Bentsi-Enchill AD, et al.     Estimates of the effectiveness of a whole-cell pertussis vaccine from an outbreak in an immunized population. Vaccine. 1997 Feb;15(3):301-6. PMID: 9139490; UI: 97227584.     

Bassili WR, Stewart GT.  Epidemiological evaluation of immunisation and other factors in the control of whooping-cough.  Lancet 1976 Feb 28;1(7957):471-4  
The general incidence of whooping-cough is lower in fully immunised children, but present immunisation schedules do not adequately protect the infant below 1 year of age either from contracting infection or from its complications. In a recent outbreak in Glasgow, nearly one-third of notified cases were fully immunised. In Glasgow and probably in the U.K. as a whole, the persistance of whooping-cough in some areas is more strongly correlated with adverse socio-economic conditions that with lack of immunisation. The decline in recent years could be attributable to improvement in these conditions at least as much as to immunisation. There is no epidemiological justification for continuing mass immunisation, but there is a strong case for an intensified eradication policy which might include selective immunisation in high-risk groups and areas.

Stewart, GT; Immunisation against whooping cough; British Medical Journal, 31 January 1976; letters:
Sir: In showing that 75% of infants below 3 months of age with whooping cough were admitted to hospital and that 42% of all hospital admissions of children notified as whooping cough were infants or 5 months or younger, Drs. Christina L. Miller and W.B, Fletcher (17 January, p 117) have indeed confirmed the widely-held belief that :in young infants whooping cough is still dangerous". They have not shown that "at all ages previous vaccination reduced the severity of the disease." What they have shown is that, among notified cases, a significantly higher proportion of the more severe cases and of those admitted to hospital were not immunised or were incompletely immunised. This does not mean that immunisation is necessarily protective. Of 8092 cases notified to them, 2940 (36%) were fully immunised while only 2424(30%) were definitely not immunised.
        In the same issue (p128) Dr. ND Noah claims that "current vaccines provide young children with substantial protection against whooping cough". What he actually shows, in a single tabulation of notifications uncorrected for age, is that the incidence of whooping cough is lower in immunised than in non-immunised children. But the rate of notified infection was still relatively high (50 per 100,000) in 1974 in children fully immunised with the new vaccine. There is no evidence in either article that immunisation of older children protects younger ones.
        Several questions arise:
What kind of immunisation is this for which success is being claimed? It is an immunisation which leaves those at highest risk (that is, below 6 months of age) unprotected and which, even when complete, is associated only with partial protection of those in the lowest risk groups.
        What kind of epidemiology is this which advocates immunisation by excluding consideration of factors other than immunisation? It is admitted in both articles and is indeed obvious from the data that factors other than immunisation must influence susceptibility to whooping cough. If immunisation is to be tested for efficacy, the data must be standardised for domestic, demographic and social factors.
        Whooping cough is much lower in incidence, hospital admissions are less frequent, and immunisation schedules are often better maintained in districts where socioeconomic conditions are favourable. Thereported association between protection and immunisation could be an expression of better social conditions and child care as much as of biological protection by pertussis vaccine.
        What kind of editorial policy is this which publishes incomplete data and promotes far-reaching claims about the efficacy of immunisation but refuses to publish collateral data questioning this efficacy?
        Paradoxically, the articles by Drs. Miller and Fletcher and Dr. Noah reinforce the suggestion made in my letter in your issue of 10 January (p 93) that evidence about the efficacy of pertussis vaccine is lacking. But the question remains.

Ditchburn, Robert K.; Whooping Cough after stopping pertussis immunisation; British Medical Journal; 1979, 1, 1601-1603; 16, June 1979;
Summary and Conclusions: An epidemic of whooping cough occurred in a rural practice in Shetland, containing 144 children under 16. Before July 1974, all children were immunised against pertussis, but after that date immunisation was stopped. Of the 134 children studied, 93 had been immunised. Sixty five of the children developed whooping cough. The incidence of infections was similar in those who had and had not been immunised. The incidence was also similar in those born before and after July 1974. There was not evidence to support the routine use of pertussis immunisation in rural Shetland.

Tomaszunas-Blaszczyk J Zaklad [Pertussis in 1997]. Epidemiologii Panstwowego, Zakladu Higieny, Warszawa. Przegl Epidemiol 1999;53(1-2):23-32 [Article in Polish]

In 1997 an epidemic increase of pertussis was observed in Poland. The incidence was 5.4/100,000 population and was more than six times higher than in the preceding year. No clear reason for a sudden increase in pertussis incidence was found, in particular the vaccination coverage rates have remained high. In December 1997 the DTP vaccine coverage rate for children below two with four doses of DTP was 97.5%. The distribution of cases according to age during the last 20 years was analysed and it was shown that since the beginning of the '90 a growing proportion of cases occurs among fully vaccinated children and the average age of the cases has a steadily growing tendency. A hypothesis was put forward that the come-back of pertussis is presently due to waning of short-term immunity following immunisation, in cohorts of children who grew up in conditions of very
low B. pertussis natural transmission. An open question remains whether to introduce to the immunisation calendar an additional booster dose of pertussis vaccine in school-aged children. PMID: 10402846, UI: 99331257

D. C. Christie, et al., "The 1993 Epidemic of Pertussis in Cincinnati: Resurgence of Disease in a Highly Immunized Population of Children," New England Journal of Medicine (July 7, 1994), pp. 16-20.

MMWR November 05, 1993 / 42(43);840-841,847 Diphtheria Outbreak -- Russian Federation, 1990-1993
Despite high levels of vaccination coverage against diphtheria, an ongoing outbreak of diphtheria has affected parts of the Russian Federation since 1990 (1); as of August 31, 1993, 12,865 cases had been reported. This report summarizes epidemiologic information about this outbreak for January 1990- August 1993, and is based on reports from public health officials in the Russian Federation.

