Pertussis burden and acellular pertussis vaccine effectiveness in high risk children

Sarah Sheridan; Peter McIntyre; Bette Liu; Parveen Fathima; Thomas Snelling; Christopher Blyth; Nicholas de Klerk; Hannah Moore; Heather Gidding; Linkage Investigator Team

doi:10.1016/j.vaccine.2021.10.013

Pertussis burden and acellular pertussis vaccine effectiveness in high risk children

Vaccine. 2022 Feb 23;40(9):1376-1382. doi: 10.1016/j.vaccine.2021.10.013. Epub 2022 Jan 31.

Authors

Sarah Sheridan¹, Peter McIntyre², Bette Liu³, Parveen Fathima⁴, Thomas Snelling⁵, Christopher Blyth⁶, Nicholas de Klerk⁷, Hannah Moore⁸, Heather Gidding⁹; Linkage Investigator Team

Affiliations

¹ School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia. Electronic address: sarah.sheridan1@health.nsw.gov.au.
² National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia; Dunedin School of Medicine, Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand. Electronic address: peter.mcintrye@otago.ac.nz.
³ School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia. Electronic address: bette.liu@unsw.edu.au.
⁴ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: parveen.fathima@telethonkids.org.au.
⁵ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: tom.snelling@sydney.edu.au.
⁶ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Perth Children's Hospital, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Perth Children's Hospital, Perth, WA, Australia. Electronic address: christopher.blyth@uwa.edu.au.
⁷ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: nick.de.klerk@uwa.edu.au.
⁸ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia. Electronic address: Hannah.moore@telethonkids.org.au.
⁹ School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia. Electronic address: heather.gidding@sydney.edu.au.

PMID: 35101268
DOI: 10.1016/j.vaccine.2021.10.013

Abstract

Background: Pertussis hospitalisation is more common among infants born prematurely, who have significant comorbidities, or are Indigenous, but acellular pertussis (aP) vaccine effectiveness (VE) estimates in these sub-groups are lacking. We measured aP VE by Indigenous status, and policy-relevant categories of prematurity and comorbidity, in a population-based Australian cohort.

Methods: Perinatal, disease notification, hospitalisation, mortality, and vaccination data were linked to birth records in two Australian states (Western Australia and New South Wales) 2001-2012, with follow-up to the end of 2013. Children followed to 18 months of age were stratified by Aboriginality, prematurity (<32 vs 32-<37 weeks gestation) and comorbidities identified from hospital discharge coding. Rates, rate ratios and VE were calculated for first episode of hospitalised and non-hospitalised pertussis notifications using adjusted Cox proportional hazards models.

Results: Among >1,300,000 children, 63,867 (4·9%) were Aboriginal, 47,721 (3·6%) had at least one comorbidity and 3,771 first episodes of notified pertussis occurred <18 months of age; of these, 1,207 (32.0%) had an associated pertussis-coded hospitalisation. For hospitalised pertussis in Aboriginal and non-Aboriginal children, there was significant protection post dose 1 (VE 51% v 25%), 2 (VE 69% v 74%) and 3 (VE 76% v 80%). For children with co-morbidities, VE for hospitalised pertussis was low and non-significant post dose 1 (0%) and 2 (30%). Post dose 3, VE was significant for hospitalised pertussis (70%; 95% CI 29-87) but not for non-hospitalised pertussis (24%; 95% CI -49 to 61).

Conclusions: For most Aboriginal and non-Aboriginal children, improved timeliness of current infant doses and higher antenatal coverage should further improve protection against pertussis of any severity. For children at highest risk of severe pertussis (born <32 weeks gestation or with significant medical comorbidities), our data suggest that additional measures-such as extra doses of pertussis-containing vaccines and/or vaccines with improved immunogenicity-are needed for protection.

Keywords: Comorbid conditions; Data linkage; Indigenous; Pertussis; Prematurity; Vaccine effectiveness.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Child
Cohort Studies
Female
Humans
Infant
Pertussis Vaccine / therapeutic use
Pregnancy
Vaccination
Vaccine Efficacy
Whooping Cough* / epidemiology
Whooping Cough* / prevention & control

Substances

Pertussis Vaccine