One-time whopping cough vaccination for all adolescents in the U.S. is likely to be cost effective, according to a report published in the medical journal Pediatrics. If implemented, such a strategy may help stem the rise in whopping cough rates seen in the past two decades.
By contrast, the study did not find adult vaccination for whopping cough, also known as pertussis, to be cost effective, nor was the use of booster shots.Childhood vaccination rates are at an all-time high and vaccine effectiveness is still strong, but there has been an increase in pertussis cases in the U.S., mostly among adolescents and adults, lead author Dr. Grace M. Lee, from Harvard Medical School in Boston, told Reuters Health. “This could be due to increased detection or to waning immunity.”Several studies have suggested that, at best, “immunity from childhood pertussis vaccination lasts only 15 years, leaving adolescents susceptible to the disease,” Lee noted. Thus, a vaccination strategy targeting this age group as well as adults might help bring pertussis rates down. Still, it was unclear if such an approach would be cost effective.To investigate, the researchers constructed a statistical model and used probability and cost data from numerous published and unpublished sources. Incidence data from Massachusetts were used for estimates of adolescent and adult disease.With a vaccination cost of $15 and vaccine coverage of 76 percent, one-time adolescent vaccination would cost $1100 per case prevented, the report indicates.As noted, adult and booster vaccination was not cost effective in the initial analysis. However, these strategies might be cost effective if the true incidence of disease in adolescents and adults is much higher than the estimated rate and if the cost of vaccination was below $10.Lee noted that “Canada and Australia have already implemented pertussis vaccination programs for adolescents.” She added that the Advisory Committee on Immunization Practices will be meeting at the end of June to determine if such an approach should be used in the U.S. as well.Last week, the Journal of the American Medical Association released a study showing that a 5-component acellular pertussis booster vaccine combined with tetanus and diphtheria toxoids (Adacel, Sanofi Pasteur Limited, Toronto) results in a robust immune response in adolescents and adults. (see Reuters Health report June 2, 2005.)(Source: Pediatrics, Reuters Health, June 2005.)