Strategies to Decrease Pertussis Transmission to Infants

Abstract

The Global Pertussis Initiative (GPI) is an expert scientific forum addressing the worldwide burden of pertussis, which remains a serious health issue, especially in infants. This age cohort is at risk for developing pertussis by transmission from those in close proximity. Risk is increased in infants aged 0 to 6 weeks, as they are too young to be vaccinated. Older infants are at risk when their vaccination schedules are incomplete. Infants also bear the greatest disease burden owing to their high risk for pertussis-related complications and death; therefore, protecting them is a high priority. Two vaccine strategies have been proposed to protect infants. The first involves vaccinating pregnant women, which directly protects through the passive transfer of pertussis antibodies. The second strategy, cocooning, involves vaccinating parents, caregivers, and other close contacts, which indirectly protects infants from transmission by preventing disease in those in close proximity. The goal of this review was to present and discuss evidence on these 2 strategies. Based on available data, the GPI recommends vaccination during pregnancy as the primary strategy, given its efficacy, safety, and logistic advantages over a cocoon approach. If vaccination during pregnancy is not feasible, then all individuals having close contact with infants ,6 months old should be immunized consistent with local health authority guidelines. These efforts are anticipated to minimize pertussis transmission to vulnerable infants, although real-world effectiveness data are limited. Countries should educate lay and medical communities on pertussis and introduce robust surveillance practices while implementing these protective strategies.

A Different Approach to Pertussis Immunization: Cocooning Strategy

“…25 Boğmaca enfeksiyonunun önlenmesinde koza stratejisinin başarıya ulaşmasını engelleyen bir takım faktörler bulunmaktadır. 27 Bunlardan en önemlisi, koza stratejisinin maliyetinin yüksek olmasıdır. 12,27 İspanya'da yapılan bir çalışmada, koza stratejisinin maliyetinin maternal immünizasyo-nun maliyetinden yaklaşık iki kat fazla olduğu bildirilmiştir.…”

“…27 Bunlardan en önemlisi, koza stratejisinin maliyetinin yüksek olmasıdır. 12,27 İspanya'da yapılan bir çalışmada, koza stratejisinin maliyetinin maternal immünizasyo-nun maliyetinden yaklaşık iki kat fazla olduğu bildirilmiştir. 12 İtalya'da yapılan bir çalışmada, koza stratejisinin çok kaynak gerektiren pahalı bir yaklaşım olduğu belirtilmiştir.…”

“…19 Sık kullanılan yöntemlerden biri de "koza stratejisi (cocooning)"dir. 3,10,12,18,19,[25][26][27][28][29] Sağlık hizmetlerinin her alanında olduğu gibi aşılar ve bağışıklama ile ilgili bilgiler de sürekli yenilenmektedir. Bu nedenle, sağlık profesyonellerinin güncel bilgiler doğrultusunda değişen uygulamaları takip etmesi bir gerekliliktir.…”

Pertussis: enfermedad reemergente

“…La disminución de la inmunidad inducida por la vacuna ha desplazado el pico de incidencia en los neonatos hacia los adolescentes y adultos; por otro lado, los brotes nosocomiales de la enfermedad no son infrecuentes y los trabajadores en el cuidado de la salud al ser expuestos se convierten en fuente de infección especialmente a infantes con pobre desarrollo inmunológico, como es el caso de los neonatos prematuros (17,18).…”

Benefits of maternal vaccination to prevent pertussis in infants

“…50 The Global Pertussis Initiative, an international expert group on pertussis, recommended the MV as a first-line intervention, and cocoon strategy as a second line to decrease pertussis in infants in 2015. 51 The WHO demonstrated that the MV is an important costeffectiveness strategy for preventing pertussis in infants who do not yet receive the regular vaccination schedule. 8 This coincides with the findings of Vilajeliu, who found a strong correlation between levels of IgG-BP antibodies in mothers and in their infants.…”