Abstract
Pertussis vaccination policy varies across Europe, not only in the type of vaccine—whole cell (wP) vs. acellular (aP1/2/3/5)—but also in the schedule and recommendation for parents. This study aims to investigate the determining factors for the type of vaccine, immunization schedule and maternal immunization recommendation. From March to May 2019, experts in national health agencies and major academic or research institutions from Denmark, France, Poland, Sweden and the UK were invited to a semi-structured interview. Thematic analysis was performed on the transcripts using a codebook formulated by three coders. Inter-coder agreement was assessed. Fifteen expert interviews were conducted. The identified driving factors for pertussis vaccine policy were classified into three domains: scientific factors, sociological factors, and pragmatic factors. The determining factors for the type of vaccine were prescriber’s preference, concern of adverse events following immunization (AEFI), effectiveness, and consideration of other vaccine components in combined vaccines. The determining factors for infant schedule were immunity response and the potential to improve coverage and timeliness. The determining factors for maternal immunization were infant mortality and public acceptability. To conclude, socio-political and pragmatic factors were, besides scientific factors, important in determining the pertussis vaccine type, schedule of childhood immunization and recommendations for parents.
Highlights
Whooping cough is an acute respiratory infection characterized by repeated, intense cough bouts that can last for 2 to 3 months [1]
Developed in 1930s to 1950s; routine pertussis vaccination in children less than 12 months started in the late 1950s in Europe [4]. whole cell pertussis vaccines (wP) have been replaced by acellular pertussis vaccines in many
Some authors have hypothesized that the resurgence is due to short-lived protection from acellular pertussis vaccines (aP) compared to wP [6,7]
Summary
Whooping cough is an acute respiratory infection characterized by repeated, intense cough bouts that can last for 2 to 3 months [1]. In 1906, the pathogen causing whooping cough was found to be a. Gram-negative bacterium, Bordetella pertussis (B. pertussis) [2]. It is highly contagious and spreads via droplets of the coughs or sneezes of an infected person [1]. It was a major cause of infant mortality [3]. Developed in 1930s to 1950s; routine pertussis vaccination in children less than 12 months started in the late 1950s in Europe [4]. After more than half a century, whooping cough has yet to be eradicated and there are signs for resurgence despite routine childhood immunization [3,6] with high coverage [5]. Some authors have hypothesized that the resurgence is due to short-lived protection from aP compared to wP [6,7]
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