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Vaccinations are one of the most effective measures of preventing infection illnesses. In Germany adequate vaccination rates have so far been achieved only partially. 85 - 90 % of all vaccinations are carried out by the general practitioner, who in this context plays a key role. He/she assumes varied duties such as advice on vaccinations, administering vaccines and recording it. Visits to a doctor should also be used for checking on vaccination protection and if necessary its updating. In addition continual updating the vaccination recommendations of the Permanent Vaccination Commission (Standige Impfkommission) should be followed as guideline. Regardless of the recommended vaccinations for adults additional indications for vaccinating individuals e. g. pertussis vaccination, can be put into effect. Vaccinations of adults should always be carried out by taking into account a persons?s life situation.

The aim of this study was to analyze Bordetella pertussis isolates circulating, between 1991 and 1995, in Niakhar, Senegal area where the pertussis vaccination coverage was low and to compare them with those circulating in France, before and after introduction of generalized pertussis vaccination for toddlers in 1959. We carried out bacteriological analyses, typing, genotyping and DNA microarray analyses. We found that the isolates circulating in Senegal between 1991 and 1995 are part of the same Pulsed Field Gel Electrophoresis Group, express the same antigens and possess the same gene deletions than isolates circulating in France before the introduction of vaccination, but are different from those circulating in 1991-1995. We confirmed the influence of pertussis vaccination on circulating isolates and that isolates vary with the pertussis cycle.

Objective: To evaluate the attitudes of pediatric healthcare workers (HCWs) toward pertussis vaccination. Method: A survey was conducted among pediatric HCWs, using an anonymous questionnaire, at a university children's hospital. Results: Of 298 eligible employees, 121 (40.6%) completed the questionnaire. Lack of information regarding the personal risk of acquiring a pertussis infection and fear of side effects were frequently associated with the refusal of getting immunized. Conclusion: Misconception about pertussis vaccination was prevalent, especially among nursing staff, who are in even closer contact with at-risk children than physicians. Intervention strategies should be designed with focus on nursing staff. Our findings confirm the importance of comprehensive approaches for more education on HCWs to improve acceptance of vaccination.

Rationale Worldwide, experts in vaccinology have promoted the broad annual coverage of health care workers with the influenza vaccine. Furthermore, pertussis vaccination is now recommended for young adults and health care workers working with newborns. Aim To analyse the compliance with these guidelines among experts responsible for the development or dissemination of national immunization schedules. Method A cross-sectional survey was conducted in a vaccinology workshop group of French experts, using a self-administered questionnaire. Results Among 44 experts, the average rate of influenza vaccination was 69.5% (95% confidence interval, 61.6% to 77.3%) between the 2003/04 and 2005/06 flu seasons, whereas the rate of pertussis vaccination during this period was only 30%. The main reasons that the experts gave for not being vaccinated were a lack of time or simply not remembering to do so. Conclusion Experts had low coverage rates for influenza and pertussis vaccination. To improve these rates, a multifaceted intervention combining audit and feedback strategy with a vaccine day is planned.

SUMMARY Pertussis, an acute respiratory infection caused by Bordetella pertussis, classically manifests as a protracted cough illness. The incidence of pertussis in the United States has been increasing in recent years. Immunity wanes after childhood vaccination, leaving adolescents and adults susceptible to infection. The transmission of pertussis in health care settings has important medical and economic consequences. Acellular pertussis booster vaccines are now available for use and have been recommended for all adolescents and adults. These vaccines are safe, immunogenic, and effective. Health care workers are a priority group for vaccination because of their increased risk of acquiring infection and the potential to transmit pertussis to high-risk patients. Health care worker vaccination programs are likely to be cost-effective, but further research is needed to determine the acceptability of pertussis vaccines among health care workers, the duration of immunity after booster doses, and the impact of vaccination on the management of pertussis exposures in health care settings.

