Abstract
There is limited information on the roles of different age groups in propagating pertussis outbreaks, and the temporal changes in those roles since the introduction of acellular pertussis vaccines. The relative roles of different age groups in propagating the 2010 and the 2014 pertussis epidemics in California were evaluated using the relative risk (RR) statistic that measures the change in the group's proportion among all detected cases before vs. after the epidemic peak. For the 2010-11 epidemic, evidence for a predominant transmission age group was weak, with the largest RR estimates being 1.26 (95% CI 1.08-1.46) (aged 11-13 years); 1.19 (1.01-1.4) (aged 9-10 years); 1.17 (0.86-1.59) (aged 14-15 years); 1.12 (0.86-1.46) (aged 16-19 years) and 1.1 (0.89-1.36) (aged 7-8 years). The 2014 epidemic showed a strong signal of the role of older adolescents, with the highest RR estimate being in those aged 14-15 years (RR = 1.83, 1.61-2.07), followed by adolescents aged 16-19 years (RR = 1.41, 1.24-1.61) and 11-13 years (RR = 1.26, 1.12-1.41), with lower RR estimates in other age groups. As the time following introduction of acellular pertussis vaccines in California progressed, older adolescents played an increasing role in transmission during the major pertussis outbreaks. Booster pertussis vaccination for older adolescents with vaccines effective against pertussis transmission should be considered with the aim of mitigating future pertussis epidemics in the community.