Epidemiology and Control of Pertussis in England: Impact of Maternal Immunisation Dr Gayatri Amirthalingam
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1 Epidemiology and Control of Pertussis in England: Impact of Maternal Immunisation Dr Gayatri Amirthalingam Immunisation, Hepatitis & Blood Safety department Public Health England 12 th November 2015
2 Session Outline Pertussis immunisation programme in England Recent epidemiology Evaluation of pertussis vaccination programme for pregnant women - Vaccine Coverage - Vaccine Effectiveness - Programme Impact - Impact of passive antibodies on infant immune response 2 Pertussis Immunisation in Pregnancy
3 Notifications coverage by 2nd birthday Total notifications : routine infant DTwP introduced, completed by 6M 1968: infant DTwP begun at 6M, completed by 12-14M culture 2000/01: temporary use of 3 component DTaP 1990: accelerated infant DTwP at 2,3,4M Infant schedule at 3,5,11 months : Preschool DTaP booster at 3 ½ to 5 years : enhanced surveillance of lab confirmed pertussis : 5 component DTaP at 2,3,4M : serology 2002: PCR 2013: OF Coverage (%)
4 Annual age specific pertussis incidence rates, England, Pertussis Immunisation in Pregnancy
5 Number of deaths from whooping cough in infants, England, Sources: lab confirmed cases, certified deaths, Hospital episode statistics, GP registration details Pertussis Immunisation in Pregnancy
6 Onset age of laboratory confirmed pertussis cases in infants Pertussis Immunisation in Pregnancy
7 Pertussis Immunisation in Pregnancy Recommendation: From 1 st October 2012 Offer a single dose of Repevax (dtap 5 /IPV) ideally between weeks pregnancy, up to 38 weeks Offer in every pregnancy Outbreak response measure Since July 2014, programme using Boostrix- IPV (dtap 3 /IPV) 7 Pertussis Immunisation in Pregnancy
8 Evaluation of pregnancy vaccination programme Vaccine coverage Vaccine effectiveness Programme impact Impact of passive antibodies on infant immune response 8 Pertussis Immunisation in Pregnancy
9 2013/Jan 2013/Feb 2013/Mar 2013/Apr 2013/M 2013/Jun 2013/Jul 2013/Aug 2013/Sep 2013/Oct 2013/Nov 2013/Dec 2014/Jan 2014/Feb 2014/Mar 2014/Apr 2014/M 2014/Jun 2014/Jul 2014/Aug 2014/Sep 2014/Oct 2014/Nov 2014/Dec 2015/Jan 2015/Feb 2015/Mar 2015/Apr 2015/M 2015/Jun 2015/Jul 2015/Aug 2015/Sep Vaccine Coverage January September 2015 Repevax (dtap 5 /IPV) Boostrix-IPV (dtap 3 /IPV) 80% 70% 60% 50% 40% 30% Immform CPRD 20% 10% 0%
10 Evaluation of pregnancy vaccination programme Vaccine coverage Vaccine effectiveness Programme impact Impact of passive antibodies on infant immune response 10 Pertussis Immunisation in Pregnancy
11 Pertussis programme effectiveness measured by two methods (1)Amirthalingam G et al. Lancet 2014 (2)Dabrera G et al. Clinical Infectious Diseases 2014 Analysis <2M age Cases Matched / Adjusted VE vaccinated control (95% CI) / total coverage Screening method (1) 11/81 (15%) 61% 90% (82% to 95%) Updated Vaccination at least 7days before birth 31/192 (16%) 64.3% 90% (86% to 93%) Case-control study 10/58 39/55 93% (2) (17%) (71%) (81% to 97%)
12 Evaluation of pregnancy vaccination programme Vaccine coverage Vaccine effectiveness Programme impact Impact of passive antibodies on infant immune response 12 Pertussis Immunisation in Pregnancy
13 13 Pertussis Immunisation in Pregnancy Annual age specific laboratory confirmed pertussis incidence rates, , England Introduction of temporary vaccination programme for pregnant women
14 Reconciled deaths from pertussis in infants, England <3M <3M mum vaccinated <3M mum not vaccinated 3-5M 6-11M * Sources: lab confirmed cases, certified deaths, Hospital episode statistics, GP registration details, HPZone *reported by 21/9/2015
15 Summary Pertussis remains the most common vaccine preventable disease in <1s in England Current outbreak highlights burden of infant disease prior to routine vaccination Evaluation of the pregnancy vaccination programme in England is encouraging - Vaccine programme well received - High vaccine coverage - Programme impact cases in infants <3 months have been held at low levels since introduction of programme; activity in older age groups remains high - Vaccine effectiveness calculated to be high & provide first evidence of protection against disease - Programme evaluation with respect to blunting is ongoing 15 Pertussis Immunisation in Pregnancy
16 Key Questions 1. How do we improve maternal vaccine coverage and ensure vaccines are delivered at the optimal stage in pregnancy? 2. Should the programme for pregnant women in England become routine? Introduced without CEA as a temporary outbreak control measure. a. If it is to be continued as a routine vaccination then must be shown to be cost effective b. If not, under what circumstances can the programme be stopped? 3. Should the vaccine continue to be offered in every pregnancy? 4. Are there any differences in the potential blunting of the infant immune response between the two currently available vaccines? 16 Pertussis Immunisation in Pregnancy
17 Acknowledgements Helen Campbell, Nick Andrews, Sonia Ribeiro, Edna Kara, Katherine Donegan, Norman Fry, Elizabeth Miller, Mary Ramsay, Yoon Choi Tim Fry, David Litt, Joanne White, Sukamal Das, Shamez Ladhani. Paul Heath, Chrissie Jones, Pauline Kaye, Jo Southern, Debbie Cohen, Teresa Gibbs, Bassam Hallis, Mary Matheson, Anna England, Ray Borrow, Helen Findlow, Xilian Bai, David Goldblatt, Emma Pierce, Phil Bryan With grateful thanks to Kim Taylor, Julia Stowe, Adolphe Bukasa, Rashmi Malkani, Julie Brough, Yojna Handoo-Das and the GP practices and PHE Teams that provided information on confirmed cases through the PHE pertussis enhanced surveillance programme, Vaccine nurses, participating families Pertussis Immunisation in Pregnancy
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