Estimates of the effectiveness of a whole-cell pertussis vaccine from an outbreak in an immunized population

Bentsi-Enchill, Adwoa; Halperin, Scott A.; Scott, Jeff; MacIsaac, Kay; Duclos, Philippe

doi:10.1016/s0264-410x(96)00176-4

Cited by 56 publications

(29 citation statements)

References 14 publications

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“…1) with the method developed in [16]. These estimates are at least consistent with the dynamic model (1). The force of infection so estimated depends on the fraction of the population vaccinated, on the duration of protection after vaccination in the preepidemic period, and on the fractions p " and p # of …”

Section: Model Parameterssupporting

confidence: 53%

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A model based evaluation of the 1996–7 pertussis epidemic in the Netherlands

et al. 2001

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SUMMARYIn the Netherlands a strong epidemic outbreak of pertussis took place in 1996-7. Here we investigate the possible causes of the epidemic, using an age-structured epidemic model. Motivated by the observation that during the epidemic the number of cases in vaccinated children had increased considerably compared to the preceding period, we focus on two vaccination related changes. First, we consider the possibility that the potency of the vaccine decreased so that it confers protection for a shorter period of time in newly vaccinated children. Second, we consider the possibility that at a certain point in time the duration of protection after vaccination decreased for all individuals. This may be the case if the pathogen population changed such that the current vaccine confers less protection. A comparison of the observed and simulated age-distribution of infections indicates that the second scenario is more in line with the observed pattern of the 1996-7 epidemic. We discuss the implications of this conclusion for B. pertussis circulation, and for the design of vaccination programmes in the face of a polymorphic B. pertussis population that may adapt itself to vaccination.

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Section: Model Parameterssupporting

confidence: 53%

“…However, in the last 15 years there has been a resurgence of pertussis in many developed countries (e.g. Canada [1], USA [2][3][4], UK [5]). …”

Section: Introductionmentioning

confidence: 99%

A model based evaluation of the 1996–7 pertussis epidemic in the Netherlands

et al. 2001

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“…[7][8][9] We were surprised to see a significant protective effect, given the estimated low effectiveness of this particular whole-cell vaccine of 49%-61%. [3][4][5] However, our results showed that receiving 1 or more doses of whole-cell vaccine as an infant provided significant protection from pertussis more than a decade later.…”

Section: Discussionmentioning

confidence: 58%

“…In 1997, owing to concerns about safety and effectiveness, acellular pertussis vaccine replaced the whole-cell product that had been in use since 1984. [3][4][5] In Ontario, only the 5-component acellular vaccine (containing pertussis toxoid, filamentous hemagglutinin, pertactin, and fimbriae types 2 and 3) has been available for infants and toddlers. Vaccination against pertussis is recommended at 2, 4, 6 and 18 months, and at 4-6 years.…”

mentioning

confidence: 99%

Effectiveness of pertussis vaccination and duration of immunity

Schwartz

Kwong

Deeks

et al. 2016

CMAJ

109

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Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming. Methods:We used the test-negative design, a nested case-control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 -OR) × 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine.Results : Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 testpositive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15-364 days, 84% (95% CI 77% to 89%) at 1-3 years, 62% (95% CI 42% to 75%) at 4-7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57). Interpretation:We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent. AbstractSee also www.cmaj.ca/lookup

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“…The occurrence of B. pertussis infection among adolescents and adults reflects waning immunity in these populations, improvements in diagnostic methods, and better recognition of pertussislike syndromes by health care providers (HCPs). [1][2][3][4][5][6][7] Adults, who may not present with classical whooping cough symptoms and may go undiagnosed, play an important role in the transmission of infection to infants who are at highest risk of severe disease. [8][9][10][11][12][13] Currently, the Canadian National Advisory Committee on Immunization (NACI) recommends a dose of pertussis vaccine be given during adolescence and that all adults who have not had a dose of acellular pertussis should receive a single dose.…”

Section: Introductionmentioning

confidence: 99%

Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What Canadian health care providers know and need to know

MacDougall

Halperin

MacKinnon‐Cameron

et al. 2015

Human Vaccines & Immunotherapeutics

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The tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is recommended for all adults in both Canada and the United States. There are few data on the proportion of Canadian adults vaccinated with Tdap; however, anecdotal reports indicate that uptake is low. This study aimed to explore the knowledge, attitudes, beliefs, and behaviors of Canadian health care providers (HCPs) in an attempt to identify potential barriers and facilitators to Tdap uptake. HCPs were surveyed and a geographic and practice representative sample was obtained (N D1,167). In addition, 8 focus groups and 4 interviews were conducted nationwide. Results from the survey indicate that less than half (47.5%) of all respondents reported being immunized with Tdap themselves, while 58.5% routinely offer Tdap to their adult patients. Knowledge scores were relatively low (63.2% correct answers). The best predictor of following the adult Tdap immunization guidelines was awareness of and agreement with those recommendations. Respondents who were aware of the recommendations were more likely to think that Tdap is safe and effective, that their patients are at significant risk of getting pertussis, and to feel that they have sufficient information (p < 0.0001 for each statement). Focus group data supported the survey results and indicated that there are substantial gaps in knowledge of pertussis and Tdap among Canadian HCPs. Lack of public knowledge about adult immunization, lack of immunization registries, a costing differential between Td and Tdap, workload required to deliver the vaccine, and vaccine hesitancy were identified as barriers to compliance with the national recommendations for universal adult immunization, and suggestions were provided to better translate recommendations to front-line practitioners.

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Estimates of the effectiveness of a whole-cell pertussis vaccine from an outbreak in an immunized population

Cited by 56 publications

References 14 publications

A model based evaluation of the 1996–7 pertussis epidemic in the Netherlands

A model based evaluation of the 1996–7 pertussis epidemic in the Netherlands

Effectiveness of pertussis vaccination and duration of immunity

Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What Canadian health care providers know and need to know

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