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Vashishtha VM, Kumar P. The durability of vaccine-induced protection: an overview. Expert Rev Vaccines 2024; 23:389-408. [PMID: 38488132 DOI: 10.1080/14760584.2024.2331065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Current vaccines vary widely in both their efficacy against infection and disease, and the durability of the efficacy. Some vaccines provide practically lifelong protection with a single dose, while others provide only limited protection following annual boosters. What variables make vaccine-induced immune responses last? Can breakthroughs in these factors and technologies help us produce vaccines with better protection and fewer doses? The durability of vaccine-induced protection is now a hot area in vaccinology research, especially after COVID-19 vaccines lost their luster. It has fueled discussion on the eventual utility of existing vaccines to society and bolstered the anti-vaxxer camp. To sustain public trust in vaccines, lasting vaccines must be developed. AREAS COVERED This review summarizes licensed vaccines' protection. It analyses immunological principles and vaccine and vaccinee parameters that determine longevity of antibodies. The review concludes with challenges and the way forward to improve vaccine durability. EXPERT OPINION Despite enormous advances, we still lack essential markers and reliable correlates of lasting protection. Most research has focused on humoral immune responses, but we must also focus on innate, mucosal, and cellular responses - their assessment, correlates, determinants, and novel adjuvants. Suitable vaccine designs and platforms for durable immunity must be found.
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Affiliation(s)
- Vipin M Vashishtha
- Department of Pediatrics, Mangla Hospital & Research Center, Shakti Chowk, Bijnor, Uttar Pradesh, India
| | - Puneet Kumar
- Department of Pediatrician, Kumar Child Clinic, New Delhi, India
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Tessier E, Newport D, Tran A, Nash SG, Mensah AA, Yun Wang T, Shantikumar S, Campbell H, Amirthalingam G, Todkill D. Pertussis immunisation strategies to optimise infant pertussis control: A narrative systematic review. Vaccine 2023; 41:5957-5964. [PMID: 37658001 DOI: 10.1016/j.vaccine.2023.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants. METHODS We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias. FINDINGS A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies. CONCLUSION Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants.
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Affiliation(s)
| | - Daniel Newport
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Anh Tran
- UK Health Security Agency, London, UK
| | | | | | | | | | | | | | - Daniel Todkill
- UK Health Security Agency, London, UK; Warwick Medical School, University of Warwick, Coventry, UK
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Chitkara AJ, Balasubramanian S, Choudhury J, Dash N, Forsyth K, Heininger U, Hozbor DF, Muloiwa R, Tan T, von König CHW. Pertussis in India: Past, Present, and Future. Indian J Pediatr 2023; 90:393-399. [PMID: 36522518 DOI: 10.1007/s12098-022-04384-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022]
Abstract
While vaccines have markedly reduced the incidence of pertussis, a resurgence has occurred in many countries. Until recently, pertussis has not been recognized as an important public health challenge in India due to its successful infant immunization program. However, India still accounts for a large proportion of the world's cases, and increasing reports of pertussis in other countries and in neonates have regenerated interest in pertussis among Indian authorities. The Global Pertussis Initiative (GPI) Annual Meeting was held virtually in October 2020, in part, to gain a better understanding of the epidemiology and disease burden of pertussis and to explore opportunities to improve its prevention in India. There was a consensus that pertussis cases are being underestimated in India due to multiple factors, such as a reliance on passive surveillance and diagnostic challenges. India offers both whole-cell pertussis and acellular pertussis vaccines, but vaccine coverage is inconsistent across regions due to differences in vaccine availability, access to health care, and regional administrative challenges. This report summarizes the outcomes and considers the key clinical implications of this meeting. The GPI agreed that active surveillance of pertussis in India would be optimal and recommended several studies, including serosurveillance among women of reproductive age to assess the prevalence of recent pertussis infection and to enable policy changes that will enhance the rational use of acellular and whole-cell vaccines. It also recommended engagement with nongovernmental organizations in order to encourage pregnancy immunization in the public sector. To achieve effective control of pertussis in the future, the GPI recognizes there are opportunities to characterize the burden of pertussis in India appropriately and increase vaccination coverage in multiple age groups.
