Bias in Pertussis Incidence Data and Its Implications for Public Health Epidemiology

Goldwyn, Eli E.; Rohani, Pejman

doi:10.1097/phh.0b013e31826d7f95

Cited by 2 publications

(2 citation statements)

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“…First and foremost is a lack of publicly available data to more fully explore the hypotheses suggested. This lack of available data is well known among researchers studying B. pertussis [ 51 ]. Longer time series of age-stratified data (specifically in infants too young to be vaccinated) would be required to fully explore how the natural periodicity of B. pertussis incidence shifted as wP coverage changed.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic transmission and the resurgence of Bordetella pertussis

Althouse

Scarpino

2015

BMC Med

199

171

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BackgroundThe recent increase in whooping cough incidence (primarily caused by Bordetella pertussis) presents a challenge to both public health practitioners and scientists trying to understand the mechanisms behind its resurgence. Three main hypotheses have been proposed to explain the resurgence: 1) waning of protective immunity from vaccination or natural infection over time, 2) evolution of B. pertussis to escape protective immunity, and 3) low vaccine coverage. Recent studies have suggested a fourth mechanism: asymptomatic transmission from individuals vaccinated with the currently used acellular B. pertussis vaccines.MethodsUsing wavelet analyses of B. pertussis incidence in the United States (US) and United Kingdom (UK) and a phylodynamic analysis of 36 clinical B. pertussis isolates from the US, we find evidence in support of asymptomatic transmission of B. pertussis. Next, we examine the clinical, public health, and epidemiological consequences of asymptomatic B. pertussis transmission using a mathematical model.ResultsWe find that: 1) the timing of changes in age-specific attack rates observed in the US and UK are consistent with asymptomatic transmission; 2) the phylodynamic analysis of the US sequences indicates more genetic diversity in the overall bacterial population than would be suggested by the observed number of infections, a pattern expected with asymptomatic transmission; 3) asymptomatic infections can bias assessments of vaccine efficacy based on observations of B. pertussis-free weeks; 4) asymptomatic transmission can account for the observed increase in B. pertussis incidence; and 5) vaccinating individuals in close contact with infants too young to receive the vaccine (“cocooning” unvaccinated children) may be ineffective.ConclusionsAlthough a clear role for the previously suggested mechanisms still exists, asymptomatic transmission is the most parsimonious explanation for many of the observations surrounding the resurgence of B. pertussis in the US and UK. These results have important implications for B. pertussis vaccination policy and present a complicated scenario for achieving herd immunity and B. pertussis eradication.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0382-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Asymptomatic transmission and the resurgence of Bordetella pertussis

Althouse

Scarpino

2015

BMC Med

199

171

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“…Although pertussis is a notifiable disease in the United States, pertussis cases are greatly underreported (20)(21)(22)(23). To fully account for pertussis cases, we combined data on reported case counts from the US Centers for Disease Control and Prevention (CDC) (24), hospitalization rates (25), reporting rates for hospitalized cases (20), and active surveillance of nonhospitalized cases (26) (Web Figure 3, Web Appendix 2), which yielded base-case reporting rates of 1.38% (age <1 year), 0.93% (ages 1-6 years), 0.45% (ages 7-10 years), and 0.30% (ages ≥11 years; Web Table 2).…”

Section: Epidemiologic Parametersmentioning

confidence: 99%

Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States

Atkins¹,

Fitzpatrick²,

Galvani³

et al. 2016

Am. J. Epidemiol.

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Vaccination against pertussis has reduced the disease burden dramatically, but the most severe cases and almost all fatalities occur in infants too young to be vaccinated. Recent epidemiologic evidence suggests that targeted vaccination of mothers during pregnancy can reduce pertussis incidence in their infants. To evaluate the cost-effectiveness of antepartum maternal vaccination in the United States, we created an age-stratified transmission model, incorporating empirical data on US contact patterns and explicitly modeling parent-infant exposure. Antepartum maternal vaccination incurs costs of $114,000 (95% prediction interval: 82,000, 183,000) per quality-adjusted life-year, in comparison with the strategy of no adult vaccination, and is cost-effective in the United States according to World Health Organization criteria. By contrast, vaccinating a second parent is not cost-effective, and vaccination of either parent postpartum is strongly dominated by antepartum maternal vaccination. Nonetheless, postpartum vaccination of mothers who were not vaccinated antepartum improves upon the current recommendation of untargeted adult vaccination. Additionally, the temporary direct protection of the infant due to maternal antibody transfer has efficacy for infants comparable to that conferred to toddlers by the full primary vaccination series. Efficient protection against pertussis for infants begins before birth. We highly recommend antepartum vaccination for as many US mothers as possible.

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Bias in Pertussis Incidence Data and Its Implications for Public Health Epidemiology

Abstract: PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r A fter a decline of more than 99% from 1934 to 1976,

Cited by 2 publications

References 28 publications

Asymptomatic transmission and the resurgence of Bordetella pertussis

Asymptomatic transmission and the resurgence of Bordetella pertussis

Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States

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