Nathan Saul1, Kevin Wang2, Shopna Bag3, Heather Baldwin4, Kate Alexander5, Meena Chandra6, Jane Thomas7, Helen Quinn8, Vicky Sheppeard9, Stephen Conaty10. 1. Communicable Disease Branch, 73 Miller Street, North Sydney, New South Wales 2060, Australia. Electronic address: n.saul@live.com.au. 2. Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 73 Miller Street, North Sydney, New South Wales 2060, Australia. Electronic address: kevin.wang@doh.health.nsw.gov.au. 3. Centre for Population Health, Western Sydney Local Health District, North Parramatta, New South Wales 2151, Australia. 4. Biostatistics Training Program, New South Wales Ministry of Health, 73 Miller Street, North Sydney, New South Wales 2060, Australia. 5. South Western Sydney Local Health District Public Health Unit, Level 2, 157-161 George St, Liverpool, New South Wales 2170, Australia. 6. Public Health Registrar, Public Health Unit and Department of Community Paediatrics, South Western Sydney Local Health District, 157-161 George Street, Liverpool, New South Wales 2170, Australia. Electronic address: meenakshi.chandra@sswahs.nsw.gov.au. 7. Nepean Blue Mountains Local Health District Public Health Unit, PO Box 63, Penrith, New South Wales 2751, Australia. Electronic address: jane.thomas@health.nsw.gov.au. 8. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Cnr Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia. Electronic address: helen.quinn@health.nsw.gov.au. 9. Communicable Disease Branch, 73 Miller Street, North Sydney, New South Wales 2060, Australia. Electronic address: vshep@doh.health.nsw.gov.au. 10. South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC, New South Wales 1871, Australia. Electronic address: stephen.conaty@sswahs.nsw.gov.au.
Abstract
BACKGROUND: Infants are at the highest risk of severe complications - including death - as a result of pertussis infection. Controlling pertussis in this group has been challenging, particularly in those too young to be vaccinated. Following revised national recommendations in March 2015, the state of New South Wales, Australia, introduced a funded maternal vaccination campaign at 28 - 32 weeks of gestation using a 3-component tetanus-diphtheria-acellular pertussis vaccine (dTpa; Boostrix, GSK). This study aimed to assess the effectiveness of maternal vaccination and add to the growing body of evidence for this strategy. METHODS: A 1:1 matched case-control study was conducted between 16 August 2015 and 17 August 2016. Cases were laboratory or doctor notified, laboratory confirmed (nucleic acid testing or culture) and aged <6 months at onset. Each control infant was randomly selected from public hospital births in the same geographical area in the period up to 3 days before and after the case's birthdate. Odds ratios (OR) were calculated using conditional logistic regression. Vaccine effectiveness (VE) was calculated as 1 - OR. FINDINGS: In total, 117 cases and 117 controls were recruited. The overall VE estimate was non-significantly protective for infants <6 months old (VE 39%, 95% CI -12 to 66%). Higher VE was observed for infants <3 months old (VE 69%, 95% CI 13-89%) and against hospitalisation (VE 94%, 95% CI 59-99%). INTERPRETATION: Maternal pertussis vaccination with a 3-component acellular vaccine was found to be highly effective at preventing severe disease in infants, but was less effective at preventing disease which did not require hospitalisation. The overall VE reported in this study was lower than in prior studies and suggests that maternal vaccination, while an effective strategy at preventing severe pertussis, is less effective at protecting against infection or mild disease.
BACKGROUND:Infants are at the highest risk of severe complications - including death - as a result of pertussis infection. Controlling pertussis in this group has been challenging, particularly in those too young to be vaccinated. Following revised national recommendations in March 2015, the state of New South Wales, Australia, introduced a funded maternal vaccination campaign at 28 - 32 weeks of gestation using a 3-component tetanus-diphtheria-acellular pertussis vaccine (dTpa; Boostrix, GSK). This study aimed to assess the effectiveness of maternal vaccination and add to the growing body of evidence for this strategy. METHODS: A 1:1 matched case-control study was conducted between 16 August 2015 and 17 August 2016. Cases were laboratory or doctor notified, laboratory confirmed (nucleic acid testing or culture) and aged <6 months at onset. Each control infant was randomly selected from public hospital births in the same geographical area in the period up to 3 days before and after the case's birthdate. Odds ratios (OR) were calculated using conditional logistic regression. Vaccine effectiveness (VE) was calculated as 1 - OR. FINDINGS: In total, 117 cases and 117 controls were recruited. The overall VE estimate was non-significantly protective for infants <6 months old (VE 39%, 95% CI -12 to 66%). Higher VE was observed for infants <3 months old (VE 69%, 95% CI 13-89%) and against hospitalisation (VE 94%, 95% CI 59-99%). INTERPRETATION: Maternal pertussis vaccination with a 3-component acellular vaccine was found to be highly effective at preventing severe disease in infants, but was less effective at preventing disease which did not require hospitalisation. The overall VE reported in this study was lower than in prior studies and suggests that maternal vaccination, while an effective strategy at preventing severe pertussis, is less effective at protecting against infection or mild disease.
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