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Affiliation(s)
- A J Chitkara
- Department of Pediatrics, Max Super Specialty Hospital, Shalimar Bagh, 118, Vaishali, Pitampura, Delhi, 110088, India.
| | - S Balasubramanian
- Department of Pediatrics, Kanchi Kamkoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | | | - Nabaneeta Dash
- Department of Pediatrics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Kevin Forsyth
- Department of Pediatrics, Flinders University, Adelaide, Australia
| | - Ulrich Heininger
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Daniela Flavia Hozbor
- Department of Biological Sciences, Laboratorio VacSal. Instituto de Biotecnología y Biología Molecular, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CONICET, La Plata, Argentina
| | - Rudzani Muloiwa
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Tina Tan
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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Hempel K, McDonald W, Osgood ND, Fisman D, Halperin SA, Crowcroft N, Klein NP, Rohani P, Doroshenko A. Evaluation of the effectiveness of maternal immunization against pertussis in Alberta using agent-based modeling: A Canadian immunization research network study. Vaccine 2023; 41:2430-2438. [PMID: 36775775 DOI: 10.1016/j.vaccine.2022.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The re-emergence of pertussis has occurred in the past two decades in developed countries. The highest morbidity and mortality is seen among infants. Vaccination in pregnancy is recommended to reduce the pertussis burden in infants. METHODS We developed and validated an agent-based model to characterize pertussis epidemiology in Alberta. We computed programmatic effectiveness of pertussis vaccination during pregnancy (PVE) in relation to maternal vaccine coverage and pertussis disease reporting thresholds. We estimated the population preventable fraction (PFP) of different levels of maternal vaccine coverage against counterfactual "no-vaccination" scenario. We modeled the effect of immunological blunting and measured protection through interruption of exposure pathways. RESULTS PVE was inversely related to duration of passive immunity from maternal immunization across most simulations. In the scenario of 50% maternal vaccine coverage, PVE was 87% (95% quantiles 82-91%), with PFP of 44% (95% quantiles 41-45%). For monthly age intervals of 0-2, 2-4, 4-6 and 6-12, PVE ranged between 82 and 99%, and PFP ranged between 41 and 49%. At 75% maternal vaccine coverage, PVE and PFP were 90% (95% quantiles 86-92%) and 68% (95% quantiles 65-69%), respectively. At 50% maternal vaccine coverage and 10% blunting, PVE and PFP were 86% (95% quantiles 77-87%) and 43% (95% quantiles 39-44%), respectively, while at 50% blunting, the corresponding values of PVE and PFP were 76% (95% quantiles 70-81%) and 38% (95% quantiles 35-40%). PVE attributable to interruption of exposure pathways was 54-57%. CONCLUSIONS Our model predicts significant reduction in future pertussis cases in infants due to maternal vaccination, with immunological blunting slightly moderating its effectiveness. The model is most sensitive to maternal vaccination coverage. The interruption of exposure pathways plays a role in the reduction of pertussis burden in infants due to maternal immunization. The effect of maternal immunization on population other than infants remains to be elucidated.
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Affiliation(s)
- Karsten Hempel
- Department of Medicine, Division of Preventive Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Wade McDonald
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Nathaniel D Osgood
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Scott A Halperin
- Departments of Pediatrics, Microbiology and Immunology, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Natasha Crowcroft
- World Health Organization, Geneva, Switzerland; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Pejman Rohani
- Department of Infectious Diseases, University of Georgia, Athens, GA, USA; Odum School of Ecology, University of Georgia, Athens, GA, USA.
