Anna Meyer University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
BMC Infect Dis. 2013 Mar 26;13:151. doi: 10.1186/1471-2334-13-151.
Resurgence of pertussis in the post-vaccination era has been reported in Western countries. A shift of cases from school-age children to adolescents, adults and children under 1 year of age has been described in the last decade, and mortality rates in infants are still sustained. We aimed to review and discuss the possible vaccination strategies which can be adopted in order to improve the pertussis control, by searches of Pubmed, and websites of US and European Centers for Disease Control and Prevention, between 1st January 2002, and 1st March 2013.
The following vaccination strategies have been retrieved and analysed: the cocooning strategy, the immunization of pregnant women and newborns, vaccination programs for preschool children, adolescents, adults and health-care workers. Cost-effectiveness studies provide some contrasting data, mainly supporting both maternal vaccination and cocooning. Adolescent and/or adult vaccination seems to be cost-effective, however data from observational studies suggest that this vaccination strategy, used alone, leads to a reduced pertussis burden globally, but does not affect the disease incidence in infants. Moreover, substantial logistical and economic difficulties have to be overcome to vaccinate the largest number of individuals.
The simultaneous use of more than one strategy, including cocooning strategy plus vaccination of adolescents and adults, seems to be the most reasonable preventive measure. The development of new highly immunogenic and efficacious pertussis vaccines continues to be a primary objective for the control of pertussis.
在疫苗接种时代后，百日咳在西方国家再次出现。在过去十年中，已描述了病例从学龄儿童转移到青少年、成人和 1 岁以下儿童，婴儿的死亡率仍然持续。我们旨在通过检索 Pubmed 和美国及欧洲疾病预防控制中心的网站，回顾和讨论可能的疫苗接种策略，以改善百日咳的控制，检索时间为 2002 年 1 月 1 日至 2013 年 3 月 1 日。
已经检索和分析了以下疫苗接种策略：围产期免疫策略、孕妇和新生儿免疫接种、学前儿童、青少年、成人和卫生保健工作者的疫苗接种计划。成本效益研究提供了一些相互矛盾的数据，主要支持母体疫苗接种和围产期免疫。青少年和/或成人疫苗接种似乎具有成本效益，但是来自观察性研究的数据表明，这种单独的疫苗接种策略可以减少全球的百日咳负担，但不会影响婴儿的疾病发病率。此外，要为最多的人接种疫苗，需要克服大量的后勤和经济困难。
同时使用多种策略，包括围产期免疫策略加上青少年和成人的疫苗接种，似乎是最合理的预防措施。开发具有高度免疫原性和高效力的新型百日咳疫苗仍然是控制百日咳的主要目标。
