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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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Alvarez J, Godoy P, Plans-Rubio P, Camps N, Carol M, Carmona G, Solano R, Rius C, Minguell S, Barrabeig I, Sala-Farré MR, Rodriguez R, Garcia-Cenoz M, Muñoz-Almagro C, Dominguez A. Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012-2013. Emerg Infect Dis 2020; 26:2678-2684. [PMID: 33079034 PMCID: PMC7588542 DOI: 10.3201/eid2611.181418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient's household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within <7 days, 8-14 days, 15-21 days, and >21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within <21 days after the primary patient's symptom onset, the treatment was 43.9% effective. Chemoprophylaxis started >14 days after primary patient's symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within <14 days after primary patient's symptom onset.
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Abu-Raya B, Coyle D, Bettinger JA, Vaudry W, Halperin SA, Sadarangani M. Pertussis vaccination in pregnancy in Canada: a cost-utility analysis. CMAJ Open 2020; 8:E651-E658. [PMID: 33077536 PMCID: PMC7588263 DOI: 10.9778/cmajo.20200060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Canadian National Advisory Committee on Immunization recommends universal vaccination against pertussis in pregnancy. We assessed the cost-effectiveness of vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy in Canada. METHODS We conducted a cost-utility analysis comparing a vaccination program to no program corresponding with the 2017 Canadian guideline for economic evaluation from the Canadian Agency for Drugs and Technologies in Health. We developed 2 models - part decision tree, part Markov model - to estimate the long-term cost and quality-adjusted life-years (QALYs) for pregnant women and their infants. We obtained epidemiologic data from 2006 to 2015, and derived costs and utility values from relevant sources. Results were reported in 2019 Canadian dollars. We obtained expected values through probabilistic analysis, with methodologic and structural uncertainty assessed through scenario analyses. The analysis adopted an acquisition price of Tdap vaccine of $12.50, with scenario analysis conducted to identify the threshold price for vaccination to be cost-effective. RESULTS In the base-case scenario, for every 1000 pregnant women vaccinated, the program would lead to a gain of 0.3 QALYs, occurring solely in infants, at an increased total cost of $12 987, or $44 301 per QALY gained. Based on a threshold of $50 000 per QALY gained, vaccination would have been cost-effective in 6 of the 10 years included in the model (range of incremental costs $20 463-$100 348 per QALY gained). The threshold cost for Tdap vaccine to be cost-effective over the 10-year horizon was $14.03. INTERPRETATION Based on a threshold of $50 000 per QALY gained, vaccination against pertussis in pregnancy would be cost-effective if the acquisition cost per vaccine were $14.03 or less. Province- and territory-specific analyses should be done to inform local decision-making.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Doug Coyle
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Julie A Bettinger
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Wendy Vaudry
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Scott A Halperin
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Manish Sadarangani
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
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4
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Anyiwe K, Richardson M, Brophy J, Sander B. Assessing adolescent immunization options for pertussis in Canada: A cost-utility analysis. Vaccine 2019; 38:1825-1833. [PMID: 31889607 DOI: 10.1016/j.vaccine.2019.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adolescent tetanus, diphtheria and pertussis (Tdap) immunization helps prevent pertussis infection. Timing of Tdap receipt represents an important facet of successful adolescent pertussis immunization. Potential strategies for timing of vaccine administration are each associated with different benefits - including disease prevention - and costs. The objective of this study was to assess the cost-utility of adolescent pertussis immunization strategies in Canada. METHODS A cost-utility analysis was conducted using a pertussis disease history-simulating Markov model, with adolescents (beginning at age 10 years) as the cohort of interest. The model assessed three Tdap vaccination strategies: (1) immunization of 10 year olds, (2) removal of adolescent vaccination, and (3) immunization of 14 year olds (status quo). The analysis was conducted from a healthcare payer perspective and used a lifetime time horizon. Primary outcomes included life years, quality-adjusted life years (QALYs), health system costs, and an incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted at 1.5 percent annually. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS The current recommended adolescent immunization strategy (at age 14) resulted in an average of 40.4432 expected QALYs and $26.28 per individual. This strategy was dominated by immunization at 10 years and no immunization. Compared to no immunization, immunizing adolescents at age 10 had an ICER of $74,899 per QALY. Results were most sensitive to the incidence of pertussis and the utility of moderate or severe pertussis. At a cost-effectiveness threshold of $50,000/QALY, removal of adolescent vaccination represented the most cost-effective strategy in 78% of simulations. CONCLUSION Analysis assumes a policy context where immunization of pregnant women is recommended. Findings suggest that alternate adolescent Tdap vaccine strategies - either immunization of 10 year olds, or removal of the adolescent vaccine - are more cost-effective than the current practice of immunizing 14 year olds.
