes in anti-pertussis titers in adults following pertussis vaccine

    J Allergy Clin Immunol

    (2006)
  • S.L. Prescott et al.

    Raised serum IgE associated with reduced responsiveness to DPT vaccination during infancy

    Lancet

    (1998)
  • I. Marenholz et al.

    An interaction between filaggrin mutations and early food sensitization improves the prediction of childhood asthma

    J Allergy Clin Immunol

    (2009)
  • S. Weidinger et al.

    Filaggrin mutations, atopic eczema, hay fever, and asthma in children

    J Allergy Clin Immunol

    (2008)
  • L.C. Schneider et al.

    Abnormal immune response to varicella vaccine in subjects with atopic dermatitis compared to non-atopic controls

    J Allergy Clin Immunol

    (2008)
  • S. Black

    Epidemiology of pertussis

    Pediatr Infect Dis J

    (1997)
  • D. Guris et al.

    Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996

    Clin Infect Dis

    (1999)
  • M. Tanaka et al.

    Trends in pertussis among infants in the United States, 1980-98

    JAMA

    (2003)
  • Pertussis Report 2010. The California Department of Public Health. Available at:...
  • Summary of notifiable diseases, United States, 2003

    MMWR Morb Mortal Wkly Rep

    (2003)
  • M. Pichichero et al.

    Acellular pertussis vaccine booster combined with diphtheria and tetanus toxoids for adolescents

    Pediatrics

    (2006)
  • M.E. Pichichero et al.

    Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults

    JAMA

    (2005)
  • Notifiable diseases/deaths in selected cites weekly information

    MMWR Morb Mortal Wkly Rep

    (2004)
  • Centers for Disease Control and Prevention. Pertussis fast facts. 2011. Available at:...
  • K.M. Bisgard et al.

    Infant pertussis: who was the source?

    Pediatr Infect Dis J

    (2004)
  • M. Lethbridge-Cejku et al.

    Summary of health statistics for US adults: national health interview survey, 2003

    (2005)
  • Anonymous

    Forecasted state-specific estimates of self-reported asthma prevalence—United States, 1998

    MMWR Morb Mortal Wkly Rep

    (1998)
  • World Health Organization. Fact sheet for asthma. 2005; Fact sheet for asthma N307. Available at:...
  • C. Anandan et al.

    Is the prevalence of asthma declining? Systematic review of epidemiological studies

    Allergy

    (2010)
  • T. Talbot et al.

    Asthma as a risk factor for invasive pneumococcal disease

    N Engl J Med

    (2005)
  • J.L. St Sauver et al.

    Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester Epidemiology Project

    Am J Epidemiol

    (2011)
  • C.J. Hogue et al.

    Estimators of relative risk for case-control studies

    Am J Epidemiol

    (1983)
  • M.J. Loeffelholz et al.

    Detection of Bordetella holmesii using Bordetella pertussis IS481 PCR assay

    J Clin Microbiol

    (2000)
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    Supported by the Clinician Scholarly Award from the Mayo Foundation made possible by the Rochester Epidemiology Project (R01-AR30582) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

    Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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