767. Preventing Infant Pertussis: A Decision Analysis Comparing Prenatal Vaccination to Cocooning
Session: Oral Abstract Session: Pertussis Vaccines and Challenges
Friday, October 21, 2011: 3:45 PM
Room: 156ABC

Background: Infants less than 2 months of age account for 60% of all infant hospitalizations and 87% of all infant deaths due to pertussis.  Since 2005, the U.S. Advisory Committee on Immunization Practices has recommended a cocooning strategy, where all close contacts of newborns are vaccinated with Tdap.  An alternative strategy to protect infants from pertussis is prenatal vaccination during the third trimester of pregnancy.  As with cocooning, this strategy reduces pertussis transmission from the mother, but has the benefit of providing transplacental passive immunity to the infant; however, prenatal vaccination may interfere with the immune response to the primary DTaP series. 

Methods: A cohort model reflecting U.S. 2009 births simulated the cost effectiveness of parental cocooning versus prenatal vaccination in preventing infant disease (infants < 1 year).  Program costs included Tdap vaccine dose and administration fee.  Outcomes analyzed were infant pertussis cases, hospitalizations and deaths.  Epidemiologic outcomes were converted into direct costs of disease.  To test the robustness of the results, one and multi-way sensitivity analyses were conducted.

Results: Compared to the infant DTaP series alone, prenatal vaccination would reduce total annual infant cases, hospitalizations, and deaths by 33%, 39%, and 51% respectively; whereas cocooning would reduce infant cases, hospitalizations, and deaths by 24%, 24%, and 21% respectively.  Prenatal vaccination would avert most cases in the first 2 months of life (Figure 1).  The cost per case averted using a prenatal vaccination strategy was US$ 177,000 versus US$ 485,000 with cocooning; cost per Quality Adjusted Life Year was US$ 419,401 and US$ 1,918,652  respectively.  Sensitivity analyses showed prenatal vaccination averted more cases at lower cost across a wide range of parameters.

Conclusion: Prenatal vaccination could avert more infant cases and deaths at lower cost than parental cocooning.  Prenatal vaccination should be further considered as an alternative to cocooning.

Figure 1.  Expected number of infant pertussis cases by month of age under different vaccination strategies using a simulated birth cohort model

 


Subject Category: I. Adult and Pediatric Vaccines

Andrew Terranella, MD, MPH1, Garrett Asay, PhD2, Mark Messonnier, PhD2, Thomas Clark, MD, MPH3 and Jennifer Liang, DVM3, (1)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (2)Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA, (3)Meningitis and Vaccine Preventable Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

A. Terranella, None

G. Asay, None

M. Messonnier, None

T. Clark, None

J. Liang, None

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