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Epidemiological and Economic Effects of Priming with the Whole-Cell Bordetella pertussis Vaccine

Wednesday, 30th of March 2016

The switchover from whole cell to acellular pertussis vaccine looks, in retrospect, to have been hasty.

Whatever the benefits of acellular vaccine, its introduction has been associated with pertussis outbreaks.

 

Original Investigation | March 28, 2016

Epidemiological and Economic Effects of Priming with the Whole-Cell Bordetella pertussis Vaccine

Haedi DeAngelis, MA¹; Samuel V. Scarpino, PhD²; Meagan C. Fitzpatrick, PhD³; Alison P. Galvani, PhD^3,4; Benjamin M. Althouse, PhD, ScM^1,2

[+] Author Affiliations

JAMA Pediatr. Published online March 28, 2016. doi:10.1001/jamapediatrics.2016.0047

 

Abstract below; full text is available to journal subscribers.

 

Importance  Current acellular pertussis vaccines may not protect against transmission of Bordetella pertussis.

Objective  To assess whether a priming dose of whole-cell pertussis (wP) vaccine is cost-effective at reducing pertussis infection in infants.

Design, Setting, and Participants  Mathematical model of pertussis transmission fit to US incidence data in a simulation of the US population. In this simulation study conducted from June 2014 to May 2015, the population was divided into 9 age groups corresponding to the current pertussis vaccination schedule and fit to 2012 pertussis incidence.

Interventions  Inclusion of a priming dose of wP vaccine into the current acellular pertussis vaccination schedule.

Main Outcomes and Measures  Reductions in symptomatic pertussis incidence by age group, increases in wP vaccine–related adverse effects, and quality-adjusted life-years owing to changing vaccine schedule.

Results  Switching to a wP-priming vaccination strategy could reduce whooping cough incidence by up to 95% (95% CI, 91-98), including 96% (95% CI, 92-98) fewer infections in neonates. Although there may be an increase in the number of vaccine adverse effects, we nonetheless estimate a 95% reduction in quality-adjusted life-years lost with a switch to the combined strategy and a cost reduction of 94% (95% CI, 91-97), saving more than $142 million annually.

Conclusions and Relevance  Our results suggest that an alternative vaccination schedule including 1 dose of wP vaccine may be highly cost-effective and ethically preferred until next-generation pertussis vaccines become available.