Canadian Experience With Implementation of an Acellular Pertussis Vaccine Booster-Dose Program in Adolescents: Implications for the United States

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Abstract
In Canada, the epidemiology of pertussis has changed during the past decade such that more cases occur in adolescents than in any other age cohort. The implications of the Canadian experience, as well as the experiences of France, Germany, and Australia, on the universal implementation of an acellular pertussis, diphtheria, and tetanus booster vaccine in the United States are discussed. In 1999, an acellular pertussis vaccine combined with diphtheria and tetanus toxoids formulated for adolescents and adults was licensed for use in Canada. It has taken >5 years for this vaccine to be introduced universally into the immunization programs of all provinces and territories. The delay in implementation has likely been the result of insufficient epidemiologic data available to the National Advisory Committee on Immunization and the lack of a consensus on the appropriate goals of the national pertussis control strategy. Implementation of an immunization program in all parts of the country occurred only after a national consensus was achieved and federal funding was made available for vaccine purchase. The Canadian experience demonstrates that an adolescent pertussis vaccine program can be implemented on a national scale after several factors have been considered.