Information on subjects who had at least three immunisations against pertussis was provided by longitudinal data from the 1970 British Cohort Study (BCS70) and used to assess whether three whole-cell pertussis (wP) immunisations given within less than 5 months confer less effective protection in childhood compared with a schedule with a longer interval.Age at pertussis infection was the dependent variable in a Cox regression analysis, to investigate associations with duration between first and third pertussis immunisation; with third immunisation modelled as a time-dependent covariate. Adjustment was for number of pertussis immunisations (three or four), sex, social class and other potential confounding factors.A total of 8545 children were included in the analysis and 556 had a history of whooping cough. A duration of over 4 months between first and third pertussis immunisations is statistically significantly associated with a reduced risk of pertussis infection by age 10 years, compared with three immunisations given over a shorter period, producing a statistically significant adjusted hazard ratio of 0.74 (0.62-0.92). A fourth immunisation against pertussis further enhanced the protective effect with a hazard ratio of 0.59 (0.44-0.82).These results were based on a historical UK cohort using wP vaccine, and indicate that a vaccination schedule with an interval between the immunisations greater than 4 months, and also including a fourth immunisation, would be more effective in this population than a three dose schedule within a shorter interval without booster.

SUMMARYA compartmental, age-structured mathematical model was developed and recent US pertussis epidemiology data were used to evaluate the impact on pertussis infection rates of routine and targeted adult immunization strategies. Model simulations predict that the implementation of adolescent immunization only could reverse the current rise in pertussis infection rates but may lead to a resurgence of pertussis in subsequent decades. In contrast, inclusion of a routine adult strategy is likely to lead to sustained control of pertussis. Routine adult vaccination could control the disease even with relatively low coverage rates of 40% for routine vaccination of all adults every 10 years, or 65% for a targeted vaccination of close contacts of newborns completed by one booster dose for all adults. The model also predicts that the optimal age for this booster dose is 40 years. These results support the 2006 American Academy of Immunization Practices' recommendations for adolescent and adult vaccination against pertussis.

In Taiwan, routine pertussis immunization has been implemented for more than 40 years and a low incidence of pertussis was maintained until an 80-fold increase in cases occurred in 1992. The unexpected increase emphasized the significance of pertussis. This study evaluated a total of 2452 reported cases of pertussis during 1993–2004 and surveillance data on incidence, age distribution and seasonality. The highest morbidity was in infants aged

Pertussisis an acute vaccine-preventable respiratory disease that remains a publichealth problem. In an attempt to improve the control of the disease, manycountries have incorporated new boosters in their vaccination schedule. Since the incorporation of these boosters is relatively recent, there are not enoughdata about their impact to support and/or universalize their use. Alternativestrategies such as the improvement in vaccine coverage and reduction invaccination delays, in addition to the incorporation of boosters, could beimplemented. Though these strategies are not new, they have not been adequatelyevaluated in order to be implemented and/or prioritized. To evaluate thepotential impact of these alternative strategies on pertussis incidence, wedeveloped a methodology that involves the use of data collected from vaccination centers and an age-structureddeterministic mathematical model for pertussis transmission. The results obtainedshow that strategies that avoid delays in vaccination have a strong impact onincidence reduction in the most vulnerable population (infants less than 1y). Inregions with high vaccination coverage (95%) the elimination of delays in thethree primary doses decreases pertussis incidence in infants by approximately20%. In regions where delays in the administration of vaccines are higher, thecombined action to reduce delays and improve coverage leads to a significantimprovement in disease control in infants. By repeating the calculations usingdifferent sets of parameters that describe different possible epidemiologicscenarios, we determined the robustness of our results. All the results presented highlight theimportance of having high vaccine coverage and shorter delays in vaccine administrationin order to reduce the impact of the disease in infants. Fil: Pesco, Pablo Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentina. Universidad Nacional de la Plata; Argentina Fil: Bergero, Paula Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentina. Universidad Nacional de la Plata; Argentina Fil: Fabricius, Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentina. Universidad Nacional de la Plata; Argentina Fil: Hozbor, Daniela Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Biotecnología y Biología Molecular; Argentina. Universidad Nacional de la Plata; Argentina

Highlights •Two hospitals implemented booster vaccination programmes in response to suspected staff exposure to pertussis. •Perceived vulnerability of patients was the single most important reason for healthcare workers accepting vaccination. •Pertussis vaccine uptake was high among those who had not received influenza vaccination the previous year. •Self-reported adverse effect profile following vaccination was reassuring. •Fourteen percent of staff reported a recent illness compatible with pertussis but had not notified occupational health.

