1
|
Michels SY, Daley MF, Newcomer SR. Completion of multidose vaccine series in early childhood: current challenges and opportunities. Curr Opin Infect Dis 2024; 37:176-184. [PMID: 38427536 DOI: 10.1097/qco.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. RECENT FINDINGS Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. SUMMARY Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.
Collapse
Affiliation(s)
- Sarah Y Michels
- Center for Population Health Research, University of Montana, Missoula, Montana
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, Montana
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| |
Collapse
|
2
|
Merdrignac L, Aït El Belghiti F, Pandolfi E, Acosta L, Fabiánová K, Habington A, García Cenoz M, Bøås H, Toubiana J, Tozzi AE, Jordan I, Zavadilová J, O'Sullivan N, Navascués A, Flem E, Croci I, Jané M, Křížová P, Cotter S, Fernandino L, Bekkevold T, Muñoz-Almagro C, Bacci S, Kramarz P, Kissling E, Savulescu C. Effectiveness of one and two doses of acellular pertussis vaccines against laboratory-confirmed pertussis requiring hospitalisation in infants: Results of the PERTINENT sentinel surveillance system in six EU/EEA countries, December 2015 - December 2019. Vaccine 2024; 42:2370-2379. [PMID: 38472070 PMCID: PMC11007387 DOI: 10.1016/j.vaccine.2024.02.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Monitoring effectiveness of pertussis vaccines is necessary to adapt vaccination strategies. PERTINENT, Pertussis in Infants European Network, is an active sentinel surveillance system implemented in 35 hospitals across six EU/EEA countries. We aim to measure pertussis vaccines effectiveness (VE) by dose against hospitalisation in infants aged <1 year. METHODS From December 2015 to December 2019, participating hospitals recruited all infants with pertussis-like symptoms. Cases were vaccine-eligible infants testing positive for Bordetella pertussis by PCR or culture; controls were those testing negative to all Bordetella spp. For each vaccine dose, we defined an infant as vaccinated if she/he received the corresponding dose >14 days before symptoms. Unvaccinated were those who did not receive any dose. We calculated (one-stage model) pooled VE as 100*(1-odds ratio of vaccination) adjusted for country, onset date (in 3-month categories) and age-group (when sample allowed it). RESULTS Of 1,393 infants eligible for vaccination, we included 259 cases and 746 controls. Median age was 16 weeks for cases and 19 weeks for controls (p < 0.001). Median birth weight and gestational age were 3,235 g and week 39 for cases, 3,113 g and week 39 for controls. Among cases, 119 (46 %) were vaccinated: 74 with one dose, 37 two doses, 8 three doses. Among controls, 469 (63 %) were vaccinated: 233 with one dose, 206 two doses, 30 three doses. Adjusted VE after at least one dose was 59 % (95 %CI: 36-73). Adjusted VE was 48 % (95 %CI: 5-71) for dose one (416 eligible infants) and 76 % (95 %CI: 43-90) for dose two (258 eligible infants). Only 42 infants were eligible for the third dose. CONCLUSIONS Our results suggest moderate one-dose and two-dose VE in infants. Larger sample size would allow more precise estimates for dose one, two and three.
Collapse
Affiliation(s)
| | | | - Elisabetta Pandolfi
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Lesly Acosta
- Public Health Agency of Catalonia (ASPCAT), Barcelona, Spain; Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya- BarcelonaTech (UPC), Barcelona, Spain
| | | | | | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Håkon Bøås
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Julie Toubiana
- Biodiversité et Epidémiologie des bactéries et pathogènes, Institut Pasteur, Paris, France; National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Alberto E Tozzi
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Iolanda Jordan
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | | | | | | | - Elmira Flem
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Ilena Croci
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Mireia Jané
- Public Health Agency of Catalonia (ASPCAT), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Pavla Křížová
- National Institute of Public Health, Prague, Czech Republic
| | | | - Leticia Fernandino
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Terese Bekkevold
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sabrina Bacci
- European Centre for Diseases Control and Prevention, Stockholm, Sweden
| | - Piotr Kramarz
- European Centre for Diseases Control and Prevention, Stockholm, Sweden
| | | | | |
Collapse
|
3
|
Tessier E, Newport D, Tran A, Nash SG, Mensah AA, Yun Wang T, Shantikumar S, Campbell H, Amirthalingam G, Todkill D. Pertussis immunisation strategies to optimise infant pertussis control: A narrative systematic review. Vaccine 2023; 41:5957-5964. [PMID: 37658001 DOI: 10.1016/j.vaccine.2023.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants. METHODS We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias. FINDINGS A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies. CONCLUSION Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants.