Within the report is also says: "an estimated 90% of children were fully vaccinated with four or more doses of diphtheria toxoid by the time they entered school."URL:   http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00022128.htm

The Lancet  Volume 353, Number 9150  30 January 1999   Risk of diphtheria among schoolchildren in  the Russian Federation in relation to time since last vaccination
Quote:
In 1993, the Russian Federation reported 15229 cases of diphtheria, a 25-fold increase over the 603 cases reported in 1989.1 The incidence rate among children 7-10 years of age (15ˇ7 per 100000) was twice that of adults aged 18 years or over (7ˇ9 per 100000).4 81% of the affected children aged 7-10 years had been vaccinated with at least a primary series of diphtheria toxoid, and most had received the first booster recommended to be given 12 months after completion of the primary series.

So, it's pretty hard to ascribe low immunization rates as a cause for the outbreak of Diptheria. A much more likely explanation is the social disruption that was going on at the time of great political upheaval. Breakdown of hygiene, poverty, etc.

Sebastiana

de Melker HE, et al.   Pertussis in The Netherlands: an outbreak despite high levels of immunization with whole-cell vaccine. Emerg Infect Dis. 1997 Apr-Jun;3(2):175-8. PMID: 9204299; UI: 97348248.        

Shimoni, Zvi; Dobrousin, Anatoly; Cohen, Jonathan; et al.   "Tetanus in an Immunised Patient" British Medical Journal Online (10/16/99) Vol. 319, No. 7216, P. 1049;
Israeli researchers present the case of a 34-year-old construction worker who was hospitalized after having a reported epileptic fit and experiencing flu-like symptoms. The patient had a low-grade fever, but was alert and coherent. Any attempts to speak or get up on the second day resulted in attacks of risus sardonicus, opisthotonus, and trismus. The patient was diagnosed with tetanus and given 2000 U of human tetanus immunoglobulin. Further treatment was provided, and after 15 days, the patient had stopped taking diazepam and ventilatory support was withdrawn. The man had been fully immunized against tetanus, and had received booster shots five and two years before being hospitalized. Antitetanus immunization has shown to be very successful, and the researchers note that it is exceedingly rare--about four cases per 100 million immunocompetent vaccinated people--for tetanus to develop after being vaccinated.

Kirchner, Jeffrey T., "Manifestations of Pertussis in Immunized
Children and Adults", American Family Physician, November 1, 1999,
Vol. 60, p. 2150

"Recent epidemiologic studies have shown that the incidence and
prevalence of Bordetella pertussis infection in adults are much
greater that previously reported.  In studies of adults with chronic
cough, 20 to 25 percent were found to have serologic evidence of
recent B. pertussis infection.  However, pertussis is rarely
considered in adults because the signs and symptoms are nonspecific."

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Bykowski, M., "Pertussis in Adults", OB GYN News, November 1, 1999,
Vol. 34, p. 29

"It was formerly believed that infection or immunization conferred
lifetime immunity, but now appears that any resultant immunity is in
fact short lived.  Thus, there is a growing interest in the selective
reimmunization of adults, he said.  And while pertussis was once
considered uncommon in adults and older adolescents, it's now believed
that the disease is endemic in these populations, who actually serve
as the primary reservoir for pertussis, explained Dr. Ogle, professor
of pediatrics at the University of Colorado, Denver.  Studies from
throughout the developed world suggest a 25%-30% of persistent
coughing illness in these age groups is pertussis, he added."

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Poland, Gregory A., "Still more questions on pertussis vaccines", The
Lancet, November 29, 1997, Vol. 350, pp. 1564-1565

"Despite sharply reducing severe pertussis and pertussis deaths,
whole-cell vaccines have not stopped circulation of Bordetella in the
population, do not induce sustained protective immunity, and are
precluded from routine use as boosters in adolescents and adults
because of their side-effects.  In addition, questions about safety
and efficacy remain."

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De Serres, Gaston, MD, MPH, Boulianne N., MSC, Duval, B. MD, Déry, P.
MD, Rodrigquez, A. M., MD, Massé, R., MD, and Halperin, S. MD,
"Effectiveness of whole cell pertussis vaccine in child-care centers
and schools", The Pediatric Infectious Disease Journal,
1996;15:519-524

"Despite the high rate of pertussis vaccine coverage in children
between the 2 and 9 years of age, pertussis was a common illness in
these preschool and school age children.  Although the whole cell
vaccine was demonstrated to be effective, estimates of vaccine
effectiveness were lower than the estimated in the United States and
elsewhere. ... In those studies a different whole cell vaccine
manufactured by Connaught Laboratories Inc. (Swiftwater, PA) had an
efficacy of 48% in Sweden and 36% in Italy."

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Cherry, James D., MD, Brunell, Philip A. MD, Golden, Gerald A., MD,
and Karzon, David T., MD. "Report of the Task Force on Pertussis and
Pertussis Immunization - 1988", Pediatrics, June 1988, Volume 81,
Number 6, Part 2, Supplement, p. 955

"Reported cases and outbreaks in older children and young adults may
reflect a less durable vaccine-induced protection than seen in natural
disease.  The duration of protection has varied in several studies,
depending on the epidemiological setting, ie, prevalence of natural
disease as well as the vaccine product used.  A study in Michigan
showed an efficacy of 80% 3 years after the last dose, 50% between 4
and 7 years, and virtually none after 12 years.  Breakthrough disease
noted in this study was usually mild."

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