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Children's Health

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Routine pertussis vaccination of adolescents would be beneficial and reasonably cost effective

Despite high childhood vaccination rates against pertussis (whooping cough), the vaccine's waning immunity by the mid-teens has resulted in sharply increased rates of pertussis among adolescents and adults. Routine pertussis vaccination of adolescents in the United States may benefit health and be relatively cost effective, concludes a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00063 and HS13908).

Researchers led by Grace M. Lee, M.D., M.P.H., of Harvard Medical School, modeled health outcomes over the lifetime of a hypothetical group of 4 million adolescents, presuming baseline incidence rates of 155 and 11 cases per 100,000 adolescents and adults, respectively.

Researchers calculated that about 85,000 cases would occur if no vaccination program were implemented. The adolescent and adult vaccination with boosters strategy would prevent the most pertussis cases (35,000 cases or 41 percent), but it could potentially cause 253,000 adverse events (mostly minor). The one-time adolescent vaccination strategy would prevent almost as many cases (30,800, or 36 percent), with many fewer adverse events (91,000). The one-time adult vaccination, adult vaccination with boosters, and postpartum vaccination strategies each would prevent less than 8 percent of cases because of the relatively low baseline incidence of disease among adults.

When patient preferences about disease and vaccination were incorporated into the analysis through quality-adjusted life years (QALYs), the one-time adolescent vaccination, at a vaccination cost of $15 and vaccine coverage of 76 percent, would cost $1,100 to $1,200 per case prevented or $20,000 to $23,000 per QALY saved ($50,000 or less is considered cost effective for medical interventions).

See "Pertussis in adolescents and adults: Should we vaccinate?" by Dr. Lee, Charles LeBaron, M.D., Trudy V. Murphy, M.D., and others, in the June 2005 Pediatrics 115(6), pp. 1675-1684.

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