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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Pertussis in adolescents and adults: should we vaccinate?
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Pertussis in adolescents and adults: should we vaccinate?

机译：青少年和成年人的百日咳：我们应该接种疫苗吗？

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BACKGROUND: The incidence of reported pertussis among adolescents, adults, and young infants has increased sharply over the past decade. Combined acellular pertussis vaccines for adolescents and adults are available in Canada, Australia, and Germany and may soon be considered for use in the United States. OBJECTIVE: To evaluate the potential health benefits, risks, and costs of a national pertussis vaccination program for adolescents and/or adults. DESIGN, SETTING, AND POPULATION: The projected health states and immunity levels associated with pertussis disease and vaccination were simulated with a Markov model. The following strategies were examined from the health care payer and societal perspectives: (1) no vaccination; (2) 1-time adolescent vaccination; (3) 1-time adult vaccination; (4) adult vaccination with boosters; (5) adolescent and adult vaccination with boosters; and (6) postpartum vaccination. Data on disease incidence, costs, outcomes, vaccine efficacy, and adverse events were based on published studies, recent unpublished clinical trials, and expert panel input. MAIN OUTCOME MEASURES: Cases prevented, adverse events, costs (in 2004 US dollars), cost per case prevented, and cost per quality-adjusted life-year (QALY) saved. RESULTS: One-time adolescent vaccination would prevent 30800 cases of pertussis (36% of projected cases) and would result in 91000 vaccine adverse events (67% local reactions). If pertussis vaccination cost Dollars 15 and vaccine coverage was 76%, then 1-time adolescent vaccination would cost Dollars 1100 per case prevented (or Dollars 1200 per case prevented) or Dollars 20000 per QALY (or Dollars 23000 per QALY) saved, from the societal (or health care payer) perspective. With a threshold of Dollars 50000 per QALY saved, the adolescent and adult vaccination with boosters strategy became potentially cost-effective from the societal perspective only if 2 conditions were met simultaneously, ie, (1) the disease incidence for adolescents and adults was > or =6 times higher than base-case assumptions and (2) the cost of vaccination was less than Dollars 10. Adult vaccination strategies were more costly and less effective than adolescent vaccination strategies. The results were sensitive to assumptions about disease incidence, vaccine efficacy, frequency of vaccine adverse events, and vaccine costs. CONCLUSIONS: Routine pertussis vaccination of adolescents results in net health benefits and may be relatively cost-effective.
机译：背景：在过去的十年中，报告的百日咳在青少年，成人和幼儿中的发生率急剧增加。适用于青少年和成人的脱细胞百日咳组合疫苗在加拿大，澳大利亚和德国有售，不久可能会考虑在美国使用。目的：评估针对青少年和/或成人的国家百日咳疫苗计划的潜在健康益处，风险和成本。设计，地点和人口：用马尔可夫模型模拟了与百日咳疾病和疫苗接种相关的预计健康状况和免疫水平。从卫生保健支付者和社会角度审查了以下策略：（1）不接种疫苗; （2）1次青少年疫苗接种; （3）1次成人疫苗接种; （4）成人加强免疫接种; （5）青少年和成人加强免疫接种; （6）产后疫苗接种。有关疾病发生率，成本，结局，疫苗功效和不良事件的数据均基于已发表的研究，近期未发表的临床试验以及专家小组的意见。主要观察指标：预防病例，避免不良事件，节省成本（以2004年美元计），预防每例费用以及节省的每质量调整生命年（QALY）费用。结果：一次性的青少年疫苗接种将预防30800例百日咳病例（占预计病例的36％），并导致91000例疫苗不良事件（67％的局部反应）。如果百日咳疫苗接种费用为15美元，疫苗覆盖率为76％，则从预防接种中每预防一次青少年疫苗接种将花费1100美元（每预防病例1200美元）或每个QALY节省20000美元（或每个QALY 23000美元）。社会（或卫生保健付款人）的观点。在每个QALY节省了50000美元的门槛下，从社会的角度出发，只有同时满足两个条件，青少年和成人的疫苗接种才可能具有成本效益，即（1）青少年和成人的疾病发生率>或=比基本情况的假设高6倍，并且（2）疫苗接种的成本低于10美元。成人疫苗接种策略比青少年疫苗接种策略成本更高，效果更差。该结果对有关疾病发生率，疫苗效力，疫苗不良事件发生频率和疫苗成本的假设敏感。结论：青少年常规百日咳疫苗接种可带来纯净健康益处，并且可能相对具有成本效益。

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