Abstract:Purpose:The impact of pertussis in individuals with asthma is not fully understood. We estimated the incidence, health care resource utilization (HCRU), and direct medical costs (DMC) of pertussis in patients with asthma. Patients and Methods: In this retrospective cohort study, the incidence rate of pertussis (identified using diagnostic codes) among individuals aged ≥50 years with an asthma diagnosis was assessed during 2009-2018 using Clinical Practice Research Datalink and Hospital Episode Statistics datab… Show more
“…Our overall pertussis incidence rate findings of 5.8 per 100,000 PYFU among individuals aged ≥ 50 years during 2009–2018 is comparable to the incidence rate of 7.6 per 100,000 PY reported in the United States (US) for individuals aged 50–64 years during 2006–2015 [ 20 ]. It is lower than among patients aged ≥ 50 years with a diagnosis of asthma (9.6 events per 100,000 PYFU) [ 18 ], which aligns with other studies that have reported an increased risk of pertussis among individuals with asthma [ 15 , 21 ].…”
Section: Discussionsupporting
confidence: 84%
“…For the control cohort, the index date was the date of pertussis diagnosis of the matched pertussis patient. The study was conducted similarly to two previous studies among individuals aged ≥ 50 years with diagnoses of chronic obstructive pulmonary disease (COPD) [ 17 ] or asthma [ 18 ]. Fig.…”
Introduction
Pertussis, a highly infectious respiratory disease caused by
Bordetella pertussis
, affects people of all ages. Older adults are particularly susceptible to its severe outcomes and complications.
Methods
In this retrospective cohort study, the incidence rate of pertussis among individuals aged ≥ 50 years was assessed during 2009–2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases, United Kingdom. Health care resource utilisation (HCRU) and direct medical costs (DMCs) were compared between patients with a pertussis diagnosis and propensity score-matched controls (matched on demographic and clinical variables).
Results
Among 5,222,860 individuals, 1638 had a pertussis diagnosis (incidence rate: 5.8 per 100,000 person-years; 95% confidence interval 5.5–6.0). Baseline (– 18 to – 6 months) HCRU and DMC were similar among 1480 pertussis patients and 1480 matched controls. However, there were increases in HCRU in the pertussis vs. matched cohort around the pertussis diagnosis (from months – 6 to – 1 to 5–11). The most notable increases (pertussis vs. controls) were in the rates of general practitioner (GP)/nurse visits (4.7-fold), clinical assessments (4.1-fold), and accident and emergency visits (3.0-fold) during the month before diagnosis and GP/nurse visits during the 2 months after diagnosis (2.5-fold) (all
p
< 0.001). DMCs were significantly higher in the pertussis cohort (
p
< 0.001). Total excess DMC in the pertussis cohort during months – 1 to + 11 was £318 per patient.
Conclusion
A pertussis diagnosis among adults aged ≥ 50 years resulted in significant increases in HCRU and DMC across several months around diagnosis. These results highlight the need for increased awareness of pertussis infection among adults aged ≥ 50 years and suggest that pertussis booster doses among this population should be considered.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40121-023-00774-5.
“…Our overall pertussis incidence rate findings of 5.8 per 100,000 PYFU among individuals aged ≥ 50 years during 2009–2018 is comparable to the incidence rate of 7.6 per 100,000 PY reported in the United States (US) for individuals aged 50–64 years during 2006–2015 [ 20 ]. It is lower than among patients aged ≥ 50 years with a diagnosis of asthma (9.6 events per 100,000 PYFU) [ 18 ], which aligns with other studies that have reported an increased risk of pertussis among individuals with asthma [ 15 , 21 ].…”
Section: Discussionsupporting
confidence: 84%
“…For the control cohort, the index date was the date of pertussis diagnosis of the matched pertussis patient. The study was conducted similarly to two previous studies among individuals aged ≥ 50 years with diagnoses of chronic obstructive pulmonary disease (COPD) [ 17 ] or asthma [ 18 ]. Fig.…”
Introduction
Pertussis, a highly infectious respiratory disease caused by
Bordetella pertussis
, affects people of all ages. Older adults are particularly susceptible to its severe outcomes and complications.