| | - Alexander Doroshenko
- Department of Medicine, Division of Preventive Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Botwright S, Win EM, Kapol N, Benjawan S, Teerawattananon Y. Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures. PHARMACOECONOMICS 2023; 41:77-91. [PMID: 36348154 PMCID: PMC9644008 DOI: 10.1007/s40273-022-01207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. METHODS We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2) Td vaccine and aP vaccine, and (3) Td vaccine only. We constructed two decision-tree models with Markov elements, each following a different clinical pathway, to allow us to examine structural uncertainty. Costs were converted to 2021 Thai Baht (THB) and a discount rate of 3% was applied to health and cost outcomes, with sensitivity analysis at 0% and 6%. Parameter uncertainty was investigated through deterministic and probabilistic sensitivity analysis, with expected value of perfect information analysis. RESULTS Maternal pertussis vaccination would avert 27 cases and up to one death per year. The incremental cost-effectiveness ratio (ICER) for adding aP to the maternal immunisation schedule is 2,184,025 THB/QALY and the ICER for replacing maternal Td vaccination with TdaP is 3,198,101 THB/QALY. Maternal pertussis vaccination only becomes favourable in the probabilistic sensitivity analysis at cost-effectiveness thresholds above 6,000,000 THB/QALY, far above the Thai threshold of 160,000 THB/QALY. If incidence is less than 397 cases per 100,000, maternal pertussis vaccination will not be cost-effective in Thailand, within the plausible range for vaccine effectiveness and probability of hospitalisation. Budget impact is dominated by vaccination costs, which represent 12% and 18% of the 2021 national vaccine programme budget for introducing aP vaccine or for switching Td with TdaP vaccine, respectively. CONCLUSIONS We have found that maternal pertussis immunisation is not cost-effective in Thailand. Although there may be substantial under-reporting of pertussis cases, comparison with hospital data suggests that most under-reported cases are not hospitalised and therefore have negligible impact on our results. However, considerations such as affordability and local manufacturing may also be important for national immunisation programme decision-making.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Ei Mon Win
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Nattiya Kapol
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
- National University of Singapore, Singapore, Singapore
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Kirwin E, MacDonald S, Simmonds K. Profiles in Epidemiology: Dr. Larry Svenson. Am J Epidemiol 2022. [PMID: 34850825 DOI: 10.1093/aje/kwab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zerbo O, Fireman B, Klein NP. Lessons from a mature acellular pertussis vaccination program and strategies to overcome suboptimal vaccine effectiveness. Expert Rev Vaccines 2021; 21:899-907. [PMID: 34555994 DOI: 10.1080/14760584.2021.1984891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Despite high vaccination coverage among children and adolescents, pertussis remains a public health problem, with large outbreaks occurring periodically in the US and other developed countries. AREAS COVERED We examine lessons learned more than 20 years after implementation of programs which use only acellular pertussis vaccines and propose avenues for possible effective use of acellular pertussis vaccine to prevent large outbreaks. EXPERT OPINION Acellular pertussis vaccines were introduced more than 20 years ago, yet the incidence of pertussis has been increasing over the past decade, with periodic large outbreaks marked by notable shifts in disease burden from infants and young children toward fully vaccinated adolescents and young adults. This age shift is mainly driven by the waning of vaccine immunity. To better protect adolescents against pertussis, modification of the current acellular pertussis vaccination schedule or adoption of new vaccination strategies should be considered. For infants not yet eligible to be vaccinated, maternal vaccination against pertussis during pregnancy is an effective way to protect infants from infection, severe disease and death. Implementation of maternal vaccination programs should be encouraged in countries without one or efforts to improve coverage should be supported in countries with existing program.
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Affiliation(s)
- Ousseny Zerbo
- Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Bruce Fireman
- Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Nicola P Klein
- Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
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8
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Gao H, Lau EHY, Cowling BJ. Waning immunity after receipt of Pertussis, Diphtheria, Tetanus and Polio-related vaccines: a systematic review and meta-analysis. J Infect Dis 2021; 225:557-566. [PMID: 34543411 DOI: 10.1093/infdis/jiab480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
DTP-containing (pertussis, diphtheria and tetanus) combined with polio vaccines are recommended by WHO as part of routine immunization programs. The decline of immunity after vaccination has been considered as a possible reason for the re-emergence of vaccine-preventable diseases worldwide. In this study, we evaluated the potential duration of protective immunity of pertussis, diphtheria, tetanus and polio through a systematic review and meta-analysis. We examined data on immunological and clinical outcomes. We observed evidence of waning post-vaccination immunity for pertussis and diphtheria, while tetanus and polio vaccines provided sustained protection. Further research on the risk factors of waning immunity after vaccination and the optimal timing of booster doses for pertussis and diphtheria are needed.
