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Original Investigation |

Epidemiological and Economic Effects of Priming With the Whole-Cell Bordetella pertussis Vaccine

Haedi DeAngelis, MA1; Samuel V. Scarpino, PhD2; Meagan C. Fitzpatrick, PhD3; Alison P. Galvani, PhD3,4; Benjamin M. Althouse, PhD, ScM1,2
[+] Author Affiliations
1New Mexico State University, Las Cruces
2Santa Fe Institute, Santa Fe, New Mexico
3Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut
4Yale Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut
JAMA Pediatr. 2016;170(5):459-465. doi:10.1001/jamapediatrics.2016.0047.
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Importance  Current acellular pertussis vaccines may not protect against transmission of Bordetella pertussis.

Objective  To assess whether a priming dose of whole-cell pertussis (wP) vaccine is cost-effective at reducing pertussis infection in infants.

Design, Setting, and Participants  Mathematical model of pertussis transmission fit to US incidence data in a simulation of the US population. In this simulation study conducted from June 2014 to May 2015, the population was divided into 9 age groups corresponding to the current pertussis vaccination schedule and fit to 2012 pertussis incidence.

Interventions  Inclusion of a priming dose of wP vaccine into the current acellular pertussis vaccination schedule.

Main Outcomes and Measures  Reductions in symptomatic pertussis incidence by age group, increases in wP vaccine–related adverse effects, and quality-adjusted life-years owing to changing vaccine schedule.

Results  Switching to a wP-priming vaccination strategy could reduce whooping cough incidence by up to 95% (95% CI, 91-98), including 96% (95% CI, 92-98) fewer infections in neonates. Although there may be an increase in the number of vaccine adverse effects, we nonetheless estimate a 95% reduction in quality-adjusted life-years lost with a switch to the combined strategy and a cost reduction of 94% (95% CI, 91-97), saving more than $142 million annually.

Conclusions and Relevance  Our results suggest that an alternative vaccination schedule including 1 dose of wP vaccine may be highly cost-effective and ethically preferred until next-generation pertussis vaccines become available.

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Figure 1.
Base Case Results

Base case estimates for the rates of symptomatic infection (A), hospitalizations (B), and infant deaths (C) per 100 000 total population during the first 10 years in the second epoch. Parameters are given in the Supplement.

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Figure 2.
Total Hospitalizable Bordetella pertussis–Related Adverse Events

Whooping cough complications include hospitalizations, pneumonia, seizures, and encephalopathy; vaccine adverse effects include seizures and encephalopathy. Parameters are given in the Supplement.

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