Carla Vizzotti1, Maria V Juarez2, Eduardo Bergel3, Viviana Romanin2, Gloria Califano2, Sandra Sagradini2, Carolina Rancaño2, Analía Aquino2, Romina Libster4, Fernando P Polack5, Juan Manzur2. 1. Dirección Nacional de Control de Enfermedades Inmunoprevenibles (DiNaCEI), Ministerio de Salud de la Nación, Argentina. Electronic address: cvizzotti@dicei.msal.gov.ar. 2. Dirección Nacional de Control de Enfermedades Inmunoprevenibles (DiNaCEI), Ministerio de Salud de la Nación, Argentina. 3. Fundacion INFANT, Buenos Aires, Argentina. 4. Fundacion INFANT, Buenos Aires, Argentina; Vanderbilt University, Nashville, TN, United States; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina. 5. Fundacion INFANT, Buenos Aires, Argentina; Vanderbilt University, Nashville, TN, United States.
Abstract
BACKGROUND: Pertussis disease is a growing concern for developing countries. In Argentina, rates of illness and death peaked in 2011. More than 50% of fatalities due to pertussis occurred in infants younger than two months of age, too young for vaccination. In 2012, the government offered immunization with a vaccine containing Tdap to all pregnant women after 20weeks of gestation with the intent of reducing morbidity and mortality in young infants. METHODS: Maternal acellular pertussis vaccine impact on reducing infant disease burden was estimated based on data from the Argentinean Health Surveillance System. We divided Argentinean states in two groups experiencing high (>50) and low (⩽50) Tdap vaccine coverage and compared these two groups using a Bayesian structural time-series model. Low coverage regions were used as a control group, and the time series were compared before and after the implementation of the Tdap program. FINDINGS: We observed a relative reduction of 51% (95% CI [-67%, -35%]; p=0.001) in pertussis cases in high coverage states in comparison with the low coverage areas. Analysis of infants between two and six months showed a 44% (95% CI [-66%, -24%]; p=0.001) reduction in illness. Number of deaths was highest in 2011 with 76 fatalities, for an incidence rate of 2.9 per 100,000. Comparing with 2011, rates decreased by 87% to 10 subjects, or 0.9 per 100,000 in 2013. INTERPRETATION: We show an age-dependent protective effect of maternal Tdap immunization in a developing country for infants younger than six months. Copyright Â
BACKGROUND:Pertussis disease is a growing concern for developing countries. In Argentina, rates of illness and death peaked in 2011. More than 50% of fatalities due to pertussis occurred in infants younger than two months of age, too young for vaccination. In 2012, the government offered immunization with a vaccine containing Tdap to all pregnant women after 20weeks of gestation with the intent of reducing morbidity and mortality in young infants. METHODS: Maternal acellular pertussis vaccine impact on reducing infant disease burden was estimated based on data from the Argentinean Health Surveillance System. We divided Argentinean states in two groups experiencing high (>50) and low (⩽50) Tdap vaccine coverage and compared these two groups using a Bayesian structural time-series model. Low coverage regions were used as a control group, and the time series were compared before and after the implementation of the Tdap program. FINDINGS: We observed a relative reduction of 51% (95% CI [-67%, -35%]; p=0.001) in pertussis cases in high coverage states in comparison with the low coverage areas. Analysis of infants between two and six months showed a 44% (95% CI [-66%, -24%]; p=0.001) reduction in illness. Number of deaths was highest in 2011 with 76 fatalities, for an incidence rate of 2.9 per 100,000. Comparing with 2011, rates decreased by 87% to 10 subjects, or 0.9 per 100,000 in 2013. INTERPRETATION: We show an age-dependent protective effect of maternal Tdap immunization in a developing country for infants younger than six months. Copyright Â
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