Abstract
BackgroundPrior economic evaluations of adult and adolescent vaccination strategies against pertussis have reached disparate conclusions. Using static approaches only, previous studies failed to analytically include the indirect benefits derived from herd immunity as well as the impact of vaccination on the evolution of disease incidence over time.MethodsWe assessed the impact of different pertussis vaccination strategies using a dynamic compartmental model able to consider pertussis transmission. We then combined the results with economic data to estimate the relative cost-effectiveness of pertussis immunization strategies for adolescents and adults in the US. The analysis compares combinations of programs targeting adolescents, parents of newborns (i.e. cocoon strategy), or adults of various ages.ResultsIn the absence of adolescent or adult vaccination, pertussis incidence among adults is predicted to more than double in 20 years. Implementing an adult program in addition to childhood and adolescent vaccination either based on 1) a cocoon strategy and a single booster dose or 2) a decennial routine vaccination would maintain a low level of pertussis incidence in the long run for all age groups (respectively 30 and 20 cases per 100,000 person years). These strategies would also result in significant reductions of pertussis costs (between −77% and −80% including additional vaccination costs). The cocoon strategy complemented by a single booster dose is the most cost-effective one, whereas the decennial adult vaccination is slightly more effective in the long run.ConclusionsBy providing a high level of disease control, the implementation of an adult vaccination program against pertussis appears to be highly cost-effective and often cost-saving.
Highlights
Pertussis vaccines were first licensed in the United States (US) in 1914 and were combined with diphtheria and tetanus toxoids in 1918 [1]
This is illustrated by data from the Acellular Pertussis Vaccine Trial (APERT), which reported an incidence of 370 to 450 cases per 100,000 person years in adolescents and adults [10], compared to the reported US incidence of 1.1 and 7.7 per 100,000 adults and adolescents, respectively [5]
The epidemiological model predicts that adding a booster dose of pertussis vaccine for adolescents to the current US childhood vaccine schedule has a dramatic impact on the overall incidence of pertussis, with a reduction in the overall incidence of symptomatic pertussis from about 400 to less than 90 per 100,000 person years
Summary
Pertussis vaccines were first licensed in the United States (US) in 1914 and were combined with diphtheria and tetanus toxoids in 1918 [1]. Under-diagnosis may occur differentially according to age, with most adult cases not being detected or reported This is illustrated by data from the Acellular Pertussis Vaccine Trial (APERT), which reported an incidence of 370 to 450 cases per 100,000 person years in adolescents and adults [10], compared to the reported US incidence of 1.1 and 7.7 per 100,000 adults (aged $20 years) and adolescents (aged 10 to 19 years), respectively [5]. The APERT study found that there may be approximately five cases of asymptomatic pertussis infection for every case of symptomatic infection in adults and adolescents, which may contribute to the circulation of Bordetella pertussis in the community [11]. Previous studies failed to analytically include the indirect benefits derived from herd immunity as well as the impact of vaccination on the evolution of disease incidence over time
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