Conventional wisdom suggests that if there is a vaccine that is effective in preventing a disease, vaccine uptake will increase when the disease risk is high. Recent evidence, however, suggests that this may not always be the case. In a study we conducted in Washington State, we found no population-level increase in pertussis vaccination of infants during a pertussis epidemic. In this paper, we aim to review what is known about the history of vaccine uptake during epidemics of vaccine-preventable disease, the challenges facing public health campaigns responding to these epidemics, and how the effect of a vaccine-preventable disease epidemic on vaccine uptake can be studied.

BACKGROUND: Pregnant women have an increased risk for complications and hospitalizations when infected with the influenza virus in the second or third trimester. Additionally, infants under six months of age are most vulnerable when contracting pertussis. Immunization against influenza and pertussis during pregnancy provides protection for mother and neonate against influenza and for neonates against pertussis pending protection through infant immunization. In Belgium, a gradual increase in pertussis cases over the past decade was observed. This study was undertaken to document vaccination coverage for influenza and pertussis and factors related to vaccination status in pregnant women. METHODS: Two hundred and fifty pregnant women completed a questionnaire during their third trimester. Vaccination data were collected and reasons for non-vaccination were noted as well as socio-demographic data which are known to influence vaccination coverage. RESULTS: A documented vaccination coverage of 42.8% for influenza and 39.2% for pertussis was observed. Taking into account doses which were not documented, but administered according to the expectant mother, coverage for influenza would increase to 62% and for pertussis to 46%. The most important reasons for non-vaccination were the absence of a recommendation by medical staff (9.6%) and delay in vaccination (8.4%). The GP was the most important vaccinator. Pregnant women with a lower education and those with a foreign origin were more vulnerable for non-vaccination. CONCLUSION: Incomplete documentation is the most important barrier in determining the vaccination status of pregnant women. Immunization during pregnancy needs further integration through vaccination campaigns aimed at both health care providers and pregnant women. publisher: Elsevier articletitle: Influenza and pertussis vaccination coverage in pregnant women journaltitle: Vaccine articlelink: http://dx.doi.org/10.1016/j.vaccine.2015.03.020 content_type: article copyright: Copyright © 2015 Elsevier Ltd. All rights reserved. ispartof: Vaccine vol:33 issue:18 pages:2125-31 ispartof: location:Netherlands status: published

Approximately one million adult pertussis cases occur annually in the US, and infants still die from pertussis. Computer simulations were used to predict the impact of vaccination of children, adults and/or adolescents, and household members of newborns (cocoon strategy). Childhood vaccination greatly reduced cases in children, but increased the incidence in adolescents and adults. Routine adolescent and adult vaccination had a large direct effect, whereas the cocoon strategy had a predominantly indirect effect on young infants. The number needed to vaccinate (NNV) to prevent a case of typical pertussis in the entire population was lowest for the adolescent strategy. The cocoon strategy had the lowest NNV to prevent a case of typical pertussis in young infants. The current vaccination schedule, local epidemiological data, age-specific cost of pertussis cases, and accessibility of the target population will determine which strategy has the highest likelihood of success in achieving the public health goal.

Hospitalisation and death from pertussis in highly immunised populations largely occurs before the first vaccination at 2 months. A Markov model was constructed to estimate the costs and health consequences of three strategies to reduce pertussis over the first 6 months of an infant's life. Earlier vaccination (at either birth or 1 month in addition to current practice) or vaccination of the parents soon after birth was compared with the current practice of vaccination at 2, 4 and 6 months. The model was populated using data on the incidence and costs from Australia. Disability-adjusted life-years (DALYs) were used as the primary outcome measure. The cost to the Australian public health system was chosen as the economic perspective, and Monte-Carlo simulations were used to accommodate uncertainties in the variables. Vaccination at birth was estimated to cost (S.D.) an additional A$33.21 (A$1.60) per infant and to reduce cases, deaths and DALYs by 45%. Vaccination at 1 month was estimated to cost an additional A$43.24 (A$8.98) per infant and to reduce morbidity by approximately 25%. Parental vaccination at birth was the most expensive alternative, costing an additional A$73.38 (A$4.98) per infant and reducing pertussis morbidity by 38%. The costs per DALY averted were A$330,175 (A$15,461) A$735,994 (A$147,679) and A$787,504 (A$48,075) for the birth, 1 month and parental vaccination strategies, respectively. Changing the estimated factor by which hospitalisations and deaths are under-reported, and the efficacy of early vaccination, had large effects on results. Parental vaccination at birth was most cost-effective where protection persisted for subsequent children. The birth vaccination strategy appears to offer the greatest potential benefit for one-child families, but the efficacy at birth (and 1 month) needs to be established.

