National Center forImmunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. USA.
Pediatrics. 2013 Jun;131(6):e1748-56. doi: 10.1542/peds.2012-3144. Epub 2013 May 27.
Infants <2 months of age are at highest risk of pertussis morbidity and mortality. Until recently, the US Advisory Committee on Immunization Practices (ACIP) recommended protecting young infants by "cocooning" or vaccination of postpartum mothers and other close contacts with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) booster vaccine. ACIP recommends pregnancy vaccination as a preferred and safe alternative to postpartum vaccination. The ACIP cocooning recommendation has not changed.
We used a cohort model reflecting US 2009 births and the diphtheria-tetanus-acellular pertussis schedule to simulate a decision and cost-effectiveness analysis of Tdap vaccination during pregnancy compared with postpartum vaccination with or without vaccination of other close contacts (ie, cocooning). We analyzed infant pertussis cases, hospitalizations, and deaths, as well as direct disease, indirect, and public health costs for infants in the first year of life. All costs were updated to 2011 US dollars.
Pregnancy vaccination could reduce annual infant pertussis incidence by more than postpartum vaccination, reducing cases by 33% versus 20%, hospitalizations by 38% versus 19%, and deaths by 49% versus 16%. Additional cocooning doses in a father and 1 grandparent could avert an additional 16% of cases but at higher cost. The cost per quality-adjusted life-year saved for pregnancy vaccination was substantially less than postpartum vaccination ($414 523 vs $1 172 825).
Tdap vaccination during pregnancy could avert more infant cases and deaths at lower cost than postpartum vaccination, even when postpartum vaccination is combined with additional cocooning doses. Pregnancy dose vaccination is the preferred alternative to postpartum vaccination for preventing infant pertussis.
<2 个月龄的婴儿罹患百日咳的发病率和死亡率最高。直到最近，美国免疫实践咨询委员会（ACIP）建议通过为产后母亲及其他密切接触者接种破伤风类毒素、白喉类毒素和无细胞百日咳、吸附疫苗（Tdap）加强针来保护婴儿，即“疫苗保护罩”，以预防婴儿患百日咳。ACIP 推荐孕妇接种疫苗，这是一种优于产后接种的安全选择。ACIP 的疫苗保护罩建议没有改变。
我们使用反映美国 2009 年出生情况和白喉-破伤风-无细胞百日咳免疫计划的队列模型，对妊娠期间接种 Tdap 与产后接种 Tdap （或同时接种 Tdap 及为其他密切接触者接种疫苗，即疫苗保护罩）进行决策和成本效益分析。我们分析了婴儿百日咳病例、住院和死亡情况，以及婴儿第一年的直接疾病、间接和公共卫生成本。所有成本均已更新至 2011 年美元。
与产后接种 Tdap 相比，妊娠接种 Tdap 可使婴儿百日咳年发病率降低，减少 33%的病例，20%的住院率和 49%的死亡率。为父亲和 1 位祖父母额外接种疫苗保护罩可以避免另外 16%的病例，但成本更高。与产后接种 Tdap 相比，妊娠接种 Tdap 每挽救 1 个质量调整生命年的成本低得多（414523 美元对 1172825 美元）。
与产后接种 Tdap 相比，妊娠接种 Tdap 可降低婴儿百日咳病例和死亡人数，且成本更低，即使产后接种 Tdap 与额外接种疫苗保护罩联合使用。对于预防婴儿百日咳，妊娠接种 Tdap 是产后接种 Tdap 的首选替代方案。
