Whooping cough: hybrid vaccination protocol would make sense

Old Vaccine, New Tricks: Revive Early Pertussis Shot, Study Says

Hybrid vaccination protocol could cut whooping cough cases by 95 percent, Santa Fe Institute, March 29, 2016.

Whooping cough is making a major comeback in the United States right now, and public health officials are struggling with what to do about it. Now, two SFI researchers have a surprising proposal: go back to an old vaccine—one that was largely abandoned 25 years ago because of relatively minor side effects—but do it for just the first of the usual five doses. Doing so, they says, could cut pertussis cases by 95 percent and save $142 million per year.


Epidemiological and Economic Effects of Priming With the Whole-Cell Bordetella pertussis Vaccine, JAMA Pediatrics, March 28, 2016.

Current acellular pertussis vaccines may not protect against transmission of Bordetella pertussis.

To assess whether a priming dose of whole-cell pertussis (wP) vaccine is cost-effective at reducing pertussis infection in infants.

Design, Setting, and Participants
Mathematical model of pertussis transmission fit to US incidence data in a simulation of the US population. In this simulation study conducted from June 2014 to May 2015, the population was divided into 9 age groups corresponding to the current pertussis vaccination schedule and fit to 2012 pertussis incidence.

Inclusion of a priming dose of wP vaccine into the current acellular pertussis vaccination schedule.

Main Outcomes and Measures
Reductions in symptomatic pertussis incidence by age group, increases in wP vaccine–related adverse effects, and quality-adjusted life-years owing to changing vaccine schedule.

Old Vaccine, New Tricks: Revive Early Pertussis Shot, Study Says, livescience, March 28, 2016.

Switching to a wP-priming vaccination strategy could reduce whooping cough incidence by up to 95% (95% CI, 91-98), including 96% (95% CI, 92-98) fewer infections in neonates. Although there may be an increase in the number of vaccine adverse effects, we nonetheless estimate a 95% reduction in quality-adjusted life-years lost with a switch to the combined strategy and a cost reduction of 94% (95% CI, 91-97), saving more than $142 million annually.

Conclusions and Relevance
Our results suggest that an alternative vaccination schedule including 1 dose of wP vaccine may be highly cost-effective and ethically preferred until next-generation pertussis vaccines become available.

Pertussis Vaccine recommended for Pregnant Women amid 2014 Spike in Whooping Cough Cases

This vaccination is said to be the best way to prevent whooping cough in the baby and reduces the risk of infant hospitalizations and deaths from this disease

Loyola Health logo image
Loyola Health says whooping cough vaccine is necessary to prevent disease and complications

Expectant moms should be vaccinated for pertussis, or whooping cough, during their third trimester, according to obstetricians at Loyola University Health System. Those in close contact with the infant also should be up to date with their whooping cough vaccine.

This recommendation comes on the heels of a Centers for Disease Control and Prevention report, which found a 30 percent increase in whooping cough cases (17,325) from January to mid-August this year as compared with the same period last year.

Continue reading Whooping cough vaccine recommended for pregnant women amid spike in cases,
Loyola University Health System News, 9 September 2014.

Whooping Cough Vaccination Programme in Pregnancy still advised in the UK

Pregnancy and Whooping Cough

Public Health England (PHE) welcomes today’s (16 July 2014) announcement from the Joint Committee on Vaccination and Immunisation (JCVI) advising the Department of Health (DH) that the whooping cough (pertussis) vaccination programme for pregnant women should continue for a further 5 years. The advice reflects new data on vaccine effectiveness and safety published by PHE and the Medicines and Healthcare Products Regulatory Agency (MHRA).

The DH announced the temporary vaccination programme for pregnant women in October 2012, in response to a national whooping cough outbreak that led to several infant deaths. Vaccinating women against whooping cough in pregnancy (between 28 and 38 weeks) means that the mother passes immunity on to her unborn child, protecting the baby until they receive their first whooping cough vaccination at 2 months old.

Whooping Cough vaccination image
Continuation of whooping cough vaccination programme for pregnant women advised in the UK as new evidence on effectiveness and safety published.

