Impact of a maternal immunization program against pertussis in a developing country |
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| Affiliation: | 1. Dirección Nacional de Control de Enfermedades Inmunoprevenibles (DiNaCEI), Ministerio de Salud de la Nación, Argentina;2. Fundacion INFANT, Buenos Aires, Argentina;3. Vanderbilt University, Nashville, TN, United States;4. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina;1. School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK;2. Department of Mathematics, Imperial College London, South Kensington Campus, London SW7 2AZ, UK;3. Department of Veterinary Medicine, University of Cambridge, UK;1. Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Bilthoven, The Netherlands;2. Laboratory for Infectious Diseases and Perinatal Screening, National Institute for Public Health and the Environment, Bilthoven, The Netherlands;1. Communicable Disease Control Directorate, Department of Health, Perth, WA, Australia;2. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia;3. School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia;4. Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia;1. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom;2. Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, England, United Kingdom;3. Statistics and Modelling Unit, Public Health England, London, England, United Kingdom;1. Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia;2. Murdoch Childrens Research Institute, Royal Childrens Hospital, Parkville, Australia;3. School of Mathematics and Statistics, The University of Melbourne, Parkville, Australia;4. National Centre for Immunisation Research and Surveillance, The Children''s Hospital at Westmead, Westmead, Australia;1. Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA;2. Center for Inference and Dynamics of Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, WA, USA;3. Santa Fe Institute, Santa Fe, NM, USA;4. Institute for Disease Modeling, Bellevue, WA, USA;5. New Mexico State University, Las Cruces, NM, USA;6. Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;7. Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA |
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| Abstract: | BackgroundPertussis disease is a growing concern for developing countries. In Argentina, rates of illness and death peaked in 2011. More than 50% of fatalities due to pertussis occurred in infants younger than two months of age, too young for vaccination. In 2012, the government offered immunization with a vaccine containing Tdap to all pregnant women after 20 weeks of gestation with the intent of reducing morbidity and mortality in young infants.MethodsMaternal acellular pertussis vaccine impact on reducing infant disease burden was estimated based on data from the Argentinean Health Surveillance System. We divided Argentinean states in two groups experiencing high (>50) and low (⩽50) Tdap vaccine coverage and compared these two groups using a Bayesian structural time-series model. Low coverage regions were used as a control group, and the time series were compared before and after the implementation of the Tdap program.FindingsWe observed a relative reduction of 51% (95% CI [−67%, −35%]; p = 0.001) in pertussis cases in high coverage states in comparison with the low coverage areas. Analysis of infants between two and six months showed a 44% (95% CI [−66%, −24%]; p = 0.001) reduction in illness. Number of deaths was highest in 2011 with 76 fatalities, for an incidence rate of 2.9 per 100,000. Comparing with 2011, rates decreased by 87% to 10 subjects, or 0.9 per 100,000 in 2013.InterpretationWe show an age-dependent protective effect of maternal Tdap immunization in a developing country for infants younger than six months. |
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| Keywords: | Pertussis Vaccine Maternal immunization |
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