OBJECTIVES: Robust routine immunization schedules of pertussis-containing vaccines have been applied for years, but the pertussis outbreak is still a worldwide problem. This study aimed to explore the association between vaccine hesitancy and pertussis in infants and children.

METHODS: We searched PubMed, Cochrane, Web of Science, Embase, and China National Knowledge Internet from January 2012 to June 2022 and included primary studies that assessed the association between childhood/maternal vaccine hesitancy and the pertussis odds ratios (ORs), risk ratios (RRs), or vaccine effectiveness (VE) in infants and children ≤9 years old. Random-effects meta-analysis, cumulative meta-analysis, and subgroup analysis were used to generate estimated OR/VEs with 95% confidence intervals (CIs), where heterogeneity was assessed using I².

RESULTS: Twenty-two studies were included in this analysis, with a mean quality score of 7.0 (range 6.0-9.0). Infants and children with pertussis were associated with higher vaccine hesitancy at all doses (OR = 4.12; 95% CI, 3.09-5.50). The highest OR was between children unvaccinated over 4 doses and children fully vaccinated (OR = 14.26; 95%CI, 7.62-26.70); childhood vaccine delay was not statistically significant associated with pertussis risk (OR = 1.18; 95% CI, 0.74-1.89). Maternal vaccine hesitancy was associated with significantly higher pertussis risk in infants at both 2 months and 3 months old, with higher OR in infants ≤2 months old (OR = 6.02 [95%CI: 4.31-8.50], OR = 5.14 [95%CI: 1.95-13.52] for infants ≤2 and 3 months old, respectively). Maternal and childhood pertussis-containing vaccination had significantly high VE both in preventing pertussis infection in infants and in reducing the severity of disease in infants with pertussis. The administration time of maternal vaccination had little effect on VE.

CONCLUSIONS: Vaccine hesitancy increased pertussis risks in infants and children. Ensuring children receive pertussis vaccines up-to-date is essential; short delays in childhood vaccine receipt may be unimportant. Maternal pertussis-containing vaccination should be encouraged.