liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Pertussis Immunization in Infancy and Adolescent Asthma Medication
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Analysis and Prevention, Swedish Institute for Cummunicable Disease Control (SMI), Stockholm, Solna, Sweden.
Department of Analysis and Prevention, Swedish Institute for Cummunicable Disease Control (SMI), Stockholm, Solna, Sweden.
Show others and affiliations
2014 (English)In: Pediatrics, ISSN 0031-4005, Vol. 134, no 4, 721-728 p.Article in journal (Refereed) Published
Abstract [en]

Context: Lack of infections might contribute to increased risk of asthma among children according to the ‘hygiene hypothesis’. Childhood immunization may play a causal role in the development of asthma.

Objective: To determine whether pertussis immunization in infancy is associated with asthma medication in adolescence.

Design, Settings and Participants: After 14 years of no general pertussis vaccination, almost 80,000 children were immunized for pertussis during a 12-month period in a vaccination trial. They were compared with almost 100,000 non-vaccinated children born during a 6-month period before and after the vaccination trial in a Swedish national cohort study. Information concerning dispensed prescribed asthma medication for each individual in the cohort during 2008–2010 was obtained from the National Prescription database. Multivariable regression models were used to calculate the effect size of vaccination on dispensed asthma medication (Odds ratios and 95% confidence intervals), both in an intent-to-treat model as well as per protocol. The large study size also enabled us to detect very small effects.

Main Outcome Measure: Dispensed prescribed asthma medication at the age of 15 years occurring after pertussis immunization in infancy.

Results: No statistically significant effect of vaccination was found, regardless of vaccination schedule or vaccine type. The prevalence rates of any dispensed anti-inflammatory medication or any asthma medication at 15 years of age were 4.6% and 7.0%, respectively. The crude odds ratios (OR) for any asthma medication and anti-inflammatory treatment in pertussis-vaccinated children after intent-to-treat analysis were 0.97 (95% CI 0.93 – 1.00) and 0.94 (0.90 – 0.98),respectively. Corresponding adjusted ORs were 0.99 (0.95 – 1.03) and 0.97 (0.92 – 1.01),respectively. Similar ORs were found after per-protocol analysis.

Conclusion: Pertussis immunization in infancy does not increase the risk of asthma medication in adolescents. Our study presents evidence that pertussis immunization in early childhood can be considered safe with respect to long-term development of asthma.

Place, publisher, year, edition, pages
APP Journals & Periodicals , 2014. Vol. 134, no 4, 721-728 p.
National Category
URN: urn:nbn:se:liu:diva-85157DOI: 10.1542/peds.2014-0723ISI: 000343140500055OAI: diva2:565597

On the day of the defence date the status of this article was Manuscript and the title was Does pertussis in infancy increase the risk of asthma medication in adolescents?.

Available from: 2012-11-07 Created: 2012-11-07 Last updated: 2015-03-30Bibliographically approved
In thesis
1. Early life factors and the long-term development of asthma
Open this publication in new window or tab >>Early life factors and the long-term development of asthma
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Asthma, a huge burden on millions of individuals worldwide, is one of the most important public health issues in many countries. As genetic and   environmental factors interact, asthma may be programmed very early in life, perhaps even in utero.

The aim of this thesis was to assess the impact of gestational age, cord blood immunoglobulin E (IgE), a family history of asthma, migration, and pertussis immunization in early life on the development of asthma in child and adult populations.

As a proxy for asthma disease, dispensed asthma medication was used as the main outcome variable based on data from the Swedish Prescribed Drug  Register. Data from other national registers were used to control for  confounders. Three of our studies were based on national cohorts, and one on a local birth cohort that was initiated in 1974–75.

Gestational age had an inverse dose-response relationship with dispensed asthma medication in 6– to 19-year-olds. Odds ratios for dispensed asthma medication increased with degree of prematurity compared with children born in term. Furthermore, asthma medication was more likely to be dispensed among children and adolescents born early term after 37–38 weeks’ gestation than among those at the same age who were born in term.

Elevated cord blood IgE and a family history of asthma in infancy were associated with a two- to threefold increased likelihood of dispensed asthma medication and self-reported allergen-induced respiratory symptoms at the age of 32–34 years, but the predictive power was poor.

Age at migration had an inverse dose-response relationship with dispensed asthma medication at the age of 6–25 years in adoptees and foreign-born children with foreign-born parents. International adoptees and children born in Sweden to foreign-born parents had three- to fourfold higher rates of asthma medication compared with foreign-born children who were raised by their foreign-born birth parents.

No association was found between pertussis immunization in early infancy and dispensed asthma medication in 15-year-olds. The type of vaccine or vaccine schedule did not affect the outcome.

Fetal life is a vulnerable period. This thesis strengthens the evidence that every week of gestation is important for lung maturation. Cord blood IgE, however, did not predict the risk of asthma in adults. Furthermore, the study of migrating populations demonstrated that environmental changes at any age during childhood may affect the risk of asthma. Another, important public health message from this thesis is that vaccination against pertussis in early childhood can be considered safe with respect to the long-term development of asthma.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 92 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1329
asthma, birth cohort, national register
National Category
urn:nbn:se:liu:diva-85159 (URN)978-91-7519-794-4 (ISBN)
Public defence
2012-12-06, Berzeliussalen, Hälsouniversitet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Available from: 2012-11-19 Created: 2012-11-08 Last updated: 2013-05-13Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Vogt, HartmutNilsson, Lennart
By organisation
Division of Clinical SciencesFaculty of Health SciencesDepartment of Paediatrics in LinköpingDivision of Inflammation MedicineAllergy Center
In the same journal

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 135 hits
ReferencesLink to record
Permanent link

Direct link