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Affiliation(s)
- Huizhi Gao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
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Wilkinson K, Righolt CH, Elliott LJ, Fanella S, Mahmud SM. Pertussis vaccine effectiveness and duration of protection - A systematic review and meta-analysis. Vaccine 2021; 39:3120-3130. [PMID: 33934917 DOI: 10.1016/j.vaccine.2021.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
A comprehensive review of observational pertussis vaccine effectiveness (VE) studies is needed to update gaps from previous reviews. We conducted a systematic review of VE and duration of protection studies for the whole-cell (wP) and acellular (aP) pertussis vaccines and conducted a formal meta-analysis using random effects models. Evidence continues to suggest that receipt of any pertussis vaccine confers protection in the short-term against disease although this protection wanes rapidly for aP vaccine. We detected significant heterogeneity in pooled estimates due, in part, to factors such as bias and confounding which may be mitigated by study design. Our review of possible sources of heterogeneity may help interpretation of other VE studies and aid design decisions in future pertussis VE research.
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Affiliation(s)
- Krista Wilkinson
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence J Elliott
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sergio Fanella
- Department of Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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A multisite study of pertussis vaccine effectiveness by time since last vaccine dose from three Canadian provinces: A Canadian Immunization Research Network study. Vaccine 2021; 39:2772-2779. [PMID: 33875270 DOI: 10.1016/j.vaccine.2021.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pertussis remains poorly controlled relative to other diseases targeted by childhood vaccination programs. We combined estimates from four population-based studies of pertussis vaccine effectiveness (VE) in three Canadian provinces using a meta-analytic approach to improve precision and explore regional variation in VE and durability of protection. METHODS Studies were conducted in Alberta, Manitoba, and Ontario over periods ranging from 1996 to 2015. Adjusted log odds ratios (OR; VE = 100*[1-OR]) of the effect of vaccination on pertussis risk were estimated by time since last vaccination in each study and pooled using DerSimonian and Laird random-effects models. We used the I2 statistic to estimate between-study heterogeneity and assessed methodological and clinical heterogeneity through subgroup analyses of study design and age. RESULTS Data on 3,270 pertussis cases and 23,863 controls were available. Pertussis VE declined from 86% (95% CI 79%-90%, I2 = 81.5%) at < 1 year since last vaccination to 51% (11%-74%, I2 = 80.9%) by ≥ 8 years. Effect estimates were the most heterogeneous in the least and most elapsed time periods since last vaccine dose. This was attributable mostly to variation between provinces in the distribution of age groups and number of vaccine doses received within time periods, as well as study design and small numbers in the most elapsed time period. INTERPRETATION Consistent trends of decreasing pertussis VE with increasing time since last vaccination across three Canadian provinces indicate the need for immunization schedules and vaccine development to optimize protection for all individuals, especially for adolescents and young adults at greatest risk of infection.
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Abstract
INTRODUCTION Pertussis, caused by Bordetella pertussis, remains a major public health problem, despite high vaccination coverage. Furthermore, the disease incidence has increased recently, especially in countries that have switched from whole-cell to acellular pertussis vaccines. AREAS COVERED Here, we provide a state-of-the art summary of the reasons for the pertussis resurgence and discuss potential solutions using current vaccines and challenges for the development of novel vaccines. PubMed was searched for publications with the terms pertussis and vaccines. Many new vaccine candidates are proposed but most have not reached clinical development. Most of them induce strong systemic immune responses and protection in mice. However, since B. pertussis is a mucosal pathogen, albeit with systemic effects, local immunity may be crucial to prevent B. pertussis infection and transmission. Recent efforts have focused on vaccine candidates able to induce immunity in the nasal cavity, and one of them is currently in clinical development. EXPERT COMMENTARY New pertussis vaccines are needed to durably control the disease and circulation of B. pertussis. A major challenge is to prove efficacy against disease in randomized controlled trials, while it is feasible to provide evidence for prevention of infection, since asymptomatic carriage of B. pertussis is wide spread.
