Pertussis Hospitalizations Among Infants in the United States, 1993 to 2004

Cortese, Margaret M.; Baughman, Andrew L.; Zhang, Rongping; Srivastava, Pamela U.; Wallace, Gregory S.

doi:10.1542/peds.2007-1393

Cited by 113 publications

(72 citation statements)

References 16 publications

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“…Finally, we only included a slight inflation in cases to account for underreporting; cost-effectiveness of all strategies would improve markedly if incidence was higher at baseline. 1 In June 2011, the ACIP recommended Tdap for all previously unvaccinated pregnant women. 7 Factors considered included absolute reduction in cases, morbidity and mortality, and the disproportionate impact of this intervention on young infants.…”

Section: Discussionmentioning

confidence: 99%

“…Although some studies have documented underreporting of pertussis in infants to be as high as 50%, we conservatively assumed a 15% underreporting rate for infant pertussis. 1 Probability of hospitalization with respiratory disease and death were calculated according to month of age from 2000-2007 NNDSS data. Annual probability of encephalopathy and death were also calculated from NNDSS data.…”

Section: Methodsmentioning

confidence: 99%

“…Pertussis is understood to be underreported, with true incidence among infants potentially twice the reported rate. 1 Protecting the youngest infants is challenging because they are too young to be vaccinated with diphtheria-tetanus-acellular pertussis (DTaP) vaccines.…”

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confidence: 99%

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Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Infants aged ,2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy. WHAT THIS STUDY ADDS:This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness. abstract BACKGROUND: Infants ,2 months of age are at highest risk of pertussis morbidity and mortality. Until recently, the US Advisory Committee on Immunization Practices (ACIP) recommended protecting young infants by "cocooning" or vaccination of postpartum mothers and other close contacts with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) booster vaccine. ACIP recommends pregnancy vaccination as a preferred and safe alternative to postpartum vaccination. The ACIP cocooning recommendation has not changed. METHODS:We used a cohort model reflecting US 2009 births and the diphtheria-tetanus-acellular pertussis schedule to simulate a decision and cost-effectiveness analysis of Tdap vaccination during pregnancy compared with postpartum vaccination with or without vaccination of other close contacts (ie, cocooning). We analyzed infant pertussis cases, hospitalizations, and deaths, as well as direct disease, indirect, and public health costs for infants in the first year of life. All costs were updated to 2011 US dollars.RESULTS: Pregnancy vaccination could reduce annual infant pertussis incidence by more than postpartum vaccination, reducing cases by 33% versus 20%, hospitalizations by 38% versus 19%, and deaths by 49% versus 16%. Additional cocooning doses in a father and 1 grandparent could avert an additional 16% of cases but at higher cost. The cost per qualityadjusted life-year saved for pregnancy vaccination was substantially less than postpartum vaccination ($414 523 vs $1 172 825).CONCLUSIONS: Tdap vaccination during pregnancy could avert more infant cases and deaths at lower cost than postpartum vaccination, even when postpartum vaccination is combined with additional cocooning doses. Pregnancy dose vaccination is the preferred alternative to postpartum vaccination for preventing infant pertussis. Pediatrics 2013;131: e1748-e1756 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis

et al. 2013

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“…[1][2][3][4][5] The trend in pertussis infant morbidity has increased steadily since 1977, [6][7][8] and the fatality rate increased at an average 9% annually during the 1990s, with Hispanics being overrepresented compared with the general population. 2 Most deaths occurred in infants who were either age-ineligible to commence the routine childhood immunization series at 2 months of age with combined diphtheria and tetanus toxoids and either whole-cell pertussis (wP) or acellular pertussis (aP) vaccines (diphtheria-tetanuswhole-cell pertussis [DTwP]/ diphtheria-tetanus-acellular pertussis [DTaP]) or had received ,3 DTwP/ DTaP doses by age 6 months.…”

