Page 14 - Preventing pertussis in early infancy - Visser

Chapter 1
Chapter 1
vaccination of those surrounding them. Research on safety, effectiveness and feasibility has increasingly become available for the suggested vaccination strategies (see Table 1.1), which resulted in the evolution of many recommendations for the implementation of these different strategies from diverse (inter)national recommending bodies (Table 1.2).
Table 1.1 Overview of the safety, effectiveness and feasibility of the potential additional vaccination strategies for the prevention of pertussis in early infancy, based on the 2015 WHO position paper on pertussis vaccines (WHO 2015)
Additional vaccination strategy
Neonatal vaccination
Maternal vaccination1
Booster vaccination of adolescents (or adults) Cocooning2
HCW vaccination
Safety Effect on infants
+/- +/- + +
+ - + +/-
+ +/-
Feasibility Remarks
+ Standalone pertussis vaccination is not available and there is insufficient data on the safety in newborns, especially with respect to a possible blunting effect on long-term immunity.
+/- Data on effectiveness and safety became available after 2014. The feasibility is dependent on the possibilities for implementation of the vaccination and vaccination acceptance among pregnant women.
+ Only minimal effect preventing pertussis in early infancy, most modelling studies find it not cost-effective.
+/- The effectiveness and feasibility of cocooning is dependent
on high vaccination coverage and timely vaccination. Modelling studies show diverse results. (Westra et al. 2010, Lugner et al. 2013)
+/- Impact on the nosocomial spread of pertussis only. Modelling study suggests that with a vaccination coverage of
> 25% implementation is cost-effective. (Greer et al. 2011)
1. Vaccination of pregnant women in the third trimester of pregnancy.
2. Vaccination of parents and close household contacts of infants < 6 months of age.
Table 1.2 Evolution of recommendations concerning additional strategies for the prevention of pertussis in early infancy concerning the Netherlands
Year
Recommended by
Recommendation
Pertussis cocooning and pertussis vaccination of healthcare workers
Pertussis cocooning and pertussis vaccination of healthcare workers
Maternal pertussis vaccination and pertussis vaccination of healthcare workers Maternal pertussis vaccination
Pertussis vaccination of healthcare workers
2007 GPI
When the studies for this thesis started, in 2011, pertussis cocooning and selective vaccination of HCWs seemed the most promising and important strategies (Forsyth et al. 2007). Both strategies were recommended by the WHO, and several high-income countries adapted their policies to incorporate these vaccinations (Kretsinger et al. 2006, Maltezou et al. 2014). Also in the Netherlands, where the desirability of a supplementary targeted vaccination approach was subject to thorough consideration in the Health Council of the Netherlands, introduction of these strategies seemed eminent. From countries that had already started with the introduction of pertussis cocooning vaccination and vaccination of HCWs it became clear, however, that achieving a high uptake of pertussis vaccination turned
2010
2015
2015
2017
GPI = Global Pertussis Initiative, WHO = World Health Organisation, HCN = the Health Council of the Netherlands
WHO WHO HCN HCN
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