Evaluation of the effectiveness of maternal immunization against pertussis in Alberta using agent-based modeling: A Canadian immunization research network study |
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| Affiliation: | 1. Department of Medicine, Division of Preventive Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada;2. Department of Computer Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;3. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;4. Departments of Pediatrics, Microbiology and Immunology, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada;5. World Health Organization, Geneva, Switzerland;6. Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA;7. Department of Infectious Diseases, University of Georgia, Athens, GA, USA;8. Odum School of Ecology, University of Georgia, Athens, GA, USA;9. School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada;1. Aly Lab, Beykoz Institute of Life Sciences and Biotechnology, Bezmialem Vakif University, Istanbul 34820, Turkey;2. Department of Biotechnology, Institute of Health Sciences, Bezmialem Vakif University, Istanbul 34093, Turkey;3. School of Science and Engineering, Al Akhawayn University, Ifrane 53000, Morocco;1. Ghana Health Services Regional Health Directorate, Worawora, Oti Region, Ghana;2. Nkwanta South Municipal Health Directorate, Ghana Health Services, Oti Region, Ghana;3. Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, UK;4. Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana;1. Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil;2. Universidade de Brasilia, Brasilia, DF, Brazil;3. Initiative of Immunization – Panamerican Health Organization/World Health Organization (PAHO/WHO), Brasilia, DF, Brazil;4. Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil;1. Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK;2. Public Health Department, Liverpool City Council, Liverpool, UK;3. School of Medicine, University of Nottingham, Nottingham, UK;4. Public Health England North West, Cheshire & Merseyside Health Protection Team, Liverpool, UK;5. Adult Social Care Department, Liverpool City Council, Liverpool, UK;1. Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;2. Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;3. Department of Communication, Portland State University, Portland, OR, United States;4. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States;5. Seattle Children’s Research Institute, Seattle, WA, United States;6. Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States |
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| Abstract: | IntroductionThe re-emergence of pertussis has occurred in the past two decades in developed countries. The highest morbidity and mortality is seen among infants. Vaccination in pregnancy is recommended to reduce the pertussis burden in infants.MethodsWe developed and validated an agent-based model to characterize pertussis epidemiology in Alberta. We computed programmatic effectiveness of pertussis vaccination during pregnancy (PVE) in relation to maternal vaccine coverage and pertussis disease reporting thresholds. We estimated the population preventable fraction (PFP) of different levels of maternal vaccine coverage against counterfactual ”no-vaccination” scenario. We modeled the effect of immunological blunting and measured protection through interruption of exposure pathways.ResultsPVE was inversely related to duration of passive immunity from maternal immunization across most simulations. In the scenario of 50% maternal vaccine coverage, PVE was 87% (95% quantiles 82–91%), with PFP of 44% (95% quantiles 41–45%). For monthly age intervals of 0–2, 2–4, 4–6 and 6–12, PVE ranged between 82 and 99%, and PFP ranged between 41 and 49%. At 75% maternal vaccine coverage, PVE and PFP were 90% (95% quantiles 86–92%) and 68% (95% quantiles 65–69%), respectively. At 50% maternal vaccine coverage and 10% blunting, PVE and PFP were 86% (95% quantiles 77–87%) and 43% (95% quantiles 39–44%), respectively, while at 50% blunting, the corresponding values of PVE and PFP were 76% (95% quantiles 70–81%) and 38% (95% quantiles 35–40%). PVE attributable to interruption of exposure pathways was 54–57%.ConclusionsOur model predicts significant reduction in future pertussis cases in infants due to maternal vaccination, with immunological blunting slightly moderating its effectiveness. The model is most sensitive to maternal vaccination coverage. The interruption of exposure pathways plays a role in the reduction of pertussis burden in infants due to maternal immunization. The effect of maternal immunization on population other than infants remains to be elucidated. |
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| Keywords: | Pertussis Epidemiology Vaccination Agent-based model Pregnancy Computer simulation |
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