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Researchers back pertussis vaccination during pregnancy

Vaccinating pregnant women against whooping cough is the most effective way to protect babies from contracting the disease, according to new research.

The pertussis vaccine Repevax has been used routinely offered to pregnant women in the UK since October 2012.

Findings from a range of UK studies unveiled this week support the approach, suggesting it could save lives and money.

“This data supports maternal vaccination in preventing whooping cough in infants”

Julie Lewis

Newborn babies are the group most vulnerable to serious complications and death from contracting the disease, also known as pertussis.

Researchers from Northern Ireland found a huge decrease in cases of whooping cough following the introduction of maternal vaccination across the region in October 2012.

Confirmed cases dropped by 82% with a 94% drop in cases among babies aged less than three months old, according to the study, which was led by Dr Julie Lewis at the Royal Hospital for Sick Children in Belfast.

“This data supports maternal vaccination in preventing whooping cough in infants,” said Dr Lewis.

This Gram-stained photomicrograph depicts numbers of Bordetella pertussis bacteria, which is the etiologic pathogen for pertussis, also known as whooping cough.

Bordetella pertussis bacteria

Researchers looking at the national immunisation programme for pregnant women in Scotland found it had led to an 85% reduction in cases among infants, while another study from Belgium concluded the “cocoon vaccination” of children and adolescents was not enough to protect newborn babies from getting infected.

Meanwhile, a study by vaccine company Sanofi Pasteur MSD highlighted the soaring costs linked to treating whooping cough as a result of a surge of cases in England.

It found the cost of hospital treatment soared to £2.2m during the 2012-13 whooping cough epidemic with children aged under one accounting for 85% of secondary care costs.

“We encourage pregnant women to have the vaccine in the final trimester of pregnancy”

Louise Silverton

The studies were presented at the annual meeting of the European Society for Paediatric Infectious Diseases in Dublin.

The Royal College of Midwives said it fully supported the vaccination of pregnant women to protect babies against whooping cough.

“Whooping cough is on the increase among young babies and it can be a dangerous and potentially infection,” said Louise Silverton, the RCM’s director for midwifery.

“We encourage pregnant women to have the vaccine in the final trimester of pregnancy to protect themselves and their baby from the disease in the first weeks after it is born.”

She stressed there was a need to ensure pregnant women “are aware of the seriousness of the infection and that they have all the information they need” to make an informed decision about whether to have the vaccine.

 

 

FULL STUDY ABSTRACTS:

 

ESPID-0346 ATTITUDES OF IRISH MOTHERS TO THE NATIONAL ‘WHOOPING COUGH’ VACCINATION RECOMMENDATIONS: THEIR KNOWLEDGE CLINICAL PERTUSSIS AND IMMUNITY AMONG HOUSEHOLD CONTACTS M. Parmar1, E. Moylett1 1Academic Department of Paediatrics, National University of Ireland Galway, Galway, Ireland

Introduction: The recent increase in neonatal pertussis cases has prompted the National Immunization Advisory Committee (NIAC) to recommend the Tdap vaccine for women at 28-32 weeks gestation or to women in the immediate post-partum period.

Objectives: Aims of this study were (1) to assess maternal knowledge of clinical pertussis infection, (2) to determine vaccination status of immediate newborn household contacts, and (3) to determine maternal attitudes towards the recent NIAC recommendations.

Methods: Knowledge, immunity and attitudes were determined via a prospective questionnaire-based study involving mothers on the ante- and post-natal wards of University Hospital Galway. Knowledge of clinical pertussis was determined via a series of questions, 1 point for each correct answer, maximum score of 10. Relevant socio-economic demographics were also recorded. Statistical analysis was performed using SPSS 21.

Results: 240/265 mothers completed the survey. The average knowledge score was 4.6/10 (SD±2.46), statistically higher among those with higher education level, (p <0.02). Concerning mothers and adult household contacts, only 6/240 and 3/263 respectively had received a recent (within 10 years) pertussis-containing vaccine; 114/121 children <5 years were up-to-date. Regarding maternal attitudes to immunization, 65.4% of respondents were willing to receive the Tdap booster during gestation, 81.2% postpartum.

Conclusion: Maternal knowledge of pertussis infection was poor with decreased awareness of key clinical knowledge and vaccination recommendations for both adolescents and pregnant women Most respondents and adults household contacts were likely ‘at risk’ to develop clinical pertussis. There was an overall acceptance of the recent NIAC recommendations concerning maternal pertussis vaccination

 

ESPID-0644 PERTUSSIS OUTBREAK IN SCOTLAND 2012-2013: IMPACT OF PERTUSSIS VACCINATION IN PREGNANCY

A. Smith-Palmer1, J.C. Cameron1, E. McDonald1, J.R.,A. Love1 1Vaccine Preventable Disease, Health Protection Scotland, Glasgow, United Kingdom

Introduction

A national pertussis outbreak started in 2012 continuing throughout 2013. During 2012, 1926 laboratory confirmed cases of Bordetella pertussis were reported to Health Protection Scotland, a 16-fold increase compared to 119 reports in 2011. Incidence remained high in 2013 with 1178 confirmed cases.

