Using computer simulations to compare pertussis vaccination strategies in Australia
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Published on: February 22, 2019
Herbert W Hethcote1, Peter Horby, Peter McIntyre
1Department of Mathematics, University of Iowa, 14 MacLean Hall, Iowa City, IA 52242, USA. hethcote@math.uiowa.edu
Insights
Shifting the pertussis booster vaccine to adolescents aged 12-17 years in Australia is predicted to significantly reduce pertussis cases in infants and adolescents. This strategy is expected to lower overall pertussis incidence without increasing program costs.
Area of Science:
- * Epidemiology and Public Health
- * Vaccine Preventable Diseases
- * Mathematical Modeling in Health Sciences
Background:
- * Persistent pertussis (whooping cough) outbreaks in Australia affect adolescents and adults.
- * Severe infant disease and mortality continue despite high childhood immunization rates.
- * Availability of adult-formulated pertussis vaccines necessitates exploring alternative control strategies.
Purpose of the Study:
- * To evaluate the impact of different pertussis vaccination strategies on disease transmission in Australia.
- * To compare the effectiveness of adolescent boosters versus current infant booster schedules.
- * To project pertussis incidence across age groups over a 50-year period.
Main Methods:
- * An age-structured computer simulation model was employed to forecast pertussis transmission.
- * Epidemiological parameters and vaccination coverage data from Australia were utilized.
- * Sensitivity analyses were conducted to assess the robustness of model predictions.
Main Results:
- * Replacing the 18-month booster with an adolescent booster (12-17 years) at 80% coverage reduced pertussis cases by 30% in infants (0-23 months) and 25% in adolescents.
- * A 15% increase in pertussis cases was observed in 2-4-year-old children under the simulated adolescent booster strategy.
- * No significant shift of pertussis cases to child-bearing age groups was predicted.
Conclusions:
- * The shift to an adolescent pertussis booster vaccination schedule is likely to decrease overall pertussis incidence in Australia.
- * This revised strategy is anticipated to reduce severe disease in vulnerable infants.
- * The change is expected to be cost-neutral within the existing vaccine program framework.
Abstract:
High levels of notified pertussis in adolescents and adults, persisting severe disease (hospitalization and deaths) in infants despite high childhood immunization coverage, together with the availability of adult-formulated pertussis vaccines, have made alternate strategies for vaccine control of pertussis an important issue in Australia. An age-structured computer simulation model was used to compare the likely effects of adopting different vaccination strategies in Australia on pertussis transmission by age group over a 50 year time period. Epidemiological parameters and vaccination coverage in Australia were estimated from previous pertussis modeling studies and existing data. In the simulations, replacing the pertussis booster at 18 months with a booster dose for adolescents at an age between 12 and 17 years, assuming 80% coverage, led to decreases in pertussis cases of 30% in children of ages 0-23 months (who have the highest complication rates) and of 25% in adolescents, but an increase of 15% in cases in 2-4-year-old children. The simulations did not suggest any shift of pertussis cases into the adult child-bearing years. Varying parameter values in the simulations in a series of sensitivity analyses showed the model predictions to be robust over a plausible range. The results of these simulations suggest that the recent change in the Australian pertussis vaccination schedule, replacing the 18 month dose with a pertussis booster in 15-17-year-old adolescents, is very likely to reduce overall pertussis incidence in Australia without increasing the cost of the current vaccine program.
