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Children were 5 times more likely to have pertussis if it had been more than 3 years since their last vaccine dose.
Coverage in kids 4 and younger was 67.8% last season, down 2.2 percentage points.
The vaccine protected 78% of newborns from pertussis and 90% from hospitalized cases.
Though coverage still isn't optimal, for the first time rates topped 60%, with the boys' level gaining ground on the girls'.
Babies living in countries affected by conflict made up more than half of the total of unvaccinated group.
The vaccine offers strong protection to infants, especially during the first 2 months of life.
A meta-analysis of 50 studies finds vaccine refusal common in measles, pertussis outbreaks.
A working group for a vaccine advisory board recommended against a second dose of Tdap vaccine for teens, citing lack of a booster effect.
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