L'histoire de l'implementation du vaccin contre la coqueluche aux Etats-Unis au XXe siecle, et les controverses qui ont marque l'adoption du vaccin, nees de la decouverte des risques accompagnant les pratiques de vaccination. Les auteurs presentent d'abord la maladie avant de s'interesser au vaccin et a la connaissance scientifique concernant les effets et reactions observes apres les vaccinations. Le processus qui a conduit a l'elaboration d'un vaccin plus sur dont on maitrise les effets secondaires est decrit dans la derniere partie de l'article.

Vaccine safety has become a major community concern and of particular importance for parents, vaccine recipients and vaccine providers. A hypotonic-hyporesponsive episode (HHE) is a sudden and unexpected episode of loss of tone, unresponsiveness and colour change which uncommonly affects infants and children after vaccination. Although any vaccine may be associated with this adverse event, HHE usually follows administration of a pertussis containing vaccine. There has been renewed interest in this adverse event in the light of community concerns regarding vaccine safety. The focus of this interest has been to formulate an acceptable case definition, to document possible risk factors and to better define the outcome of HHE. In addition, studies have documented the outcome of revaccination of children who have had an HHE. Although much remains to be learnt about HHE it would appear that there are no long-term sequelae and that children who have had an HHE can be revaccinated. Parents should be provided with the available information such that they can make an assessment of the risks and benefits of pertussis vaccination. The benefits of pertussis vaccination still outweigh the risk and universal childhood pertussis vaccination should continue to be advocated.

Pertussis notifications have increased over the past decade in Australia and other industrialised countries. This study estimates the effectiveness of pertussis vaccination in one Australian State (New South Wales, NSW) among children aged less than 14 years, during a period when an Australian whole- cell pertussis vaccine was in routine use. Cases noti- fied with pertussis between 1996 and 1998 and pertussis vaccine coverage estimates from the Aus- tralian Childhood Immunisation Register were used. Vaccine effectiveness (VE) was calculated using the screening method, with adjustment for age group, year of disease onset and area of residence. VE was highest (91%) in the youngest age group (8- 23 months) and lowest (78%) in the oldest age group (9-13 years). Pertussis vaccination is highly effective at preventing pertussis in NSW children, as measured by notified cases. Ongoing monitoring will be im- portant to evaluate VE following Australia's change to an acellular vaccine based program.

Maternal pertussis vaccination provides more than 90% protection for babies in the first two months of life, the critical period before they can receive their first childhood jabs, research has shown.1 In 2012 the Department of Health urged pregnant women to be vaccinated against whooping cough because of rising numbers of cases in infants.2 The UK’s Joint Committee on Vaccination and Immunisation recommends that vaccination should be offered from gestational weeks 16 to 32 to help babies …

In Spain, whole cell pertussis vaccination started in 1975, with three doses before the age of 6-7 months. Doses at 15-18 months and 4-6 years were introduced in 1996 and 2001, respectively. Spain switched to an acellular vaccine in 2005. From 1998 to 2009, pertussis incidence rates remained ≤1.5 cases/100,000 inhabitants but increased from 2010 to 7.5 cases/100,000 in 2012. Data from 1998 to 2012 were analysed to assess disease trends and susceptible populations. We defined four epidemic periods: 1998-2001 (reference), 2002-05, 2006-09 and 2010-12. In 2002-05, the incidence rate increased in individuals aged 15-49 years (IRR: 1.41 (95% CI: 1.11-1.78)) and ≥50 years (IRR: 2.78 (95% CI: 1.78-4.33)) and in 2006-09 increased also in infants aged

Despite pertussis vaccination rates in excess of 95%, pertussis rates in the United States have been rising over the last 30 years, with increasingly larger outbreaks in 2004, 2010, and 2012. The reasons for this resurgence of pertussis are not clearly understood. The recent development of a baboon model of pertussis, along with the future development of a human challenge model of pertussis, has the potential to provide a path forward for answering critical questions about pertussis pathogenesis and host responses and will likely aid in the development of next-generation pertussis vaccines.

