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Epidemiological and Economic Effects of Priming With the Whole-Cell Bordetella pertussis Vaccine
Haedi DeAngelis1, Samuel V Scarpino2, Meagan C Fitzpatrick3
1New Mexico State University, Las Cruces.
Insights
A whole-cell pertussis (wP) vaccine priming dose could significantly reduce whooping cough infections and healthcare costs. This strategy is cost-effective and ethically preferable to current acellular vaccines.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Vaccinology
Background:
- Current acellular pertussis vaccines exhibit limitations in preventing Bordetella pertussis transmission.
- There is a need to evaluate cost-effective strategies to reduce pertussis burden in infants.
Purpose of the Study:
- To assess the cost-effectiveness of a whole-cell pertussis (wP) vaccine priming dose for reducing infant pertussis infection.
- To evaluate the impact of integrating a wP priming dose into the existing vaccination schedule.
Main Methods:
- A mathematical model simulating pertussis transmission in the US population was developed.
- The model was fitted to US incidence data from 2012 and incorporated a priming dose of wP vaccine into the current schedule.
Main Results:
- A wP-priming strategy could decrease pertussis incidence by up to 95%, with 96% fewer infections in neonates.
- This strategy is projected to reduce quality-adjusted life-years lost by 95% and save over $142 million annually.
- Potential increases in vaccine adverse effects were noted but outweighed by the benefits.
Conclusions:
- An alternative vaccination schedule with a single wP vaccine dose appears highly cost-effective.
- This approach is ethically preferred for pertussis prevention until advanced vaccines are available.
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.
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