A major cause of pertussis resurgence: gaps in vaccination coverage.

TO THE EDITOR—We read with great interest Plotkin’s excellent article, “The Pertussis Problem,” and we agree wholeheartedly that there is an obvious need for improvements in the acellular pertussis vaccine if we are to ultimately prevent what was once believed to be a completely preventable disease [1]. However, we believe his article misses on the second half of the story, which is the dismally low use of available vaccines. A significant vaccination gap exists, and new vaccinations alone will not solve the challenges of pertussis unless adequate vaccination coverage is ensured. Vaccine coverage in both developed and developing countries remains remarkably low, and there have been multiple updates in the past several years that may elude some providers [2]. Ensuring adequate vaccination coverage remains a major challenge. Several studies have demonstrated substantial gaps in pertussis vaccination coverage (eg, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap] coverage ranging from 5.9% to 45.5%) and in adherence with recommendations, including by patients with free access to medical care and those with adequate insurance coverage [3–5]. Despite a record number of pertussis cases in 2012, data suggest that only 14% of all adults and 26% of those living with infants had received Tdap [6].The problem is amplified worldwide where an estimated 22.6 million children did not complete the appropriate pertussis vaccination series (3 doses in the first year of life) [7].Unfortunately, this leaves the most vulnerable patients at risk. Additionally, it is very disappointing that healthcare workers have demonstrated low rates of vaccination as well [8]. In order to improve vaccination, healthcare organizations need to think outside the box and consider a multipronged approach to vaccination (Table 1) [9]. Plotkin correctly recognizes that such strategies as depicted would be a costly public health strategy. However, a growing body of literature suggests that