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High effectiveness of infant vaccination against pertussis in 1- and 2-year-olds, the Netherlands, 2013-2024
Dimphey L van Meijeren1, Annika M van Roon1, Brechje de Gier1
1Dutch National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720, BA, Bilthoven, the Netherlands.
Insights
Infant pertussis vaccination is highly effective, showing 98.2% vaccine effectiveness (VE) against pertussis up to 36 months. High vaccination uptake is crucial for protecting young children from this disease.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health
Background:
- Pertussis (whooping cough) remains a significant concern for young children, necessitating effective vaccination strategies.
- Understanding the real-world vaccine effectiveness (VE) of infant immunization is critical for public health policy.
- Changes in vaccine formulations and schedules (NIP period 1 vs. period 2) in the Netherlands warrant evaluation.
Purpose of the Study:
- To estimate the vaccine effectiveness (VE) of the full infant pertussis vaccination schedule.
- To compare VE estimates derived from a case-control study versus the screening method.
- To assess the impact of different national immunization program (NIP) periods on VE.
Main Methods:
- A case-control study was conducted with laboratory-confirmed pertussis cases aged 12-35 months (2013-2024) matched to four controls.
- Conditional logistic regression was used to estimate stratum-specific odds ratios (ORs), with interaction terms for age group and NIP period.
- Vaccine effectiveness was calculated as (1-OR)*100% and compared with estimates from the screening method.
Main Results:
- The study included 1156 cases and 4624 controls; 89% of controls were fully vaccinated compared to 27% of cases.
- The case-control study yielded an overall VE of 98.2% (95% CI: 97.6-98.6), indicating high protection.
- VE showed a decline with increasing time since vaccination, with slightly greater waning in NIP period 1. Screening method estimates were comparable (96.4% VE).
Conclusions:
- Full infant pertussis vaccination provides highly effective protection against pertussis up to 36 months of age.
- Findings were consistent across both case-control and screening methods, reinforcing the reliability of the VE estimates.
- High uptake of infant pertussis vaccination is essential for disease control and prevention in young children.
Introduction:
With still high circulation of pertussis and risk for severe disease in young children, insight into vaccine effectiveness (VE) of infant pertussis vaccination is important. In the Netherlands, NIP period 1 corresponds to the period during which the DT3aP-IPV-Hib-HBV vaccine and the 3 + 1 dose schedule were used, and NIP period 2 to the period during which the DT5aP-IPV-Hib-HBV vaccine was used, maternal Tdap vaccination was implemented, and both the 3 + 1 and 2 + 1 dose schedules were used. We estimated the VE of full infant vaccination against pertussis.
Methods:
We conducted a case-control study including all laboratory-confirmed pertussis cases aged 12-35 months, notified between 2013 and 2024, each matched to four controls by year and month of birth. Conditional logistic regression including age group and NIP period as interaction terms was used to estimate stratum-specific odds ratios (ORs) with 95% confidence intervals (CIs). We compared these estimates to those obtained by the screening method, applying logistic regression with the log-odds of the national vaccination coverage in the corresponding birth cohorts of cases as an offset. VE was calculated as (1-OR)*100 for both methods.
Results:
We included 1156 cases and 4624 controls. Among cases, 27% were fully vaccinated, 4% partly vaccinated and 69% unvaccinated; among controls these percentages were 89%, 6% and 5% respectively. Overall VE of the case-control study was 98.2% (95% CI: 97.6-98.6). VE decreased with increasing time since vaccination (p < 0.001) and this was slightly more pronounced for NIP period 1 compared to period 2 (p < 0.001). Estimates using the screening method were slightly lower, with overall VE being 96.4% (95% CI: 95.9-96.8), but similar trends were observed.
Conclusion:
Full infant pertussis vaccination is highly effective up to 36 months of age. These findings, consistent across both methods, emphasize importance of high infant pertussis vaccination uptake.
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