Background: Vaccination rates of children in Germany are unsatisfying and regional endemic outbreaks have been reported. Few studies have analysed physicians’ attitude towards vaccination. We investigated whether there is an association between physicians’ attitude and vaccination coverage on the regional level for Germany. Methods: In a representative cross-sectional survey, anonymized questionnaires were sent to random samples of all paediatricians (50%) and general practitioners (10%) in private practice in Germany. Attitude towards vaccination was operationalized in three scores. Measles and pertussis vaccination coverage rates were obtained from the 16 Federal States’ Health Departments. Geographic methods and linear regression models were used for analysis. Results: A total of 2010 paediatricians (response proportion: 64.1%) and 1712 general practitioners (response proportion 39.1%) were included in the analysis. We found an association of physicians’ attitude towards vaccination and vaccination coverage rate ( P < 0.0001). There is also an important association between vaccination coverage and the geographic location, with lower coverage rates especially in the States of former Western Germany (compared with our reference State Mecklenburg - Western Pomerania; pertussis: maximum −5.86% in Bavaria, P < 0.0001; measles: maximum −20.20% in Berlin, P = 0.0002). Conclusions: The regional association between vaccination coverage rates and physicians’ attitude towards vaccination seems to be superposed by population-related variables. An increase of vaccination coverage requires better information and training of both, physicians and the general population.

Background The compliance with recommendations for Pertussis vaccination was assessed in the Lyon population through vaccination coverage (VC). Methods A cross-sectional study was conducted in collaboration with 10 private biological analysis laboratories between October 2010 and March 2012, on 1930 adults (>19 years of age) from the Lyon area. Proof of vaccination (PV) was requested to prove the current vaccination status. Results A percentage of 30.3% (585/1930) of surveyed individuals provided a PV. A positive vaccination status was confirmed in 10.76% [CI 95% 8.45–13.48] (63/585) and didn’t vary in relation to gender ( P = 0.57), age ( P = 0.06), or level of schooling ( P = 0.41). Coverage vaccination was not updated in parents with childbearing project (84.2% (64/76) [CI 95% 74.7–91.2]) or people in contact with children less than 6 years of age (83.6% (87/104) [CI 95% 75.6–89.8]). Pertussis vaccination wasn’t confirmed in 80.0% (124/155) of those who thought being vaccine up to date. Conclusions The Lyon population poorly complied with the cocooning strategy implemented in 2004. The pertussis vaccine coverage confirmed by a PV proved the inadequate rate of vaccination compared to objectives. It is mandatory to strengthen the vaccinal policy for this vaccine booster.

Recently, pertussis has become a problem also in the adult population, with incidences even higher than in children. Pediatric health care workers (HCWs) are an important source of transmission, exposing very young and immunocompromised patients to an increased risk of potentially severe pertussis infections. Encouraging HCWs to get vaccinated can play a vital role in stopping the transmission of pertussis, thereby reducing institutional outbreaks. In Germany, HCWs come up with all sorts of reasons for not getting pertussis vaccination. This study was meant to provide information in order to better understand the backgrounds of these attitudes. A survey was conducted at the children's university hospital in Frankfurt, using an anonymous questionnaire. Survey results were used to design an intervention to increase the immunization rate of staff. Disappointingly, our efforts to increase the acceptance of the immunization program by providing information in advance were not yet satisfying. Misconception about pertussis vaccination was prevalent especially among nursing staff. The main reasons for non-compliance included: unawareness of an own risk of infection, the belief that pertussis is not a serious illness, fear of side effects, the belief that the pertussis vaccine might trigger the pertussis disease itself, and skepticism about the efficacy of the pertussis vaccination.

Pregnant women and their newborns are at increased risk for influenza-related complications; the latter also have an increased risk for pertussis-related complications. In Germany, seasonal influenza vaccination is recommended for pregnant women since 2010. A dose of pertussis-containing vaccine has been recommended since 2004 for women of childbearing age if they have not been vaccinated within the past 10 years. We conducted a nationwide cross-sectional survey among pregnant women in February/March 2013 to assess knowledge, attitudes, and practices related to influenza vaccination during pregnancy and to identify factors associated with their pertussis vaccination status. In total, 1025 pregnant women participated and provided information through a self-administered questionnaire. Of these, 23.2% were vaccinated against seasonal influenza during the 2012/13 season; 15.9% during their pregnancy. Major reasons for being unvaccinated (n=686 respondents) were lack of confidence in the vaccine (60.4%) and the perception that vaccination was not necessary (40.3%). Influenza vaccination during pregnancy was independently associated with having received influenza vaccine in the previous season, having received a recommendation from a physician, a high level of vaccine-related knowledge and of perceived disease severity. In contrast, knowledge of the recommendation for regular hand-washing to prevent influenza and the perception that vaccine-related side effects were likely to occur or likely to be severe were negatively associated with vaccine uptake. Receipt of a pertussis vaccine in the past 10 years was reported by 22.5% of participants. Pertussis vaccine uptake was independently associated with living in the Eastern federal states and receiving seasonal influenza vaccination annually, while a migration background was associated with a lower uptake. To enhance vaccine uptake in pregnant women and women of childbearing age, special efforts must be undertaken to improve knowledge of both recommendations and the benefits of vaccination. Gynecologists could serve as important facilitators.