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Affiliation(s)
- Camille Locht
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur De Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
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Ohfuji S, Okada K, Mouri Y, Mihara Y, Ishii S, Miyata A, Fujino M, Motomura C, Ito H, Ohta M, Kasahara Y, Nakamura H, Hasui M, Yoshikawa T, Tanaka T, Nakano T, Koshida R, Araki K, Hara M, Hirota Y. Effectiveness of four doses of pertussis vaccine during infancy diminished in elementary school age: A test-negative case-control study in Japan. Vaccine 2020; 39:11-17. [PMID: 33229109 DOI: 10.1016/j.vaccine.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Japanese national immunization program recommends that children receive 4 doses of acellular pertussis vaccine between 3 months and 2 years of age. Nevertheless, the number of pertussis cases is increasing in elementary school children aged 6-12 years. Therefore, a test-negative case-control study was conducted to assess the effectiveness of the pertussis vaccine program. METHODS Subjects included children aged ≥3 months who visited a collaborating hospital due to pertussis-specific cough between October 2017 and November 2019. All subjects underwent diagnostic tests for pertussis, and those diagnosed as positive were regarded as cases. Subjects diagnosed as pertussis-negative were classified as controls. Vaccination history was collected using a questionnaire administered to parents with reference to immunization records. Logistic regression models were employed to calculate the odds ratio (OR) and 95% confidence interval for laboratory-confirmed pertussis. RESULTS Of 187 recruited subjects (120 cases and 67 controls), questionnaire responses were obtained for 145 subjects (95 cases and 50 controls). Compared with unvaccinated subjects, the vaccine effectiveness (VE) of 4 doses was 70% among all subjects and reached to 90% with marginal significance among subjects under 6 years of age. However, among school-aged subjects, the VE was not suggestive of protection against pertussis (VE: 8%). For vaccinees given 4 doses, the OR for developing pertussis increased significantly with longer duration since the fourth dose (compared with <4.5 years, OR of 6.0-8.2 years = 5.74; OR of ≥8.3 years = 3.88; P for trend by duration < 0.01). CONCLUSION Effectiveness of administering 4 doses of pertussis vaccine during infancy decreases with time passed since the fourth dose. This regimen does not protect school-aged children against pertussis.
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Affiliation(s)
- Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-city, Osaka 545-8585, Japan.
| | - Kenji Okada
- Division of Basic Nursing, Fukuoka Nursing College, 2-15-1, Tamura, Sawara-ku, Fukuoka-city, Fukuoka 814-0193, Japan
| | - Yoko Mouri
- Department of Pediatrics, Mouri Clinic, 14017-5, Mimasaka, Yamauchi-cho, Takeo-city, Saga 849-2303, Japan
| | - Yuka Mihara
- Department of Pediatrics, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya-city, Aichi 448-8505, Japan
| | - Shigeki Ishii
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, 5-30, Kita-takamatsu-cho, Miyazaki-city, Miyazaki 880-8510, Japan
| | - Akiko Miyata
- Department of Pediatrics, Saiwai Kodomo Clinic, 1-11-3, Saiwai-cho, Tachikawa-city, Tokyo 190-0002, Japan
| | - Motoko Fujino
- Department of Pediatrics, Tokyo Saiseikai Central Hospital, 1-4-17, Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Chikako Motomura
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, 4-39-1, Yakatabaru, Minami-ku, Fukuoka-city, Fukuoka 811-1394, Japan
| | - Hiroaki Ito
- Department of Pediatrics, Kameda Medical Center, 929, Higashi-cho, Kamogawa-city, Chiba 296-8602, Japan
| | - Mitsuhiro Ohta
- Department of Pediatrics, Ohta Pediatric Clinic, 7323-1, Takeo, Takeo-cho, Takeo-city, Saga 843-0022, Japan
| | - Yoshihito Kasahara
- Department of Pediatrics, Kasahara Pediatric Clinic, 2-205, Oowada, Fukui-city, Fukui 910-0836, Japan
| | - Hideo Nakamura
- Department of Pediatrics, Nakamura Pediatric Clinic, 6-179, Oshino, Nonoichi-city, Ishikawa 921-8802, Japan
| | - Masaki Hasui
- Department of Pediatrics, Hasui Pediatric Clinic, 105, Ryusuke-cho, Komatsu-city, Ishikawa 923-0926, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake-city, Aichi 470-1192, Japan
| | - Takaaki Tanaka
- Department of Pediatrics, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama-city, Okayama 700-8505, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama-city, Okayama 700-8505, Japan
| | - Rie Koshida
- Ekinishi Health and Welfare Center, 3-4-25, Sainenn, Kanazawa-city, Ishikawa 920-8533, Japan
| | - Kaoru Araki
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga-city, Saga 849-8501, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga-city, Saga 849-8501, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, Medical Co. LTA (SOUSEIKAI), 3-5-1, Kashii-Teriha Higashi-ku, Fukuoka-city, Fukuoka 813-0017, Japan
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