Aimee Simone, Editorial Intern

A new study finds that the effectiveness of the pertussis vaccine wanes in the 5 years after children receive their last dose, which may help explain recent outbreaks.

The United States is on track to have the 

highest number of whooping cough cases this year since the late 1950s

, despite a high rate of vaccination against the condition. Many have suspected that the waning effectiveness of the diphtheria, tetanus, acellular pertussis (DTap) vaccine over time is to blame for recent outbreaks. Support for this hypothesis can be found in a new 

The DTap vaccine is typically administered to children in 5 doses, starting at the age of 2 months and ending between the ages of 4 and 6 years. A booster shot (called Tdap) is recommended at the age of 11 or 12 years. Prior to 1997, a whole-cell version of the pertussis vaccine was available, but it was phased out due to unproven concerns over an association with neurological problems and adverse reactions.

The new case-control study, which was conducted between 2006 and 2011, assessed the risk of pertussis in children aged 4 to 12 years who received health care from Kaiser Permanente Northern California during the 5 years following their fifth dose of the vaccine. A group of 277 pertussis-positive case patients was compared with a control group of 3318 pertussis-negative children and a group of 6086 matched controls.

The researchers found that the odds of contracting pertussis increased by 42% each year after receipt of the fifth DTap dose. Based on these findings, if the initial effectiveness of the vaccine were 95%, it would decrease to 71% after 5 years, and if it were 90%, it would decrease to 42% in 5 years. The researchers also found that, on average, pertussis-positive children received their fifth DTap dose earlier than children in both sets of controls.

In addition, a greater portion of older children were pertussis-positive, with most cases occurring between the ages of 8 and 11 years. The number of cases dropped, however, between the ages of 12 and 15 years. (The researchers note that children aged 12 to 15 years during the study period were old enough to have received the whole-cell vaccination as infants, possibly giving them greater protection against pertussis.)

In light of recent whooping cough outbreaks, researchers suggest that administering the Tdap booster shot to younger children may be advisable. However, they point out that developing a new vaccine would constitute a better, more permanent solution.

“Prevention of future outbreaks will be best achieved by developing new pertussis-containing vaccines that provide long-term immunity,” the researchers write.

In the meantime, Nicola Klein, MD, PhD, co-director of the Kaiser Permanente Vaccine Study Center and lead author of the study, emphasized that children should continue to receive the recommended sequence of 5 DTaP shots.

“The DTaP vaccine is effective and remains an important tool for protection against whooping cough for children and the communities in which they live, and following current CDC recommendations remains important,” she said in a press release.

Articles

Pertussis Vaccine Appears to Lose Strength Over Time

Customer satisfaction with mail-order pharmacies declined again in an annual study by J.D. Power and Associates.

Customer satisfaction scores for mail-order pharmacies continue to decline, falling short of those for brick-and-mortar pharmacies, according to the 

 of the 2012 U.S. Pharmacy Study conducted by J.D. Power and Associates.

The study, released on September 27, 2012, scored customer satisfaction on a 1000-point scale and was based on responses from more than 12,700 pharmacy customers who filled a prescription during 2012. The average score for mail-order pharmacies was 792, while the average score for all brick-and-mortar pharmacies, which include chain pharmacies, supermarket pharmacies, and mass merchandisers, was 814. (Compared with the 2011 study, the average score for mail-order pharmacies was down 14 points and the average score for brick-and-mortar pharmacies was down 4 points.) The average score for all supermarket pharmacies was 822; for all mass merchandisers, 798; and for all chain pharmacies, 799.

Customer satisfaction with mail-order pharmacies was measured in 4 areas: cost competiveness, prescription delivery, ordering, and customer service. The study found that satisfaction decreased in each category, especially cost competiveness, which is generally seen as the main advantage of mail-order pharmacies.

The decline in satisfaction is most likely tied to customer service, according to Rick Millard, senior director of the healthcare practice at J.D. Power and Associates.

“Customer service is becoming an increasingly important advantage of the brick-and-mortar pharmacy experience,” Millard said in a press release. “The pharmacist is at the heart of that customer service. While the majority of customers don’t speak with the pharmacist, their presence may help draw customers to stores.”