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Affiliation(s)
- Kika Anyiwe
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
| | - Marina Richardson
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Jason Brophy
- Department of Pediatrics, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Division of Infectious Diseases, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada
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5
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McGirr A, Fisman DN, Tuite AR. The health and economic burden of pertussis in Canada: A microsimulation study. Vaccine 2019; 37:7240-7247. [PMID: 31585727 DOI: 10.1016/j.vaccine.2019.09.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite excellent vaccine coverage, pertussis persists in Canada, with high incidence during recent outbreaks and non-negligible incidence in non-outbreak years. While Canadian pertussis incidence is well-characterized, the full health and economic impact of pertussis have not been examined in Canada. We estimated age-specific life years (LYs) and quality-adjusted life years (QALYs) lost, and costs due to pertussis in Ontario, Canada, using a model-based approach. METHODS We developed a microsimulation model to simulate pertussis natural history. Daily probabilities of pertussis complications, hospitalizations, and disease sequelae as well as utilities and costs for health states were literature-derived. A healthcare payer perspective was used with a lifetime time horizon. Model outcomes were compared to those from a model with no pertussis health states. Probabilistic sensitivity analyses were used to generate distributions for estimates. Economic burden was estimated by multiplying case cost estimates by annual age-specific incidence. RESULTS Overall, LYs lost per pertussis case was low, with negligible LYs lost in those aged >4 years. Infants (<6 months) had the greatest mean QALY loss per case (0.58), while adults lost only 0.05 QALYs per case. Infants experienced the greatest mean cost per case of $22,768 (95% CI: 21,144-23,406). Case costs generally declined with age, but increased in seniors (aged 65+) with mean cost of $1920 (95% CI: 1800-2033). Based on historic age-specific incidence, pertussis costs the Ontario healthcare system approximately $7.6-$21.5 M annually. In total economic cost estimates with QALYs valued at 1xGDP (3xGDP) per capita, the net impact of pertussis in Ontario was estimated at $21.7-$66.5 M annually ($50.0-$156.3 M). For all of Canada, total economic costs were estimated at $79.6-$241.3 M ($187.5-$580.5 M) annually. CONCLUSION The health and economic consequences of pertussis persistence are substantial and highlight the need for improved control strategies.
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Affiliation(s)
- Ashleigh McGirr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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6
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Godoy P, García-Cenoz M, Toledo D, Carmona G, Caylà JA, Alsedà M, Àlvarez J, Barrabeig I, Camps N, Plans P, Company M, Castilla J, Sala-Farré MR, Muñoz-Almagro C, Rius C, Domínguez À. Factors influencing the spread of pertussis in households: a prospective study, Catalonia and Navarre, Spain, 2012 to 2013. ACTA ACUST UNITED AC 2017; 21:30393. [PMID: 27918260 PMCID: PMC5144939 DOI: 10.2807/1560-7917.es.2016.21.45.30393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 02/28/2016] [Indexed: 11/24/2022]
Abstract
We aimed to investigate transmission rates of pertussis in household contacts of cases and factors associated with transmission. A prospective epidemiological study was conducted in 2012 and 2013 to determine the incidence of pertussis among household contacts of reported cases in Catalonia and Navarre, Spain. An epidemiological survey was completed for each case and contact, who were followed for 28 days to determine the source of infection (primary case) and detect the occurrence of secondary cases. Odds ratios (ORs) were used to estimate the effectiveness of vaccination and chemoprophylaxis in preventing new cases, using the formula (1 − OR) × 100. For the 688 primary cases, a total of 2,852 contacts were recorded. The household transmission rate was 16.1% (459/2,852) and rose according to the age (> 18 years) and lack of immunisation of the primary cases, and also the age (0–18 years), family relationship (siblings and children), lack of vaccination and chemoprophylaxis of contacts. Pertussis vaccine effectiveness in preventing new cases was 65.0% (95% confidence interval (CI): 11.6 to 86.2) for full vaccination (≥ 4 doses) and 59.7% (95% CI: −6.8 to 84.8) for incomplete vaccination (< 4 doses). The effectiveness of chemoprophylaxis was 62.1% (95% CI: 40.3 to 75.9). To reduce household transmission, contacts should be investigated to detect further cases and to administer chemoprophylaxis. The current vaccination status of cases and contacts can reduce household transmission.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Institut de Recerca Biomèdica de Lleida, IRBLleida, Lleida, Spain
| | - Manuel García-Cenoz
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain.,Universidad Pública de Navarra (UPNA), Navarre, Spain
| | - Diana Toledo
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Joan A Caylà
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Miquel Alsedà
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Institut de Recerca Biomèdica de Lleida, IRBLleida, Lleida, Spain
| | - Josep Àlvarez
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Neus Camps