Homeschooled children represent an increasing proportion of school-aged children in the United States. Immunization rates among homeschooled children are largely unknown because they are usually not subject to state-based school-entry vaccination requirements. Geographic foci of underimmunized children can increase the risk for outbreaks of vaccine-preventable diseases. In 2012, 2 cases of tetanus were reported in Oklahoma; both cases involved homeschooled children without documentation of diphtheria-tetanus-acellular pertussis vaccination. We describe the characteristics of both patients and outline innovative outreach measures with the potential to increase vaccination access and coverage among homeschooled children.

We use the ARIMA model with intervention in order to analyse the epidemiological situation of whooping-cough in England and Wales for the period of 1940–1990. The ARIMA modelling of this illness contains intervention variables, such as the introduction of widespread vaccination in 1957 and the fall in the level of vaccination down to 30% in 1978. The results of this analysis confirm the role of the intervention variables on the evolution of the morbidity due to whooping-cough, by quantifying their impact on the level of the morbidity, as well as the delay needed before they have an influence on the increase of recorded cases of whooping-cough.

Papers p 902 “No child should be denied immunisation without serious thought as to the consequences both for the individual and the community.” This powerful statement prefaces the chapter on contraindications in the new edition of the United Kingdom's Handbook on Immunisation against Infectious Disease .1 In the 1970s a barricade of contraindications to pertussis vaccine was erected in response to undue concerns about safety. As the evidence has been reassessed, this barricade has now been largely demolished. In 1981, without scientific substantiation, pertussis vaccine was contraindicated for a wide range of conditions, including cerebral irritation in the neonatal period and a family history of epilepsy or other diseases of the central nervous system.2 Interpretation of these recommendations was left to the …

INTRODUCTION In New Zealand, pertussis vaccination is recommended and government-funded during every pregnancy to protect the infant after birth. However, uptake is low and needs to be increased. AIM To investigate enablers and barriers for uptake of the pertussis vaccination by pregnant women in New Zealand, and explore the acceptability of provision in pharmacies. METHODS Women with infants were recruited in selected pharmacies and interviewed using abrief structured interview. Transcripts were analysed using a framework approach. RESULTS Thirty-seven women aged 18–43 years provided data for analysis. Seventeen women reported receiving a pertussis vaccination during their pregnancy. Information from health professionals appeared important to encourage vaccination, but other sources of information (eg antenatal groups and media) were also cited. Non-vaccination arose from being unaware of the need for pertussis vaccination during pregnancy, concerns about safety, and misinformation. Participants supported pertussis vaccination in pharmacies to help access or increase the opportunity for health professionals to inform women. DISCUSSION The information received by participants affected their uptake of the pertussis vaccine during pregnancy. Education of the public and health professionals about the pertussis vaccine during pregnancy is necessary.

Pertussis (“whooping cough”) remains endemic in the United States with disease outbreaks generally occurring every 3–5 years. There has been a steady rise in the total number of cases in the United States since historically low rates were recorded in the 1970s, making it a poorly controlled vaccine-preventable disease. In the first half of 2012, many states reported increased pertussis cases, including but not limited to the ongoing epidemic in Washington State [1]. Im

