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Measuring protection; a case study of pertussis vaccines--Swedish Trial II: secondary non-randomized comparisons
P Olin1, H O Hallander, L Gustafsson
1Swedish Institute for Infectious Disease Control, Stockholm.
Insights
A delayed third dose of pertussis vaccine, particularly the five-component acellular type, may offer better protection against whooping cough. This finding supports a revised infant vaccination schedule for improved pertussis prevention.
Area of Science:
- Immunology
- Vaccinology
- Pediatrics
Background:
- Pertussis (whooping cough) remains a public health concern globally.
- Current infant vaccination schedules vary, impacting vaccine efficacy.
- Acellular pertussis vaccines are increasingly used, but optimal scheduling requires further study.
Purpose of the Study:
- To compare the efficacy of different acellular pertussis vaccines against a whole-cell vaccine.
- To evaluate the impact of two different infant vaccination schedules (2-4-6 vs. 3-5-12 months) on pertussis risk.
- To assess the immunogenicity of delayed third vaccine doses.
Main Methods:
- A double-blind, randomized controlled trial involving over 82,000 children.
- Comparison of two-, three-, and five-component acellular vaccines with a whole-cell vaccine.
- Evaluation of pertussis incidence and parental-reported whooping cough risk across two different dosing schedules.
Main Results:
- A delayed third dose (3-5-12 schedule) showed a lower or similar overall risk of pertussis compared to the 2-4-6 schedule, despite higher background incidence.
- Parental reports indicated the lowest risk of whooping cough with five-component acellular and whole-cell vaccines.
- The delayed third dose boosted responses for filamentous hemagglutinin but not other pertussis antigens.
Conclusions:
- A two-dose infant vaccination followed by a third dose in the second year of life may be a recommended strategy for highly efficacious pertussis vaccines.
- The five-component acellular vaccine demonstrates promising efficacy, particularly with a delayed third dose.
- Optimizing pertussis vaccine schedules can enhance protection against whooping cough in children.
Abstract:
In a double-blind trial two-, three- and five-component acellular vaccines were compared to a British whole-cell vaccine: in areas using three doses at three, five and 12 months of age (3-5-12 schedule), 72,698 children and in areas using a two, four and six months schedule (2-4-6 schedule), 10,194 children were evenly randomized to the four groups. The background incidence of pertussis was higher in the 3-5-12 schedule areas than in the 2-4-6 schedule areas; in spite of this, the point estimates of the relative risks for the 3-5-12 schedule versus the 2-4-6 schedule were close to or below one for the multicomponent acellular and the whole-cell vaccine groups, indicating a lower overall risk of pertussis when the third dose was delayed. The risk of whooping cough according to parents was lowest for the five-component and whole-cell vaccine groups in both schedules. The delayed third dose elicited booster responses for filamentous haemagglutinin but not for the other pertussis antigens. For highly efficacious pertussis vaccines two doses in infancy followed by a third dose in the second year of life may be recommended.