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Pere Plans
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - María Company
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Jesús Castilla
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | | | - Carmen Muñoz-Almagro
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Hospital de Sant Joan de Dèu, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Rius
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Àngela Domínguez
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
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- Members of the group are listed at the end of the article
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7
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Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: Microbiology, Disease, Treatment, and Prevention. Clin Microbiol Rev 2016; 29:449-86. [PMID: 27029594 PMCID: PMC4861987 DOI: 10.1128/cmr.00083-15] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pertussis is a severe respiratory infection caused by Bordetella pertussis, and in 2008, pertussis was associated with an estimated 16 million cases and 195,000 deaths globally. Sizeable outbreaks of pertussis have been reported over the past 5 years, and disease reemergence has been the focus of international attention to develop a deeper understanding of pathogen virulence and genetic evolution of B. pertussis strains. During the past 20 years, the scientific community has recognized pertussis among adults as well as infants and children. Increased recognition that older children and adolescents are at risk for disease and may transmit B. pertussis to younger siblings has underscored the need to better understand the role of innate, humoral, and cell-mediated immunity, including the role of waning immunity. Although recognition of adult pertussis has increased in tandem with a better understanding of B. pertussis pathogenesis, pertussis in neonates and adults can manifest with atypical clinical presentations. Such disease patterns make pertussis recognition difficult and lead to delays in treatment. Ongoing research using newer tools for molecular analysis holds promise for improved understanding of pertussis epidemiology, bacterial pathogenesis, bioinformatics, and immunology. Together, these advances provide a foundation for the development of new-generation diagnostics, therapeutics, and vaccines.
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Affiliation(s)
- Paul E Kilgore
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Abdulbaset M Salim
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Marcus J Zervos
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Health System and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Heinz-Josef Schmitt
- Medical and Scientific Affairs, Pfizer Vaccines, Paris, France Department of Pediatrics, Johannes Gutenberg-University, Mainz, Germany
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8
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Salim AM, Liang Y, Kilgore PE. Protecting Newborns Against Pertussis: Treatment and Prevention Strategies. Paediatr Drugs 2015; 17:425-41. [PMID: 26542059 DOI: 10.1007/s40272-015-0149-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pertussis is a potentially severe respiratory disease, which affects all age groups from young infants to older adults and is responsible for an estimated 195,000 deaths occurred globally in 2008. Active research is ongoing to better understand the pathogenesis, immunology, and diagnosis of pertussis. For diagnosis, molecular assays (e.g., polymerase chain reaction) for detection of Bordetella pertussis have become more widely available and support improved outbreak detection. In children, pertussis vaccines have been incorporated into routine immunization schedules and deployed for pertussis outbreak control. Lower levels of vaccine coverage are now being observed in communities where vaccine hesitancy is rising. Additionally, recognition that newborn babies are at risk of pertussis in the USA and UK has led to recommendations to immunize pregnant women. Among adolescents and older adults in the USA, Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular pertussis (Tdap) Vaccines are recommended, but substantial individual- and system-level barriers exist that will make achieving national Healthy People 2020 targets for immunization challenging. Current antimicrobial regimens for pertussis are focused on reducing the severity of disease, reducing rates of sequelae, and minimizing transmission of infection to susceptible individuals. Continued surveillance for pertussis will be important to identify opportunities for reducing young infants' exposure and reducing the impact of outbreaks among school-aged children. Laboratory-based surveillance for newly emerging strains of B. pertussis will be important to identify strains that may evade protection elicited by currently available vaccines. Efforts to develop new-generation pertussis vaccines should be considered now in anticipation of vaccine development programs, which may require ten or more years to deliver a licensed vaccine.
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Affiliation(s)
- Abdulbaset M Salim
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
| | - Yan Liang
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA. .,Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College, Kunming, China.
| | - Paul E Kilgore
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
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