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Pertussis burden and acellular pertussis vaccine effectiveness in high risk children
Sarah Sheridan1, Peter McIntyre2, Bette Liu3
1School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia.
Insights
Acellular pertussis vaccine effectiveness varies significantly in high-risk infants. Indigenous infants and those with comorbidities show lower protection, necessitating further research into enhanced vaccination strategies for vulnerable populations.
Area of Science:
- Immunology
- Public Health
- Pediatrics
Background:
- Pertussis (whooping cough) hospitalisation disproportionately affects premature infants, those with comorbidities, and Indigenous children.
- Existing acellular pertussis (aP) vaccine effectiveness (VE) data lacks granularity for these critical subgroups.
- Understanding VE in vulnerable populations is crucial for targeted public health interventions.
Purpose of the Study:
- To measure aP vaccine effectiveness (VE) stratified by Indigenous status, prematurity, and comorbidities in Australian infants.
- To identify specific subgroups of infants with potentially reduced vaccine protection.
- To inform public health policy regarding pertussis prevention in high-risk infant populations.
Main Methods:
- Linked population-based data from Western Australia and New South Wales (2001-2013) were used.
- Infants were followed to 18 months of age and stratified by Aboriginality, gestational age (<32 vs 32-<37 weeks), and comorbidities.
- Adjusted Cox proportional hazards models calculated rates, rate ratios, and VE for hospitalised and non-hospitalised pertussis notifications.
Main Results:
- Among over 1.3 million children, significant VE was observed for hospitalised pertussis in both Aboriginal (post-dose 3: 76%) and non-Aboriginal (post-dose 3: 80%) children.
- Infants with comorbidities showed low and non-significant VE post-dose 1 (0%) and dose 2 (30%) for hospitalised pertussis.
- Post-dose 3, VE was significant for hospitalised pertussis (70%) in children with comorbidities, but not for non-hospitalised pertussis (24%).
Conclusions:
- While current infant pertussis vaccination schedules offer protection, improved timeliness and antenatal coverage are recommended for all infants.
- Infants born extremely prematurely (<32 weeks gestation) or with significant medical comorbidities require additional strategies.
- Further research into additional vaccine doses or improved immunogenicity vaccines is warranted for highest-risk infants to ensure adequate pertussis protection.
Background:
Pertussis hospitalisation is more common among infants born prematurely, who have significant comorbidities, or are Indigenous, but acellular pertussis (aP) vaccine effectiveness (VE) estimates in these sub-groups are lacking. We measured aP VE by Indigenous status, and policy-relevant categories of prematurity and comorbidity, in a population-based Australian cohort.
Methods:
Perinatal, disease notification, hospitalisation, mortality, and vaccination data were linked to birth records in two Australian states (Western Australia and New South Wales) 2001-2012, with follow-up to the end of 2013. Children followed to 18 months of age were stratified by Aboriginality, prematurity (<32 vs 32-<37 weeks gestation) and comorbidities identified from hospital discharge coding. Rates, rate ratios and VE were calculated for first episode of hospitalised and non-hospitalised pertussis notifications using adjusted Cox proportional hazards models.
Results:
Among >1,300,000 children, 63,867 (4·9%) were Aboriginal, 47,721 (3·6%) had at least one comorbidity and 3,771 first episodes of notified pertussis occurred <18 months of age; of these, 1,207 (32.0%) had an associated pertussis-coded hospitalisation. For hospitalised pertussis in Aboriginal and non-Aboriginal children, there was significant protection post dose 1 (VE 51% v 25%), 2 (VE 69% v 74%) and 3 (VE 76% v 80%). For children with co-morbidities, VE for hospitalised pertussis was low and non-significant post dose 1 (0%) and 2 (30%). Post dose 3, VE was significant for hospitalised pertussis (70%; 95% CI 29-87) but not for non-hospitalised pertussis (24%; 95% CI -49 to 61).
Conclusions:
For most Aboriginal and non-Aboriginal children, improved timeliness of current infant doses and higher antenatal coverage should further improve protection against pertussis of any severity. For children at highest risk of severe pertussis (born <32 weeks gestation or with significant medical comorbidities), our data suggest that additional measures-such as extra doses of pertussis-containing vaccines and/or vaccines with improved immunogenicity-are needed for protection.
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