Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States
Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States
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DOI：
10.1093/aje/kwv347
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发表时间：
2016-06-15
影响因子：
5
通讯作者：
Townsend, Jeffrey P.
中科院分区：
文献类型：
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作者：
Atkins, Katherine E.;Fitzpatrick, Meagan C.;Townsend, Jeffrey P.
百日咳疫苗接种大大减轻了疾病负担，但最严重的病例和几乎所有死亡病例都发生在年龄太小而无法接种疫苗的婴儿身上。最近的流行病学证据表明，母亲在怀孕期间有针对性地接种疫苗可减少其婴儿百日咳的发病率。为了评估美国产前母亲接种疫苗的成本效益，我们创建了一个年龄分层的传播模型，结合美国接触模式的经验数据，并明确建模父母-婴儿暴露。与成人不接种疫苗的策略相比，产前产妇接种疫苗每个质量调整生命年的成本为114,000美元（95%预测区间：82,000,183,000），根据世界卫生组织的标准，这在美国是具有成本效益的。相比之下，为父母二人接种疫苗并不具有成本效益，父母任何一方的产后疫苗接种主要由产前母亲接种。尽管如此，产前未接种疫苗的母亲的产后疫苗接种在目前推荐的无目标成人疫苗接种的基础上有所改善。此外，由于母体抗体转移而对婴儿的临时直接保护对婴儿的效力与完整的初级疫苗系列对幼儿的效力相当。婴儿在出生前就开始有效地预防百日咳。我们强烈建议尽可能多的美国母亲产前接种疫苗。
Vaccination against pertussis has reduced the disease burden dramatically, but the most severe cases and almost all fatalities occur in infants too young to be vaccinated. Recent epidemiologic evidence suggests that targeted vaccination of mothers during pregnancy can reduce pertussis incidence in their infants. To evaluate the cost-effectiveness of antepartum maternal vaccination in the United States, we created an age-stratified transmission model, incorporating empirical data on US contact patterns and explicitly modeling parent-infant exposure. Antepartum maternal vaccination incurs costs of $114,000 (95% prediction interval: 82,000, 183,000) per quality-adjusted life-year, in comparison with the strategy of no adult vaccination, and is cost-effective in the United States according to World Health Organization criteria. By contrast, vaccinating a second parent is not cost-effective, and vaccination of either parent postpartum is strongly dominated by antepartum maternal vaccination. Nonetheless, postpartum vaccination of mothers who were not vaccinated antepartum improves upon the current recommendation of untargeted adult vaccination. Additionally, the temporary direct protection of the infant due to maternal antibody transfer has efficacy for infants comparable to that conferred to toddlers by the full primary vaccination series. Efficient protection against pertussis for infants begins before birth. We highly recommend antepartum vaccination for as many US mothers as possible.