Background The “Staying Healthy in Child Care” Australian guidelines provide for illness and disease exclusions and encourage vaccination of staff in child care settings, however these requirements are not subject to accreditation and licensing, and their level of implementation is unknown. This study aimed to describe pertussis vaccination coverage in child care workers in a regional area of northern NSW during 2010; review current staff pertussis vaccination practices; and explore barriers to vaccination. Methods A cross sectional survey of all child care centre directors in the Hunter New England (HNE) area of northern NSW was conducted in 2010 using a computer assisted telephone interviewing service. Results Ninety-eight percent (319/325) of child care centres identified within the HNE area participated in the survey. Thirty-five percent (113/319) of centres indicated that they had policies concerning respiratory illness in staff members. Sixty-three percent (202/319) of centres indicated that they kept a record of staff vaccination, however, of the 170 centre’s who indicated they updated their records, 74% (125/170) only updated records if a staff member notified them. Of centres with records, 58% indicated that fewer than half of their staff were vaccinated. Conclusion Many childcare workers have not had a recent pertussis immunisation. This potentially places young children at risk at an age when they are most vulnerable to severe disease. With increasing use of child care, national accreditation and licensing requirements need to monitor the implementation of policies on child care worker vaccination. Higher levels of vaccination would assist in reducing the risk of pertussis cases and subsequent outbreaks in child care centres.

Since the last decades, an increase of reported incidence of pertussis has been observed in many countries, including Poland, despite high vaccination coverage among infants and children. Before the vaccinations era, pertussis was a major cause of morbidity and mortality among infants and young children. Currently, pertussis is increasingly reported in adolescents and adults. The objective of this paper was to present the epidemiology of pertussis in Mazovian region in Poland in years 2005–2009. In this report we analyzed retrospectively the epidemiological data collected by the Sanitary Station in Warsaw, Poland. A total of 1,455 cases of pertussis were reported in the Mazovian region of Poland in the years 2005–2009. The incidence of pertussis ranged from 2.4/100,000 (2006) to 7.9/100,000 (2008). The incidence was the highest in two groups: infants (>1 year of age; from 13.3/100,000 in 2005 to 32.7/100,000 in 2007) and teenagers (age of 10–14 years; from 11.8/100,000 in 2006 to 68.5/100,000 in 2008). The highest proportion of cases was also reported in the 10–14 years age-group (from 26.4% in 2009 to 46.0% in 2008). The number of hospitalizations due to pertussis ranged from 137 (2005) to 46 (2006), while the percentage of cases requiring hospitalization ranged from 37% (2005) to 25% (2007 and 2008). Three hundred ninety two (27%) cases of pertussis were reported among patients with negative or not confirmed history of pertussis vaccination. We conclude that there is an urgent need for booster vaccination against pertussis in adolescents and adults in Poland.

According to this study: * Siblings have surpassed mothers as the most common source of pertussis infection among infants in the United States. * Still, pertussis vaccination of the mother during pregnancy is recommended to directly protect infants.

Background: Several laboratory studies have suggested that many people favor potentially harmful omissions over less harmful acts. The authors studied the role of this omission bias in parents' decisions whether to vaccinate their children against pertussis. Methods: Two hundred mail surveys were sent to subscribers to a magazine that had published articles favoring and opposing pertussis vaccination. Subjects were asked about their beliefs about the vaccine and the disease, and whether they had vaccinated their own children or planned to, and they were given test items to identify omission bias in their reasoning. Results: One hundred and three subjects (52%) responded to the survey. Respondents who reported they did not or would not allow their children to be vaccinated (n = 43; 41 %) were more likely to believe that vaccinating was more dangerous than not vaccinating (p < 0.001 ). They were also more likely to exhibit omission bias (p = 0.004), holding constant their stated beliefs about the danger of the vaccine. Conclusions: Omission bias plays a role in decisions not to vaccinate with pertussis vaccine, beyond the role played by belief about the risk of vaccination. Key words: behavioral sciences; decision making; decision theory; ethics; health policy; judgment; pertussis vaccine; probability; psychology; public health; risk; vaccination; whooping cough. (Med Decis Making 1994;14:118-123)

Universal pertussis vaccination continues to prevent a previously common and serious disease of childhood. Despite widespread gains in disease control, pertussis has not been beaten and remains a m...

SUMMARYWe examined pertussis hospitalizations among infants aged vs. 4·5 months, P=0·12). Seventeen patients required mechanical ventilation. Of the 17 cases, 14 infants were aged

Four patients each had a single subcutaneous nodule at the site of a previous vaccine injection; three after injection of diphtheria, tetanus, and pertussis vaccination and one after tetanus toxoid vaccination. Presentation was with a mass 4–22 months after vaccination at the site of injection. Hist