GSK Panama, Research & Development, Ciudad del Saber Edificio 230, Panama City, Panama.
Estimatio SC, Health Economics and Outcome Research Services, Heriberto Frías 116-403, Col. Del Valle, Del. Benito Juárez, 03100 Ciudad de México, Mexico.
Vaccine. 2021 Apr 15;39(16):2311-2318. doi: 10.1016/j.vaccine.2021.02.038. Epub 2021 Mar 25.
Pertussis is a highly contagious infectious disease caused by Bordetella pertussis and a leading cause of infant mortality in Mexico. The Tetanus-diphtheria-acellular pertussis (Tdap) vaccine was recommended in the Mexican Immunisation Programme for pregnant women in 2013. We describe pertussis morbidity and mortality trends in infants ≤2 and ≤12 months of age), before and after maternal Tdap immunisation implementation in Mexico.
An ecological retrospective database study was performed in the Mexican National and Workers Social Security Institutes (IMSS; ISSSTE). Data were collected on confirmed pertussis ambulatory cases, hospitalisations, and deaths, plus vaccination coverage (Tdap; Diphtheria-tetanus-acellular pertussis [DTPa]) and population estimates. Descriptive and regression time-trend analyses were performed for pertussis morbidity and mortality in infants between pre- (2010-2012) and post- (2014-2018) maternal Tdap immunisation periods.
Around 1 million infants a year are covered in IMSS/ISSSTE databases. Average full primary infant DTPa vaccine coverage was 71.4%-72.7% nationally. Since 2013, annual maternal Tdap vaccine coverage ranged from 70%-93%. Between 2010-2018, 2,024 pertussis cases, 2,518 hospitalisations and 71 deaths were reported in infants. Among infants 0-2 months old (maternal immunisation target group), there was a significant decrease, post-maternal vaccination, in pertussis incidence (49.9%, p < 0.000), hospitalisation (70.0%, p < 0.000) and mortality (82.4%, p = 0.003). In infants 0-12 months old, pertussis hospitalisations (28.9%, p = 0.000) and mortality (36.2%, p = 0.059) decreased, but incidence increased (61.8%, p = 0.000).
After maternal immunisation was implemented, there was a decreasing trend in incidence, hospitalisation and death due to pertussis in infants 0-2 months old. Increases in incidence reported in 0-12-month-olds are likely due to major changes in diagnosis and reporting introduced during the study period as well as limited vaccination and health coverage in some states. These findings confirm the important contribution of the Tdap maternal immunisation programme in reducing pertussis disease burden, particularly severe disease, among infants in Mexico.
百日咳是由博德特氏菌引起的高度传染性传染病，也是墨西哥婴儿死亡的主要原因。2013 年，墨西哥免疫规划建议孕妇接种破伤风白喉无细胞百日咳（Tdap）疫苗。我们描述了在墨西哥实施母体 Tdap 免疫接种前后，2 月龄和 12 月龄以下婴儿百日咳发病率和死亡率的趋势。
在墨西哥国家和工人社会保障协会（IMSS；ISSSTE）进行了一项生态学回顾性数据库研究。收集了经证实的百日咳门诊病例、住院和死亡数据，以及疫苗接种覆盖率（Tdap；白喉破伤风无细胞百日咳[DTPa]）和人口估计数。对母体 Tdap 免疫接种前（2010-2012 年）和后（2014-2018 年）期间婴儿百日咳发病率和死亡率进行了描述性和回归时间趋势分析。
IMSS/ISSSTE 数据库每年覆盖约 100 万婴儿。全国婴儿全剂量 DTPa 疫苗覆盖率平均为 71.4%-72.7%。自 2013 年以来，年度母体 Tdap 疫苗覆盖率在 70%-93%之间。2010-2018 年间，报告了 2024 例婴儿百日咳病例、2518 例住院和 71 例死亡。在 0-2 月龄婴儿（母体免疫目标人群）中，母体接种疫苗后百日咳发病率（49.9%，p<0.000）、住院率（70.0%，p<0.000）和死亡率（82.4%，p=0.003）显著下降。在 0-12 月龄婴儿中，百日咳住院率（28.9%，p=0.000）和死亡率（36.2%，p=0.059）下降，但发病率增加（61.8%，p=0.000）。
实施母体免疫接种后，0-2 月龄婴儿因百日咳导致的发病率、住院率和死亡率呈下降趋势。在 0-12 月龄婴儿中，发病率的增加可能是由于研究期间引入了主要的诊断和报告变化，以及一些州的疫苗接种和卫生保健覆盖率有限。这些发现证实了 Tdap 母体免疫规划在减少墨西哥婴儿百日咳疾病负担方面的重要贡献，特别是严重疾病。
