Prevention of pertussis: Recommendations derived from the second Global Pertussis Initiative roundtable meeting
Introduction
The Global Pertussis Initiative (GPI) was established in 2001 with three main objectives: to raise the profile of pertussis as an important and preventable disease that warrants greater global public health attention; to improve understanding of the increasing incidence of reported pertussis; and to develop effective immunization strategies for pertussis control. The GPI is composed of 37 experts in the field of pertussis from 17 countries worldwide and its work is supported by an unrestricted educational grant from sanofi pasteur. After in-depth evaluation of the available data, prioritization of various immunization strategies, creation of a health economic model to study the cost effectiveness of the proposed strategies, and identification of potential barriers to implementation of the recommendations and possible solutions to these barriers, the GPI concluded that current vaccination strategies needed to be reinforced and expanded. Vaccination should include the addition of booster doses for adolescents in developed countries. Additionally, the group recommended that immediate universal adolescent vaccination and immunization of healthcare and childcare workers should be instituted. Australia introduced an adolescent booster in 2003, and the addition of an adolescent booster was suggested for Argentina and Japan [1]. Some other countries, including, Austria, Canada, France, Germany, and the United States, have incorporated an adolescent booster dose into their current immunization schedules, as advocated by the GPI [2].
The GPI held its second roundtable meeting in December 2005 to re-evaluate previous recommendations and to discuss the progress made in pertussis control since their first meeting in 2002. Twenty-three members of the GPI, led by the Chairman, Professor Stanley Plotkin of the United States, met for 2 days to present the latest developments on the epidemiology and diagnosis of pertussis and to examine various vaccination strategies with the aim of proposing updated recommendations. This paper summarizes the key points derived from the meeting and presents the group's recommendations for adolescent and selective adult immunization.
Section snippets
Epidemiology of pertussis
Although progress has been made since the first GPI meeting in 2002 toward gaining a better understanding of the transmission and control of pertussis, in 2006 the disease remains an important public health concern. The World Health Organization (WHO) estimates that at least 27 million children did not receive DTP3 in 2004, and estimates that 294,000 deaths from pertussis in children under age 5 (2002 data) could have been preventable by vaccines [3]. It continues to be endemic worldwide, with
Differential diagnosis
Correct diagnosis of pertussis can be a challenge because of the overlap of symptoms with other respiratory infections caused by viruses and other bacteria. Differential diagnosis of prolonged cough, even with paroxysms, may include Bordetella parapertussis, Bordetella bronchiseptica, Chlamydia pneumoniae, Mycoplasma pneumoniae, adenoviruses, respiratory syncytial virus (RSV), human parainfluenza viruses, influenza viruses A and B, rhinovirus, and human metapneumovirus [22].
Although culture is
Prevention of pertussis: vaccination strategies
Since it was established in 2001, GPI members have reviewed the international literature and exchanged data, knowledge, experience, and opinion through teleconferences, a password-protected interactive Web site, and the two roundtable meetings. With the goal of identifying and addressing potential barriers to pertussis control, they evaluated a number of immunization strategies, including universal immunization of adolescents; universal immunization of adults; selective immunization of new
Utilization of Tdap in 4–6 year olds
Booster doses of DTaP vaccines given at 4–6 years of age are commonly followed by large injection site reactions, with an increase in redness, swelling, and pain compared to previous reactions [70]. Several studies have shown that the adolescent/adult formulation diphtheria, tetanus, and acellular pertussis combination vaccine with lower pertussis and diphtheria antigen content (Tdap) was significantly less reactogenic and slightly less immunogenic than the pediatric formulation combination
Economic assessment
An understanding of the impact of vaccination on disease transmission (i.e., capturing herd immunity) is a key to being able to assess the economic value of adult strategies. A modeling study conducted by Drs. A. Van Rie and J. Caro was designed to provide transmission probabilities data to better assess the impact of the following adolescent and adult vaccination strategies in the United States: routine adolescent vaccination; the cocoon strategy; and routine adult vaccination every 10 years
Conclusions and recommendations
Since 2001, there has been notable progress in the understanding of B. pertussis disease, but it continues to affect millions of people worldwide and is a major cause of infant mortality, especially in developing countries. Previously, the GPI recommended that an acellular pertussis vaccine be incorporated into the current dT vaccine schedule for adolescents, either as dTaP or as a stand alone aP booster, and several countries have incorporated that recommendation into their immunization
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