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Pertussis in adolescents and adults: should we vaccinate?
Pediatrics. 2005 Jun; 115(6):1675-84.Ped

Abstract

BACKGROUND

The incidence of reported pertussis among adolescents, adults, and young infants has increased sharply over the past decade. Combined acellular pertussis vaccines for adolescents and adults are available in Canada, Australia, and Germany and may soon be considered for use in the United States.

OBJECTIVE

To evaluate the potential health benefits, risks, and costs of a national pertussis vaccination program for adolescents and/or adults.

DESIGN, SETTING, AND POPULATION

The projected health states and immunity levels associated with pertussis disease and vaccination were simulated with a Markov model. The following strategies were examined from the health care payer and societal perspectives: (1) no vaccination; (2) 1-time adolescent vaccination; (3) 1-time adult vaccination; (4) adult vaccination with boosters; (5) adolescent and adult vaccination with boosters; and (6) postpartum vaccination. Data on disease incidence, costs, outcomes, vaccine efficacy, and adverse events were based on published studies, recent unpublished clinical trials, and expert panel input.

MAIN OUTCOME MEASURES

Cases prevented, adverse events, costs (in 2004 US dollars), cost per case prevented, and cost per quality-adjusted life-year (QALY) saved.

RESULTS

One-time adolescent vaccination would prevent 30800 cases of pertussis (36% of projected cases) and would result in 91000 vaccine adverse events (67% local reactions). If pertussis vaccination cost $15 and vaccine coverage was 76%, then 1-time adolescent vaccination would cost $1100 per case prevented (or $1200 per case prevented) or $20000 per QALY (or $23000 per QALY) saved, from the societal (or health care payer) perspective. With a threshold of $50000 per QALY saved, the adolescent and adult vaccination with boosters strategy became potentially cost-effective from the societal perspective only if 2 conditions were met simultaneously, ie, (1) the disease incidence for adolescents and adults was > or =6 times higher than base-case assumptions and (2) the cost of vaccination was less than $10. Adult vaccination strategies were more costly and less effective than adolescent vaccination strategies. The results were sensitive to assumptions about disease incidence, vaccine efficacy, frequency of vaccine adverse events, and vaccine costs.

CONCLUSIONS

Routine pertussis vaccination of adolescents results in net health benefits and may be relatively cost-effective.

Authors+Show Affiliations

Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts 02215, USA. grace_lee@hphc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15930232

Citation

Lee, Grace M., et al. "Pertussis in Adolescents and Adults: Should We Vaccinate?" Pediatrics, vol. 115, no. 6, 2005, pp. 1675-84.
Lee GM, Lebaron C, Murphy TV, et al. Pertussis in adolescents and adults: should we vaccinate? Pediatrics. 2005;115(6):1675-84.
Lee, G. M., Lebaron, C., Murphy, T. V., Lett, S., Schauer, S., & Lieu, T. A. (2005). Pertussis in adolescents and adults: should we vaccinate? Pediatrics, 115(6), 1675-84.
Lee GM, et al. Pertussis in Adolescents and Adults: Should We Vaccinate. Pediatrics. 2005;115(6):1675-84. PubMed PMID: 15930232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pertussis in adolescents and adults: should we vaccinate? AU - Lee,Grace M, AU - Lebaron,Charles, AU - Murphy,Trudy V, AU - Lett,Susan, AU - Schauer,Stephanie, AU - Lieu,Tracy A, PY - 2005/6/3/pubmed PY - 2005/11/11/medline PY - 2005/6/3/entrez SP - 1675 EP - 84 JF - Pediatrics JO - Pediatrics VL - 115 IS - 6 N2 - BACKGROUND: The incidence of reported pertussis among adolescents, adults, and young infants has increased sharply over the past decade. Combined acellular pertussis vaccines for adolescents and adults are available in Canada, Australia, and Germany and may soon be considered for use in the United States. OBJECTIVE: To evaluate the potential health benefits, risks, and costs of a national pertussis vaccination program for adolescents and/or adults. DESIGN, SETTING, AND POPULATION: The projected health states and immunity levels associated with pertussis disease and vaccination were simulated with a Markov model. The following strategies were examined from the health care payer and societal perspectives: (1) no vaccination; (2) 1-time adolescent vaccination; (3) 1-time adult vaccination; (4) adult vaccination with boosters; (5) adolescent and adult vaccination with boosters; and (6) postpartum vaccination. Data on disease incidence, costs, outcomes, vaccine efficacy, and adverse events were based on published studies, recent unpublished clinical trials, and expert panel input. MAIN OUTCOME MEASURES: Cases prevented, adverse events, costs (in 2004 US dollars), cost per case prevented, and cost per quality-adjusted life-year (QALY) saved. RESULTS: One-time adolescent vaccination would prevent 30800 cases of pertussis (36% of projected cases) and would result in 91000 vaccine adverse events (67% local reactions). If pertussis vaccination cost $15 and vaccine coverage was 76%, then 1-time adolescent vaccination would cost $1100 per case prevented (or $1200 per case prevented) or $20000 per QALY (or $23000 per QALY) saved, from the societal (or health care payer) perspective. With a threshold of $50000 per QALY saved, the adolescent and adult vaccination with boosters strategy became potentially cost-effective from the societal perspective only if 2 conditions were met simultaneously, ie, (1) the disease incidence for adolescents and adults was > or =6 times higher than base-case assumptions and (2) the cost of vaccination was less than $10. Adult vaccination strategies were more costly and less effective than adolescent vaccination strategies. The results were sensitive to assumptions about disease incidence, vaccine efficacy, frequency of vaccine adverse events, and vaccine costs. CONCLUSIONS: Routine pertussis vaccination of adolescents results in net health benefits and may be relatively cost-effective. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/15930232/Pertussis_in_adolescents_and_adults:_should_we_vaccinate L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=15930232 DB - PRIME DP - Unbound Medicine ER -