Objectives & Aims

To describe the outbreak among infants and the impact of a vaccination programme for pregnant women.

Methods

In October 2012 a national immunisation programme was introduced for pregnant women, ideally at 28-38 weeks gestation, aiming to provide passive immunity to infants during the first few weeks of life prior to their own immunisations. A point of delivery audit was conducted in maternity units in January 2013 to estimate vaccine uptake.

Results

Vaccine uptake among pregnant women was high 78.1%.

In 2012, there were 140 confirmed cases in infants < 1 year, accounting for 7.2% of all confirmed cases; an incidence of 235.7 per 100,000, (compared to 36.8 per 100,000 across all ages). In 2013, the provisional number of confirmed cases in infants <1 year decreased to 19, accounting for 1.6% of all confirmed cases, an incidence of 32.0 per 100,000 (22.6 per 100,000 across all ages).

For 13/19 infant cases in 2013, information was available on whether the mother received pertussis immunisation whilst pregnant, 10 were unvaccinated and three vaccinated.

Conclusion

The over 85% reduction in incidence among infants is an indication of the immunisation programme effectiveness in reducing disease in those most susceptible to complications.

* data for 2013 is still provisional.

 

ESPID-0460 THE NHS ENGLAND SECONDARY CARE COST BURDEN ASSOCIATED WITH THE 2012 PERTUSSIS OUTBREAK

T. Holbrook1, V.A.H. Coles2, S. Carroll2, C. Pollard3, S. Oakley4 1Health Economics and Outcomes Research, Adelphi Real World, Bollington, United Kingdom 2Health Economics, Sanofi Pasteur MSD, Maidenhead, United Kingdom 3Value Insight and Communication, Adelphi Values, Maidenhead, United Kingdom 4Scientific Affairs, Sanofi Pasteur MSD, Maidenhead, United Kingdom

Introduction: The 2012 UK pertussis epidemic saw the highest number of reported cases since the 1990s. Objectives/aims: This study aimed to quantify the 2012 pertussis-related secondary care cost burden in England and compare this to previous years.

Methods: Secondary care admissions for patients with pertussis were analysed from March 2006-February 2013 using Hospital Episode Statistics data and associated International Classification of Diseases (10th revision) codes. Pertussis-related costs were calculated for each patient using the Healthcare Resource Group tariff assigned to each pertussis admission, any previous admissions within that study year and any subsequent admissions within a 6 month period. The comparative cost burden was determined by analysing results versus age-matched controls.

Results: In 2012-13, 934 patients were admitted to hospital with pertussis, compared with 424 in 2011-12 and 421 in 2008-09, the last peak year. Mean per patient cost burden remained fairly consistent between 2006-2013. A higher number of pertussis patients admitted during 2012 resulted in an increased annual secondary care cost burden.

Table 1: Annual costs relating to whooping cough in England

  2006-072007-082008-092009-102010-112011-122012-13
 Number of admitted patients269305421270183424934
 Mean per patient cost burden (£)1891270524882188229828902357
 SEM per patient cost burden (£)215302227411347365160
 Annual cost burden (£)508730825131104753759065342052412253122201773

Patients under 1 year of age accounted for 85% of pertussis-related secondary care costs. A significantly higher proportion of pertussis patients had low birth weight versus matched controls.

Conclusions: The 2012 pertussis outbreak led to increased secondary care costs in England – double the previous peak year. These results highlight the importance of maintaining high coverage rates within an optimal vaccination schedule.

 

ESPID-0781 PERTUSSIS VACCINATION AND EPIDEMIOLOGY IN FLANDERS (BELGIUM) - NEED FOR ALTERNATIVE VACCINATION STRATEGIES FOR FUTURE

G. Top1, A. Paeps1 1Infectious Disease Control and Vaccinations, Flemish Agency for Care and Health, Brussels, Belgium

Background and aims

Since the change from whole cell to acellular pertussis vaccines in the vaccination programme of Flanders, extra pertussis vaccination moments have been implemented for children and adolescents. We want to evaluate the impact of these vaccinations and the need for new strategies to better protect the population against pertussis.

Methods

We reviewed the epidemiology of all notified pertussis cases in Flanders from 2000 till 2013 in relation to changes in the vaccination programme. Based upon these findings decision is made for future strategies to avoid pertussis.

Results

Despite of high vaccination coverage the number of notified pertussis cases increased from 2004 onwards. A booster dose of pertussis vaccine at the age of 6 years was given from 2004 onwards. In 2009 adolescent vaccination was started at the age of 14 years. The next three years less cases were notified. From 2012 onwards the number of reported cases is rising again.

As cocoon vaccination is hard to realise and doesn’t seem to be successful, alternative strategies are needed to protect the most vulnerable for pertussis, the newborns.

Conclusions

In Flanders decision was made to add pertussis vaccination of all pregnant women to the vaccination programme in order to protect newborns with maternal antibodies at birth, awaiting protection by their own immune system after vaccination.

To reduce spread of pertussis, we consider offering a combination vaccine with pertussis at the moment of the next adult booster vaccine

 

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