Customer satisfaction with brick-and-mortar pharmacies was measured in 5 areas: ordering and pickup process, store, cost competiveness, non-pharmacist staff, and pharmacist. The researchers found that, after location, customer service was the most important factor to consumers when choosing a particular pharmacy.

The study found that 37% of customers who use in-store pharmacies are asked by the pharmacy staff if they want to speak with a pharmacist, a slight increase from 35% in 2011. Among the 23% of customers who speak with a pharmacist in person, 61% purchased additional OTC medications during their visit, compared with just 24% of those who do not speak with a pharmacist.

“Pharmacists, who are viewed as one of the most highly esteemed professional groups, are there to provide customer service, not just dispense prescriptions,” said Millard. “It’s surprising that more customers don’t utilize the opportunity, given that pharmacists provide free health advice, and you don’t have to make an appointment.”

Among chain drug stores, Health Mart ranked highest in terms of customer satisfaction, with a score of 848. Good Neighbor Pharmacy and the Medicine Shoppe Pharmacy tied for second, with a score of 843.

Sam’s Club ranked highest among mass merchandiser pharmacies with a score of 838, followed by Target (835) and Costco (819).

Publix ranked highest for the third consecutive year in the supermarket segment, with a score of 872. Wegmans ranked second (861), followed by Winn-Dixie/Bi-Lo (842).

Kaiser Permanente Pharmacy ranked highest among mail-order pharmacies for the fourth consecutive year, with a score of 847, followed by Humana RightSourceRx (805).

To read our article about the results of last year's survey, click 

Mail-Order Pharmacy Customer Satisfaction Declines

A recent study finds pre-diluted gray tattoo ink to be the cause of a 

skin infection outbreak in Rochester, New York.

Researchers studying a recent outbreak of tattoo infections in Rochester, New York, urge tattoo patrons to take skin reactions seriously.

, which was published in the September 13, 2012 edition of the 

, investigates the cause of infections with 

, bacteria that is sometimes found in tap water, in 19 patrons of the same tattoo artist at the same parlor. Researchers determined that a premixed gray ink, popularly used in portrait and photography tattoos, was the source of the infection.

The Monroe County Department of Public Health began the investigation on January 4, 2012, after receiving a report from a dermatologist of a 20-year-old man who had developed a rash that resisted treatment. The infection began after he received a new tattoo in October 2011. (The man had gotten previous tattoos without health problems.) After a skin biopsy, the rash was confirmed to be caused by infection with 

Investigators identified 18 other patients with similar rashes who had obtained tattoos from the same artist at the same tattoo parlor. Based on an examination of the facilities and interviews with clients, public health officials found no fault in the health and safety practices of the parlor. However, they did learn that the artist had used a new hand-blended, diluted gray wash ink from May to December 2011.

The FDA inspected the ink manufacturer, which was based in Arizona, collecting samples and sending them to the Centers for Disease Control and Prevention (CDC) for analysis. Skin biopsies were performed on 17 out of 19 patients and evaluated at the University of Rochester Medical Center. 

was found in 14 of the 17 biopsies. The CDC found the bacteria in the ink as well.

As a result, the CDC issued an alert regarding the outbreak, and the manufacturer voluntarily recalled the premixed ink. To help minimize the likelihood of future outbreaks, researchers provided information and educational materials to tattoo artists and patrons at a trade show in Rochester.

The researchers suggest that in order to prevent future infections associated with tattoos, ink manufacturers need closer monitoring.

“Our investigation of this outbreak shows that premixed ink contaminated before distribution poses a risk to public health, which may suggest the need for enhanced oversight of not just tattooing but also the inks used in tattooing to ensure public safety,” the researchers write.

However, the researchers suggest that the most important thing tattoo patrons can do is to acknowledge rashes and reactions before they become difficult to handle.

“Patients and doctors need to have a certain level of suspicion when they see a rash developing in a tattoo,” said Mary Gail Mercurio, MD, a dermatologist at the University of Rochester Medical Center who saw most of the patients in the study, in a press release. “Many of the patients I saw thought their skin was just irritated and the issue would go away during the healing process. In actuality, they had an infection that needed to be treated with an antibiotic; it wasn't going to go away easily on its own."

A recent study finds pre-diluted gray tattoo ink to be the cause of a Mycobacterium chelonae skin infection outbreak in Rochester, New York.