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Epidemiology of Pertussis and Haemophilus influenzae type b Disease in Canada With Exclusive Use of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Poliovirus-Haemophilus influenzae type b Pediatric Combination Vaccine and an Adolescent-Adult Tetanus-Diphtheria-Acellular Pertussis Vaccine: Implications for Disease Prevention in the United States

Greenberg, David P. MD*†; Doemland, Martha PhD*; Bettinger, Julie A. PhD, MPH; Scheifele, David W. MD; Halperin, Scott A. MD§; Waters, Valerie MD; Kandola, Kami MD, MPHfor the IMPACT Investigators

The Pediatric Infectious Disease Journal: June 2009 - Volume 28 - Issue 6 - p 521-528
doi: 10.1097/INF.0b013e318199d2fc
Original Studies

Background: During the decade 1998-2007, a combination DTaP5-IPV/Hib vaccine was used exclusively in Canada to immunize infants and young children against diphtheria, tetanus, pertussis, polio, and invasive Haemophilus influenzae type b (Hib) disease.

Methods: Medline was used to search for publications during 1996–2008 related to the epidemiology and vaccine prevention of pertussis and invasive Hib disease in Canada. Related abstracts and presentations were reviewed, when available, and epidemiologic data since 1985 were obtained from the Public Health Agency of Canada public Web site.

Results: Reports of pertussis have declined substantially in preschool and school-aged children during the past decade, and cyclical peaks in disease incidence have been blunted or eliminated. In provinces and territories where Tdap5 vaccine has been administered to 14- to 16-year-olds, marked reductions of pertussis have been documented in adolescents as well as younger age groups, possibly due to herd immunity. Incidence rates of invasive Hib disease among Canadian children <5 years declined markedly after introduction of Hib conjugate vaccines, and the disease has remained under control with exclusive use of DTaP5-IPV/Hib vaccine. Most cases of invasive Hib disease occur among unimmunized or only partially vaccinated children. The reduction of Hib case reports has been documented throughout Canada, including among Aboriginal children who are at high risk for this disease.

Conclusions: The Canadian experience with DTaP5-IPV/Hib and Tdap5 vaccines is relevant to the United States because immunization schedules, vaccination coverage rates, and epidemiologic patterns of pertussis and Hib diseases are similar in the 2 countries, and because both vaccines are licensed for use in the United States.


From the *Scientific and Medical Affairs, Sanofi Pasteur Inc, Swiftwater, PA; †Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; ‡Vaccine Evaluation Center, BC Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; §Clinical Trials Research Center, IWK Health Center and Dalhousie University, Halifax, Nova Scotia, Canada; ¶Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada; and ∥Stanton Territorial Health Authority, Yellowknife, Northwest Territories, Canada.

Accepted for publication December 22, 2008.

Supported by the Public Health Agency of Canada for pertussis and Hib surveillance.

Presented in part at the Fifth Pediatric Infectious Disease Conference, October 9-11, 2005, Napa, CA.

Some of the surveillance activity reported herein was conducted as part of the Canadian Immunization Monitoring Program Active (IMPACT), a national surveillance initiative managed by the Canadian Paediatric Society (CPS) and conducted by the IMPACT network of paediatric investigators on behalf of the Public Health Agency of Canada (PHAC)'s Center for Immunization and Respiratory Infections.

Address for correspondence: David P. Greenberg, MD, Sanofi Pasteur Inc, One Discovery Drive, Swiftwater, PA 18370. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.