Deputy Chief Medical Officer, Professor John Watson said:

” Babies too young to start their vaccinations are at greatest risk from whooping cough. It’s an extremely distressing illness that can lead to young babies being admitted to hospital and can potentially be fatal. The JCVI’s advice will be welcomed by families and we will work with NHS England to ensure the programme continues to be offered to mums-to-be. ” 

New PHE research published today in The Lancet Infectious Diseases shows that vaccinating pregnant women against whooping cough has been highly effective in protecting young infants from this potentially fatal disease. Babies born to women vaccinated at least a week before delivery had a 91% reduced risk of becoming ill with whooping cough in their first weeks of life, compared to babies whose mothers had not been vaccinated.

These findings are supplemented by the first large study of the whooping cough vaccine safety in pregnancy, published by the MHRA in the British Medical Journal. Reviewing data from around 18,000 vaccinated women from the Clinical Practice Research Datalink (CPRD), the research found no evidence of risk from the vaccine to pregnancy or the developing baby, and rates of normal, healthy births were similar to those seen in unvaccinated women.

Dr Katherine Donegan, lead author of the MHRA study, said:

”  Coupled with the new evidence from Public Health England on the effectiveness of the vaccine, our research should provide further reassurance on the safety and benefits of the vaccine for expectant mothers and healthcare professionals who offer the vaccine” 

Out today, the latest PHE data also show an overall decline in whooping cough cases since the pregnancy programme started in October 2012. The greatest decrease in disease seen has been in infants under 6 months old, who are targeted by the maternal vaccination programme, which provides good evidence it is working.

There were 14 deaths in infants diagnosed with whooping cough in 2012 and born before the vaccination in pregnancy programme started. Eight deaths have been reported in infants diagnosed with whooping cough in 2013 and so far this year. The mothers of 7 of these 8 babies were not vaccinated in pregnancy.

PHE’s head of immunisation, Dr Mary Ramsay, said:

” We welcome JCVI’s advice that the vaccination programme for pregnant women is continued, particularly while whooping cough continues to circulate at elevated levels. It has been highly effective at preventing disease, and deaths in young babies.

The latest figures show that around 60% of pregnant women have received the whooping cough vaccination, which is a testament to the health professionals implementing this programme. However, these infant deaths reminds us how important it is that every pregnant woman is informed about the benefits of the vaccine, and given the opportunity to receive it at the right time so their babies are protected from birth.

Although we have also seen a decline in cases in older children and adults from the peak in 2012 the numbers still remain considerably higher than those in 2011, suggesting the infection has not fallen to background levels.

Today, we urge pregnant women to ensure they are vaccinated between 28 and 32 weeks of their pregnancy wherever possible, although vaccination may be given up to 38 weeks. We are also working with GPs, midwives and other health professionals to ensure they have the facts at hand, including the latest evidence from the PHE and MHRA studies, to help women take up this highly effective and safe vaccine. ” 

Whooping cough affects all ages and is highly infectious. Young infants are at highest risk of severe complications and death from whooping cough as babies do not complete vaccination until they are 4 months old. In older children and adults whooping cough can be an unpleasant illness but it does not usually lead to serious complications.

Dr Ramsay, continues:

” Parents should also be alert to the signs and symptoms of whooping cough – which include severe coughing fits which may be accompanied by difficulty breathing (or pauses in breathing in young infants) or vomiting after coughing and the characteristic ‘whoop’ sound in young children. In older children or adults it may present simply as a prolonged cough.

Parents must also ensure their children are vaccinated against whooping cough on time, even babies of women who’ve had the vaccine in pregnancy – this is to provide continued protection through childhood” 

Sources and More Information

  • Continuation of whooping cough vaccination programme in pregnancy advised, Gov.UKDepartment of Health, 16 July 2014.,
  • Continuation of whooping cough vaccination programme for pregnant women advised as new evidence on effectiveness and safety published, MHRA, News, Press Release and PDF con435838, 16 July 2014.
  • Laboratory confirmed pertussis in England: data to end-May 2014, HPA, Vol8 N°28, hpr2814_AA, 16 July 2014.
  • Effectiveness of maternal pertussis vaccination in England: an observational study, The Lancet, doi:10.1016/S0140-6736(14)60686-3, 16 July 2014.
  • Safety of pertussis vaccination in pregnant women in UK: observational study, BMJ 2014; 349 doi: bmj.g4219, 11 July 2014.
  • Pregnancy and Whooping Cough, CDC, get-vaccinated, June 11, 2014.
  • Whooping cough vaccination in pregnancy, NHS, Pregnancy and baby, 24/09/2012.