Impact of vaccination and birth rate on the epidemiology of pertussis: a comparative study in 64 countries

Bordetella pertussis infection remains an important public health problem worldwide despite decades of routine vaccination. A key indicator of the impact of vaccination programmes is the inter-epidemic period, which is expected to increase with vaccine uptake if there is significant herd immunity. B...

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Bibliographic Details
Published in:Proceedings of the Royal Society. B, Biological sciences Biological sciences, 2010-11, Vol.277 (1698), p.3239-3245
Main Authors: Broutin, H., Viboud, C., Grenfell, B. T., Miller, M. A., Rohani, P.
Format: Article
Language:English
Subjects:
Birth Rate
Birth rates
Bordetella pertussis
Bordetella pertussis - immunology
Comparative Approach
Disease models
Disease Outbreaks - prevention & control
Disease transmission
Epidemics
Epidemiology
Humans
Immunity
Immunity, Herd - immunology
Infections
Models, Immunological
Periodicity
Pertussis
Pertussis Vaccine - administration & dosage
Pertussis Vaccine - immunology
Retrospective Studies
Stochastic Processes
Vaccination
Vaccination - standards
Whooping cough
Whooping Cough - epidemiology
Whooping Cough - immunology
Whooping Cough - transmission
World Health Organization
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Summary:Bordetella pertussis infection remains an important public health problem worldwide despite decades of routine vaccination. A key indicator of the impact of vaccination programmes is the inter-epidemic period, which is expected to increase with vaccine uptake if there is significant herd immunity. Based on empirical data from 64 countries across the five continents over the past 30–70 years, we document the observed relationship between the average inter-epidemic period, birth rate and vaccine coverage. We then use a mathematical model to explore the range of scenarios for duration of immunity and transmission resulting from repeat infections that are consistent with empirical evidence. Estimates of pertussis periodicity ranged between 2 and 4.6 years, with a strong association with susceptible recruitment rate, defined as birth rate × (1 − vaccine coverage). Periodicity increased by 1.27 years on average after the introduction of national vaccination programmes (95% CI: 1.13, 1.41 years), indicative of increased herd immunity. Mathematical models suggest that the observed patterns of pertussis periodicity are equally consistent with loss of immunity that is not as rapid as currently thought, or with negligible transmission generated by repeat infections. We conclude that both vaccine coverage and birth rate drive pertussis periodicity globally and that vaccination induces strong herd immunity effects. A better understanding of the role of repeat infections in pertussis transmission is critical to refine existing control strategies.
ISSN:0962-8452
1471-2954
DOI:10.1098/rspb.2010.0994