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NEW THIS SUNDAY: TWO ON COCOON PERTUSSIS IMMUNIZATION

Saturday, 13th of July 2013

• TWO ON COCOON IMMUNIZATION

 

• THE NUMBER NEEDED TO VACCINATE TO PREVENT INFANT PERTUSSIS HOSPITALIZATION AND DEATH THROUGH PARENT COCOON IMMUNIZATION

 

Clin Infect Dis. 2012 Feb 1;54(3):318-27. doi: 10.1093/cid/cir836. Epub 2011 Dec 8.

Skowronski DM, Janjua NZ, Tsafack EP, Ouakki M, Hoang L, De Serres G.

Source

Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control (BCCDC), Vancouver; Canada. danuta.skowronski@bccdc.ca

Abstract below; full text is at http://cid.oxfordjournals.org/content/54/3/318.long

BACKGROUND:

Parental immunization has been recommended as a "cocoon" strategy to prevent serious pertussis outcomes in early infancy. We illustrate the high number needed to vaccinate (NNV) for this program based on recent epidemiologic data from the provinces of Québec and British Columbia (BC), Canada.

METHODS:

Surveillance trends were summarized for the period 1990-2010. Hospitalization, intensive care unit (ICU) admission, and mortality data were compiled from 2000 to 2009. The proportion of infant pertussis attributed to a parent was estimated at 35%, explored up to 55%. Adult vaccine efficacy (VE) was estimated at 85%. The NNV was calculated as [2 parents/(parent-attributable infant risk × parent VE)]. To capture at least 1 recent cyclical peak, NNV was derived for the period 2005-2009 and explored for peak/trough years.

RESULTS:

Substantial decline has occurred in pertussis incidence across all age groups including infants, reaching a 20-year nadir in 2010 in both provinces. For the period 2005-2009, the risk of infant hospitalization and ICU admission was 57 and 7, respectively, per 100 000 in Québec and 33 and 7, respectively, per 100 000 in BC. In both provinces the risk of infant pertussis-related death over that period was <0.5 per 100 000. The NNV for parental immunization was at least 1 million to prevent 1 infant death, approximately 100 000 for ICU admission, and >10 000 for hospitalization.

CONCLUSIONS:

In the context of low pertussis incidence, the parental cocoon program is inefficient and resource intensive for the prevention of serious outcomes in early infancy. Regions contemplating the cocoon program should consider the NNV based on local epidemiology.

Comment in

Infant pertussis: what to do next? [Clin Infect Dis. 2012]

Infant pertussis: what to do next?Healy CM, Baker CJ. Clin Infect Dis. 2012 Feb 1; 54(3):328-30. Epub 2011 Dec 8.

• PARENT "COCOON" IMMUNIZATION TO PREVENT PERTUSSIS-RELATED HOSPITALIZATION IN INFANTS: THE CASE OF PIEMONTE IN ITALY.

 

Vaccine. 2013 Feb 6;31(8):1135-7. doi: 10.1016/j.vaccine.2012.12.061. Epub 2013 Jan 7.

Meregaglia M, Ferrara L, Melegaro A, Demicheli V.

Source

ASL-AL Regional Epidemiology Unit for Infectious Diseases, Alessandria, Italy.

Abstract below; full text available to journal subscribers

Pertussis incidence in Piemonte (Italy) is now at the lowest level ever reached (0.85 per 100,000 in 2010) but the disease is still endemic in infants (54 per 100,000 in 2005-2010). Parental "cocoon" immunization has been proposed in some countries (i.e. United States, France) as a measure to protect newborns from serious pertussis outcomes. We assessed the number needed to vaccinate (NNV) to prevent hospital admissions in infants (<12 months) and the potential cost-effectiveness of this strategy in Piemonte. The NNV for parental immunization was at least 5000 to prevent one infant hospitalization in the latest epidemic cycle (2005-2010) at the cost of >€100,000. The "cocoon" programme leads to net costs from a National Health Service (NHS) perspective (ROI<1). In contexts of low incidence and without reliable data on a high parent-attributable infant risk, the parental "cocoon" programme is poorly efficient and very resource intensive in preventing pertussis in infants.

Copyright © 2012 Elsevier Ltd. All rights reserved