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Pregnancy dose Tdap and postpartum cocooning to prevent infant pertussis: a decision analysis.
Pediatrics. 2013 Jun; 131(6):e1748-56.Ped

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 quality-adjusted 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.

Authors+Show Affiliations

National Center forImmunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23713104

Citation

Terranella, Andrew, et al. "Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: a Decision Analysis." Pediatrics, vol. 131, no. 6, 2013, pp. e1748-56.
Terranella A, Asay GR, Messonnier ML, et al. Pregnancy dose Tdap and postpartum cocooning to prevent infant pertussis: a decision analysis. Pediatrics. 2013;131(6):e1748-56.
Terranella, A., Asay, G. R., Messonnier, M. L., Clark, T. A., & Liang, J. L. (2013). Pregnancy dose Tdap and postpartum cocooning to prevent infant pertussis: a decision analysis. Pediatrics, 131(6), e1748-56. https://doi.org/10.1542/peds.2012-3144
Terranella A, et al. Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: a Decision Analysis. Pediatrics. 2013;131(6):e1748-56. PubMed PMID: 23713104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pregnancy dose Tdap and postpartum cocooning to prevent infant pertussis: a decision analysis. AU - Terranella,Andrew, AU - Asay,Garrett R Beeler, AU - Messonnier,Mark L, AU - Clark,Thomas A, AU - Liang,Jennifer L, Y1 - 2013/05/27/ PY - 2013/5/29/entrez PY - 2013/5/29/pubmed PY - 2013/8/21/medline KW - Tdap KW - pertussis KW - pregnancy KW - vaccines SP - e1748 EP - 56 JF - Pediatrics JO - Pediatrics VL - 131 IS - 6 N2 - 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 quality-adjusted 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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/23713104/Pregnancy_dose_Tdap_and_postpartum_cocooning_to_prevent_infant_pertussis:_a_decision_analysis_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=23713104 DB - PRIME DP - Unbound Medicine ER -