Collapse
Affiliation(s)
| | - Daniel Newport
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Anh Tran
- UK Health Security Agency, London, UK
| | | | | | | | | | | | | | - Daniel Todkill
- UK Health Security Agency, London, UK; Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
4
|
Sánchez-González G, Luna-Casas G, Mascareñas C, Macina D, Vargas-Zambrano JC. Pertussis in Mexico from 2000 to 2019: A real-world study of incidence, vaccination coverage, and vaccine effectiveness. Vaccine 2023; 41:6105-6111. [PMID: 37661533 DOI: 10.1016/j.vaccine.2023.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The national immunization program in Mexico includes a 3-dose primary series of pertussis vaccine and a toddler booster dose. In Mexico, whole-cell pertussis vaccines (wP) were switched in 2007 to acellular pertussis vaccines (aP). METHODS This retrospective study using Mexican National Databases of Health and population surveillance (2000-2019) assessed the incidence of pertussis, infant pertussis vaccination coverage, and vaccine effectiveness (VE) against clinically-diagnosed and/or laboratory-confirmed pertussis in children aged 6.5-18.5 or 24.5 months for the primary series, and children aged 18.5 or 24.5-48.5 months for the toddler booster. RESULTS The incidence of pertussis sharply increased in 2012 and was highest in 2012, 2015, and 2016 (0.84-0.94/100,000 person-years). Coverage was highest for the first dose in the primary series, decreasing for each subsequent dose. The VE against notified pertussis was 96.4% (95% CI: 94.7, 97.6) for the first three doses of wP vaccine (2000-2007) and 95.7% (95% CI: 95.1, 96.2) for the first three doses of aP vaccine (2008-2019). CONCLUSIONS Our findings suggested high levels of vaccine effectiveness overall were achieved for the aP and wP vaccines in Mexico between 2000 and 2019.
Collapse
Affiliation(s)
- Gilberto Sánchez-González
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Gerardo Luna-Casas
- Estimatio, Health Economics and Outcome Research Services, Heriberto Frías 116-403, Col. Del Valle, Del. Benito Juárez, 03100 Mexico City, Mexico
| | - Cesar Mascareñas
- Sanofi, Vaccines Medical, 14 Espace Henry Vallée, 69007 Lyon, France
| | - Denis Macina
- Sanofi, Vaccines Medical, 14 Espace Henry Vallée, 69007 Lyon, France
| | | |
Collapse
|
5
|
Zhu P, Wu D, Wang Y, Liu X, Rodewald LE, Li Y, Zheng H, Cao L, Song Y, Song L, Zhao X, Yao J, Wang F, Li M, Zhang Q, Yan T, Yin Z. Effectiveness of DTaP Against Pertussis in ≤2-Year-Old Children - Linyi Prefecture, Shandong Province, China, 2017-2019. China CDC Wkly 2023; 5:374-378. [PMID: 37197447 PMCID: PMC10184384 DOI: 10.46234/ccdcw2023.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
What is already known about this topic? Vaccine effectiveness (VE) is positively correlated with the number of administered co-purified diphtheria, tetanus, and acellular pertussis vaccine (DTaP) doses. A matched case-control study conducted in Zhongshan City revealed that the co-purified DTaP VE against pertussis-related illnesses in children aged 4-11 months was 42% for one dose, 88% for two doses, and 95% for three doses, respectively. What is added by this report? The results of this study contribute to the current body of research. We found that the VE of co-purified DTaP against pertussis-related illness and hospitalization increased substantially, ranging from 24%-26% after one dose to 86%-87% after four doses. What are the implications for public health practice? The results of this study underscore the significance of prompt and comprehensive immunization using co-purified DTaP to decrease the incidence of pertussis. Additionally, these findings offer evidence supporting the modification of China's pertussis vaccination approach.