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confidence: 99%

First Pertussis Vaccine Dose and Prevention of Infant Mortality

2015

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BACKGROUND: American infants are at highest risk of severe pertussis and death. We investigated the role of $1 pertussis vaccinations in preventing pertussis-related deaths and risk markers for death among infants aged ,42 days. METHODS:We analyzed characteristics of fatal and nonfatal infant pertussis cases reported nationally during 1991-2008. Infants were categorized into 2 age groups on the basis of eligibility to receive a first pertussis vaccine dose at age 6 weeks; dose 1 was considered valid if given $14 days before illness onset. Multivariable logistic regression was used to estimate the effect of $1 pertussis vaccine doses on outcome and risk markers.RESULTS: Pertussis-related deaths occurred among 258 of 45 404 cases. Fatal and nonfatal cases were confirmed by culture (54% vs 49%) and polymerase chain reaction (31% vs 27%). All deaths occurred before age 34 weeks at illness onset; 64% occurred before age 6 weeks. Among infants aged $42 days, receiving $1 doses of vaccine protected against death (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11-0.74), hospitalization (aOR: 0.69; 95% CI: 0.63-0.77), and pneumonia (aOR: 0.80; 95% CI: 0.68-0.95). Risk was elevated for Hispanic ethnicity (aOR: 2.28; 95% CI: 1.36-3.83) and American Indian/Alaska Native race (aOR: 5.15; 95% CI: 2.37-11.2) and lower for recommended antibiotic treatment (aOR: 0.28; 95% CI: 0.16-0.47). Among infants aged ,42 days, risk was elevated for Hispanic ethnicity and lower with recommended antibiotic use. CONCLUSIONS:The first pertussis vaccine dose and antibiotic treatment protect against death, hospitalization, and pneumonia.

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“…5 The former group has proven to be particularly vulnerable; in children hospitalized in the United States with pertussis between 1993 and 2004, 95% of infants requiring mechanical ventilation and all of the infants who died were ,3 months old. 6 Pneumonia, apnea, and episodic cyanosis are the most common complications of pertussis. 7 However, the most severe cases can involve respiratory failure, ARDS, pulmonary hypertension, and death.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopy With N-Acetylcysteine Lavage in Severe Respiratory Failure From Pertussis Infection

Mata

Sarnaik

2013

Pediatrics

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Pertussis is an illness that causes significant morbidity and mortality, especially in infants younger than 3 months old. In the most severe cases, it can cause pneumonia, respiratory failure, acute respiratory distress syndrome, pulmonary hypertension, and death. There are reports of using rescue extracorporeal membrane oxygenation (ECMO) as a rescue therapy. However, the mortality of ECMO with pertussis is higher than with other causes of pediatric respiratory failure. We report here the case of a 2-month-old boy with severe respiratory failure and pulmonary hypertension who satisfied ECMO criteria but was successfully treated with repeated bronchoscopy with instillation of N-acetylcysteine. Our patient' s respiratory failure was refractory to multiple therapies that have shown benefit in pediatric hypoxemic respiratory failure, including open lung strategies, prone positioning, intratracheal surfactant, and inhaled nitric oxide. Although pulmonary hypertension is a key factor in most cases of fatal pertussis, the adverse effects of hyperinflation and air leaks were more important in this patient' s clinical course. Because bronchiolar obstruction from inflammatory, mucous, and airway epithelial debris can be seen in severe pertussis, a regimen of repeated therapeutic bronchoscopy was initiated, and thick, inspissated secretions were retrieved. The patient' s airway obstruction gradually resolved, and he eventually recovered with minimal sequelae. Pediatrics 2013;132:e1418-e1423

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Pertussis Hospitalizations Among Infants in the United States, 1993 to 2004

Cited by 113 publications

References 16 publications

Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis

Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis

First Pertussis Vaccine Dose and Prevention of Infant Mortality

Bronchoscopy With N-Acetylcysteine Lavage in Severe Respiratory Failure From Pertussis Infection

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