Methods
In this retrospective cohort study, the incidence rate of pertussis among individuals aged ≥ 50 years was assessed during 2009–2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases, United Kingdom. Health care resource utilisation (HCRU) and direct medical costs (DMCs) were compared between patients with a pertussis diagnosis and propensity score-matched controls (matched on demographic and clinical variables).
Results
Among 5,222,860 individuals, 1638 had a pertussis diagnosis (incidence rate: 5.8 per 100,000 person-years; 95% confidence interval 5.5–6.0). Baseline (– 18 to – 6 months) HCRU and DMC were similar among 1480 pertussis patients and 1480 matched controls. However, there were increases in HCRU in the pertussis vs. matched cohort around the pertussis diagnosis (from months – 6 to – 1 to 5–11). The most notable increases (pertussis vs. controls) were in the rates of general practitioner (GP)/nurse visits (4.7-fold), clinical assessments (4.1-fold), and accident and emergency visits (3.0-fold) during the month before diagnosis and GP/nurse visits during the 2 months after diagnosis (2.5-fold) (all
p
< 0.001). DMCs were significantly higher in the pertussis cohort (
p
< 0.001). Total excess DMC in the pertussis cohort during months – 1 to + 11 was £318 per patient.
Conclusion
A pertussis diagnosis among adults aged ≥ 50 years resulted in significant increases in HCRU and DMC across several months around diagnosis. These results highlight the need for increased awareness of pertussis infection among adults aged ≥ 50 years and suggest that pertussis booster doses among this population should be considered.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40121-023-00774-5.
“…Pertussis, commonly known as whooping cough, is a highly contagious infectious disease caused by Bordetella pertussis [1] . It is not only an important cause of mortality in infants and young children but also aggravates health risks of individuals with underlying chronic diseases such as asthma and chronic obstructive pulmonary disease [2] , [3] . Nowadays, pertussis continues to be a global public health problem in the context of even at least 90% coverage of three-dose primary series diphtheria-tetanus-pertussis (DTP3) (-containing) vaccines worldwide [4] .…”
“… 15 Accordingly, retrospective studies have shown that pertussis infection resulted in increased healthcare resource utilization and medical expenses in patients with COPD or asthma. 18 , 26 , 27 Furthermore, in a case series in Canada, pertussis was associated with increased use of bronchodilator aerosol in 93% of patients with preexisting pulmonary disease, including COPD and asthma. 28 …”
Patients with obstructive airway diseases (OAD), like chronic obstructive pulmonary disease (COPD) and asthma, may be at increased risk of pertussis infection. Pertussis may also trigger COPD and asthma exacerbations. Vaccination against pertussis could help protect OAD patients from the additional burden of pertussis, but there may be hesitancy related to vaccine safety and immunogenicity in such patients. We performed a meta-analysis on 5 clinical trials in adults receiving reduced-antigen tetanus-diphtheria-acellular pertussis vaccine (Tdap,
Boostrix
, GSK), from which we selected participants on active OAD treatment. We compared immunogenicity and reactogenicity outcomes of the meta-analysis with data from the overall populations of Tdap-vaccinated adults from 6 Tdap trials (including the 5 in the meta-analysis). The meta-analysis comprised 222 adults on active standard OAD treatment. One month post-Tdap, 89.0% and 97.2% of these adults, respectively, achieved seroprotective anti-diphtheria and anti-tetanus antibody concentrations; 78.3%–96.1% showed booster responses across the 3 pertussis antigens. These rates were consistent with those in the comparator population. The most frequently reported solicited local and systemic adverse events within 4 days post-Tdap were injection site pain (47.7%) and fatigue (19.3%), with low rates of grade 3 intensity (0.9% and 2.8%). This was consistent with Tdap reactogenicity in the comparator population. Evaluation of unsolicited and serious adverse events within 1 month post-Tdap did not identify safety concerns. In conclusion, Tdap was immunogenic and well tolerated in adults under active standard OAD treatment, with immunogenicity and safety profiles consistent with those in a comparator population representing the general adult population.
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