Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases Unit, Institut Pasteur, Inserm U1181, University of Versailles St-Quentin-en-Yvelines, Versailles, France.
Sci Transl Med. 2018 Mar 28;10(434). doi: 10.1126/scitranslmed.aaj1748.
The resurgence of pertussis over the past decades has resulted in incidence levels not witnessed in the United States since the 1950s. The underlying causes have been the subject of much speculation, with particular attention paid to the shortcomings of the latest generation of vaccines. We formulated transmission models comprising competing hypotheses regarding vaccine failure and challenged them to explain 16 years of highly resolved incidence data from Massachusetts, United States. Our results suggest that the resurgence of pertussis is a predictable consequence of incomplete historical coverage with an imperfect vaccine that confers slowly waning immunity. We found evidence that the vaccine itself is effective at reducing overall transmission, yet that routine vaccination alone would be insufficient for elimination of the disease. Our results indicated that the core transmission group is schoolchildren. Therefore, efforts aimed at curtailing transmission in the population at large, and especially in vulnerable infants, are more likely to succeed if targeted at schoolchildren, rather than adults.
过去几十年来，百日咳的死灰复燃导致发病率水平达到了自 20 世纪 50 年代以来未曾见过的程度。其根本原因一直是人们猜测的对象，特别是对最新一代疫苗的缺陷的关注。我们制定了包含关于疫苗失败的竞争假设的传播模型，并对它们进行了挑战，以解释来自美国马萨诸塞州的 16 年高分辨率发病率数据。我们的研究结果表明，百日咳的死灰复燃是历史覆盖率不完全和具有缓慢衰减免疫作用的不完美疫苗的必然结果。我们发现证据表明，疫苗本身可以有效降低整体传播，但仅依靠常规疫苗接种不足以消除该疾病。我们的研究结果表明，核心传播人群是学龄儿童。因此，如果将努力集中在学龄儿童而不是成年人身上，以减少人群中的传播，特别是在脆弱的婴儿身上，那么成功的可能性更大。
