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Control of pertussis--lessons learnt from a 10-year surveillance programme in Sweden
Rose-Marie Carlsson1, Birger Trollfors
1Centre for Defence Medicine, Swedish Armed Forces, Box 5155, S-426 05 Västra Frölunda, Sweden. rose-marie.carlsson@mil.se
Insights
Sweden
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- Sweden uniquely lacked general pertussis vaccination upon acellular pertussis (aP) vaccine introduction.
- aP vaccines have been administered since 1996 at 3, 5, and 12 months with 99% coverage.
- A 10-year enhanced surveillance project monitored long-term aP vaccine effects.
Purpose of the Study:
- To evaluate the long-term effectiveness of acellular pertussis (aP) vaccines in Sweden.
- To assess the impact of aP vaccination on pertussis incidence and severity in children.
- To inform future pertussis control strategies.
Main Methods:
- Long-term surveillance of pertussis incidence and vaccination status.
- Analysis of hospitalization data and mortality related to pertussis.
- International workshop to discuss surveillance findings.
Main Results:
- aP vaccines significantly reduced pertussis burden in preschool children.
- Unvaccinated infants or those with single-dose vaccination had the highest incidence.
- Most hospitalizations and eight infant deaths occurred in unvaccinated infants.
Conclusions:
- The Swedish aP vaccination program successfully reduced pertussis in young children.
- Further strategies are necessary to mitigate morbidity from circulating Bordetella pertussis.
- High vaccine coverage is crucial for controlling pertussis.
Abstract:
Sweden was the only country in the world without any general pertussis vaccination when acellular pertussis (aP) vaccines were introduced. Since 1996 aP vaccines are given at the ages of 3, 5 and 12 months, with a 99% coverage, and until 2007 without a later booster. The long-term effects of aP vaccines, monitored within an enhanced surveillance project, were discussed at an international workshop in Stockholm in November 2008. The unique Swedish experience demonstrates that aP vaccines are capable of achieving the primary goal of a national vaccination programme, i.e., to significantly reduce the burden of pertussis in pre-school children. Throughout the 10-year surveillance period the highest age-specific incidence was reported in unvaccinated infants or those who had received only one dose, with most hospitalisations in this age group and eight deaths among unvaccinated infants. Complementary strategies are needed to achieve further reduction in morbidity from circulation of Bordetella pertussis.
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