The Number Needed to Vaccinate to Prevent Infant Pertussis Hospitalization and Death Through Parent Cocoon Immunization

[Guest guest]

and how do we know for sure that any number prevented anything?

Sheri

" The NNV for parental immunization was at least 1 million to prevent

1 infant death, approximately 100 000 for ICU admission, and >10 000

for hospitalization. "

" Conclusions. In the context of low pertussis

incidence, the parental cocoon program is inefficient and resource

intensive for the prevention of serious outcomes in early infancy.

Regions contemplating the cocoon program should consider the NNV based on

local epidemiology. "

http://cid.oxfordjournals.org/content/early/2011/12/01/cid.cir836.abstract?sid=446ff7dc-43cb-4f25-9696-a8dea1459a01

The Number Needed to Vaccinate to Prevent Infant Pertussis

Hospitalization and Death Through Parent Cocoon Immunization

Danuta M.

Skowronski

1

,

2,

Naveed Z.

Janjua

1

,

2,

Elodie P. Sonfack

Tsafack

3,

Manale

Ouakki

4,

Hoang

5

,

6, and

Gaston De

Serres

3

,

4

+ Author Affiliations

1Communicable Disease Prevention and

Control Services, British Columbia Centre for Disease Control

(BCCDC) 2School of

Population and Public Health, University of British Columbia, Vancouver 3Department of Social and Preventive

Medicine, Laval University, Québec 4Institut National de Santé Publique

du Québec 5BCCDC Public

Health Microbiology and Reference Laboratory 6Department of

Pathology and Laboratory Medicine, University of British Columbia,

Vancouver, Canada Correspondence: Danuta M. Skowronski, MD, MHSc, FRCPC, Communicable

Disease Prevention and Control Services, British Columbia Centre for

Disease Control (BCCDC), 655 W 12th Ave, Vancouver, British Columbia

V5Z4R4, Canada

(

danuta.skowronski@...).

Abstract

ARTICLE

Background. Parental immunization has been recommended as a

“cocoon” strategy to prevent serious pertussis outcomes in early infancy.

We illustrate the high number needed to vaccinate (NNV) for this program

based on recent epidemiologic data from the provinces of Québec and

British Columbia (BC), Canada.

Methods. Surveillance trends were summarized for the period

1990–2010. Hospitalization, intensive care unit (ICU) admission, and

mortality data were compiled from 2000 to 2009. The proportion of infant

pertussis attributed to a parent was estimated at 35%, explored up to

55%. Adult vaccine efficacy (VE) was estimated at 85%. The NNV was

calculated as [2 parents/(parent-attributable infant risk × parent VE)].

To capture at least 1 recent cyclical peak, NNV was derived for the

period 2005–2009 and explored for peak/trough years.

Results. Substantial decline has occurred in pertussis

incidence across all age groups including infants, reaching a 20-year

nadir in 2010 in both provinces. For the period 2005–2009, the risk of

infant hospitalization and ICU admission was 57 and 7, respectively, per

100 000 in Québec and 33 and 7, respectively, per 100 000 in BC. In both

provinces the risk of infant pertussis-related death over that period was

<0.5 per 100 000. The NNV for parental immunization was at least 1

million to prevent 1 infant death, approximately 100 000 for ICU

admission, and >10 000 for hospitalization.

Conclusions. In the context of low pertussis incidence, the

parental cocoon program is inefficient and resource intensive for the

prevention of serious outcomes in early infancy. Regions contemplating

the cocoon program should consider the NNV based on local epidemiology.

Received May 28, 2011. Accepted August 30, 2011

Sheri Nakken, former R.N., MA, Hahnemannian

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