Collapse
Affiliation(s)
- Pinpin Zhu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Wang
- Linyi Center for Disease Control and Prevention, Linyi City, Shandong Province, China
| | - Xiaoxue Liu
- Jinan Center for Disease Control and Prevention, Jinan City, Shandong Province, China
| | - Lance E. Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yixing Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Song
- Linyi Center for Disease Control and Prevention, Linyi City, Shandong Province, China
| | - Xiaodong Zhao
- Jinan Center for Disease Control and Prevention, Jinan City, Shandong Province, China
| | - Jianyi Yao
- Health Communication Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuzhen Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mingshuang Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingting Yan
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- Zundong Yin,
| |
Collapse
|
6
|
Hexavalent vaccines: What can we learn from head-to-head studies? Vaccine 2021; 39:6025-6036. [PMID: 34531081 DOI: 10.1016/j.vaccine.2021.08.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Three hexavalent vaccines against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B virus (HBV), and Haemophilus influenzae type b (Hib) are licensed in Europe: Infanrix hexa (DT3aP-HBV-IPV/Hib), Hexyon (DT2aP-HBV-IPV-Hib) and Vaxelis (DT5aP-HBV-IPV-Hib). METHODS A systematic literature search was performed in various electronic databases to identify published peer-reviewed head-to-head studies comparing any licensed hexavalent vaccine to another. RESULTS Predefined inclusion criteria were met by 12 articles. Individual studies concluded that the 3 hexavalent vaccines have acceptable safety profiles although some significant differences were observed in their reactogenicity profiles. The immunogenicity of DT2aP-HBV-IPV-Hib and DT5aP-HBV-IPV-Hib was non-inferior versus DT3aP-HBV-IPV/Hib. Some differences in immune responses to common antigens were observed, but their clinical relevance was not established. Anti-filamentous hemagglutinin (FHA) from pertussis and anti-polyribosylribitol phosphate (PRP) from Hib antibody concentrations tended to be higher, and anti-HBV and anti-pertussis toxin (PT) from pertussis antibody concentrations lower in DT2aP-HBV-IPV-Hib versus DT3aP-HBV-IPV/Hib vaccinees. Anti-PT and post-primary anti-PRP antibody concentrations tended to be higher, and anti-HBV, anti-FHA, anti-pertactin from pertussis and post-booster anti-PRP antibody concentrations lower in DT5aP-HBV-IPV-Hib versus DT3aP-HBV-IPV/Hib recipients. Slightly lower immune responses towards most vaccine antigens were observed with 2 + 1 versus 3 + 1 schedules post-primary vaccination, suggesting that 2 + 1 schedules should only be considered in countries with very high vaccination coverage. CONCLUSION Although the licensed hexavalent vaccines are generally considered similar, analyses of immunogenicity data from head-to-head trials highlighted differences that could be related to differences in composition and formulation. In addition, the demonstrated non-inferiority of the immunogenicity of the more recent vaccines versus DT3aP-HBV-IPV/Hib does not allow a full bridging to similar efficacy, effectiveness and safety. The availability of DT3aP-HBV-IPV/Hib over > 20 years allowed to collect a wealth of data on its long-term immunogenicity, safety and effectiveness in clinical and post-marketing studies, and makes it a key pillar of pediatric immunization.
Collapse
|
7
|
Zeitgerechtes Impfen bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Zumstein J, Heininger U. Clinical and Epidemiologic Characteristics of Pertussis in Hospitalized Children: A Prospective and Standardized Long-term Surveillance Study. Pediatr Infect Dis J 2021; 40:22-25. [PMID: 32947597 DOI: 10.1097/inf.0000000000002904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surveillance of incidence and severity of pertussis is key to control success and shortcomings of vaccination programs followed by adaptations of recommendations if necessary. In Switzerland, nationwide reporting of hospitalizations due to pertussis in children has a long tradition and resumed in 2013 to evaluate the effects of pertussis immunization in pregnancy introduced in 2013. METHODS Since 2013, all patients <16 years of age hospitalized with suspected or proven pertussis have been reported to the Swiss Pediatric Surveillance Unit. Patient data comprising clinical and epidemiologic characteristics and laboratory confirmation were assessed in a standardized fashion, and case definitions were applied to all cases reported until the end of 2019. RESULTS Two hundred thirteen of 294 cases were valid cases of pertussis. Of these, 168 (79%) occurred in <6-month-old infants. Mean duration of hospitalization was 8 days (median 5, range 2-47) overall and highest in neonates (14.2 days); 85% of all patients had ≥1 complication, most commonly cyanosis and dyspnea, especially in infants. Overall, case fatality rate was 1.4% (8.7% in neonates). Only 4 (2%) of 168 mothers of infants <6 months had been vaccinated during pregnancy; 14 (12%) of 112 patients with precise records of immunization had completed their primary series and were up-to-date for age. CONCLUSIONS Despite a decline of cases associated with the introduction of immunization against pertussis in pregnancy, control of the disease remains challenging, mainly due to failure to vaccinate rather than vaccine failure.
Collapse
Affiliation(s)
- Jana Zumstein
- From the Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Ulrich Heininger
- From the Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|