Societal costs and morbidity of pertussis in adolescents and adults
ABSTRACT Since the 1980s, the reported incidence of pertussis among adolescents and adults has been steadily increasing. To understand whether the benefits of an acellular pertussis vaccine formulated for adolescents and adults might offset its costs, policy makers will need information about morbidity and societal (medical and nonmedical) costs of pertussis.
Adolescents (age, 10-17 years) and adults (age, >or=18 years) with confirmed pertussis illness were identified by the Massachusetts enhanced pertussis surveillance system. We evaluated medical costs in a cohort of patients who had confirmed pertussis during the period of January 1998 through December 2000; nonmedical costs, by means of prospective interviews, in a cohort of patients who had confirmed pertussis during the period of December 2001 through January 2003; and morbidity in both cohorts. Our main outcome measures were mean costs per case, in 2002 US dollars.
In the analysis of medical costs, 1679 adolescents and 936 adults were found to have mean costs of 242 dollars and 326 dollars, respectively (P<.05). In interviews with 314 adolescents and 203 adults, adults had significantly higher nonmedical costs (447 dollars) than those of adolescents (155 dollars). A total of 83% of adolescents missed a mean of 5.5 days from school (range, 0.4-32 days), and 61% of adults missed a mean of 9.8 days from work (range, 0.1-180 days) because of pertussis. Thirty-eight percent of adolescents and 61% of adults were still coughing at the time of the interview, which occurred an average of 106 days and 94 days, respectively, after cough onset.
Pertussis causes significant morbidity in and costs for adolescents and adults, with time losses comprising the largest proportion of the cost. Societal costs should be considered when making decisions about potential vaccine use in the future.
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ABSTRACT: In February 2012, the Advisory Committee on Immunization Practices (ACIP) advised that all adults aged ≥65 years receive a single dose of reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap), expanding on a 2010 recommendation for adults >65 that was limited to those with close contact with infants. We evaluated clinical and economic outcomes of adding Tdap booster of adults aged ≥65 to "baseline" practice [full-strength DTaP administered from 2 months to 4-6 years, and one dose of Tdap at 11-64 years replacing decennial Td booster], using a dynamic model. We constructed a population-level disease transmission model to evaluate the cost-effectiveness of supplementing baseline practice by vaccinating 10% of eligible adults aged ≥65 with Tdap replacing the decennial Td booster. US population effects, including indirect benefits accrued by unvaccinated persons, were estimated during a 1-year period after disease incidence reached a new steady state, with consequences of deaths and long-term pertussis sequelae projected over remaining lifetimes. Model outputs include: cases by severity, encephalopathy, deaths, costs (of vaccination and pertussis care) and quality-adjusted life-years (QALYs) associated with each strategy. Results in terms of incremental cost/QALY gained are presented from payer and societal perspectives. Sensitivity analyses vary key parameters within plausible ranges. For the US population, the intervention is expected to prevent >97,000 cases (>4,000 severe and >5,000 among infants) of pertussis annually at steady state. Additional vaccination costs are $4.7 million. Net cost savings, including vaccination costs, are $47.7 million (societal perspective) and $44.8 million (payer perspective). From both perspectives, the intervention strategy is dominant (less costly, and more effective by >3,000 QALYs) versus baseline. Results are robust to sensitivity analyses and alternative scenarios. Immunization of eligible adults aged ≥65, consistent with the current ACIP recommendation, is cost saving from both payer and societal perspectives.PLoS ONE 01/2014; 9(1):e72723. DOI:10.1371/journal.pone.0072723 · 3.53 Impact Factor
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ABSTRACT: To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination.BMJ Clinical Research 06/2014; 348:g3668. DOI:10.1136/bmj.g3668 · 14.09 Impact Factor
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ABSTRACT: Background. Bordetella pertussis causes severe respiratory illness among infants and adolescents. High proportions of vaccine breakthrough cases have been observed. To understand the effect of vaccination in the era of acellular Pertussis vaccines (DTaP and Tdap), we assess if vaccination status is associated with disease severity and duration. Methods. The Multnomah County Health Department conducts enhanced Pertussis surveillance for 1.7 million residents in the Portland, Oregon metropolitan area. Surveillance activities include ascertaining demographics, clinical presentation, cough duration, vaccination history, and other health outcomes. Utilizing Advisory Council on Immunization Practices (ACIP) routine vaccination recommendations, we analyzed a cohort of persons aged 6 weeks to 18 years with confirmed Pertussis to assess illness severity and duration by vaccination status. Analysis was conducted using both logistic regression (disease severity) and survival analysis (cough duration). Results. During 2010-2012, 98.7% (n=624) of confirmed pertussis cases in our cohort had vaccination, treatment, demographic, and outcome information. Among these patients, 45% (n=286) were ACIP up-to-date with vaccinations. Ever-vaccinated cases were significantly less likely to be hospitalized or develop severe illness (adjusted odds ratio [aOR] 0.2 95% Confidence Interval [CI] 0.1-0.8, and aOR 0.4 95%CI 0.2-0.9 respectively). ACIP up-to-date cases stopped coughing significantly more rapidly than unvaccinated cases (adjusted Hazard Ratio [aHR] 1.7 95% Confidence Interval [CI] 1.3-2.2). Conclusion. Vaccinated cases of pertussis had decreased morbidity characterized by less severe illness and significantly reduced illness duration. Therefore, vaccination is recommended among at-risk individuals and research into the nature of the residual vaccine immunity is warranted.Clinical Infectious Diseases 03/2014; 58(11). DOI:10.1093/cid/ciu156 · 9.42 Impact Factor