Modest Support for a Whooping Cough Booster Shot
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Monday, June 6, 2005, 12:01 a.m. ET
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Analysis weighs costs, efficacy, disease severity, and vaccine side effects
Despite childhood vaccination rates at all-time highs, whooping cough (pertussis) has re-emerged over the past two decades, especially among adolescents, adults, and young infants. Because of this resurgence, federal health policymakers are considering a national booster vaccination program, and two booster shots are pending FDA approval: Boostrix for 10-to 18-year-olds, and Adacel for patients between 11 and 64.
Using computer simulation, an analysis in the June issue of Pediatrics offers modest support for the adolescent booster, concluding that one-time vaccination at 11 years of age may potentially be cost-effective.
Led by Grace Lee, MD, MPH, an infectious disease specialist at Children's Hospital Boston and the Center for Child Health Care Studies at Harvard Medical School and Harvard Pilgrim Health Care, the researchers compared six vaccination strategies, ranging from no vaccination after age 6 to adolescent and adult vaccination with 10-year boosters. The models incorporated existing data on pertussis incidence, disease outcomes, vaccine efficacy, vaccine costs, and side effects.
The analysis concluded that one-time adolescent vaccination ''would result in significant net health benefits and may be reasonably cost-effective,'' preventing 36% of projected pertussis cases at a cost of $1,100 per case. These estimates -- less favorable than those for Haemophilius influenza B (Hib) or measles vaccination, but similar to those for pneumococcal vaccination -- were highly sensitive to assumptions about disease incidence, vaccine efficacy, side effects, and vaccine costs, the authors write.
''In the past, vaccination programs were cost-saving and life-saving,'' says Lee. ''However, newer vaccines are now focused on reducing morbidity, rather than mortality, and we need to carefully weigh the risks and benefits of vaccination. By balancing the costs of vaccination and the potential impact of alternative vaccine policies on disease morbidity and quality of life, we can optimize decision making about vaccine use in the U.S.''
Other study authors included Tracy Lieu, MD, MPH, Center for Child Health Care Studies; Charles LeBaron and Trudy Murphy, National Immunization Program, Centers for Disease Control & Prevention; and Susan Lett and Stephanie Schauer, Massachusetts Department of Public Health.
Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 325 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: www.childrenshospital.org/research.
The Center for Child Health Care Studies is a research center dedicated to improving the health of children. It is located within the Department of Ambulatory Care and Prevention (DACP), a research and teaching collaboration between Harvard Pilgrim Health Care and Harvard Medical School. The principal goals of the DACP are to influence health policy, enhance collaborations between health care delivery systems and traditional public health agencies, train clinicians to manage care effectively, develop improved methods for delivery of health care and develop new information about disease and therapeutics. The DACP conducts research on a wide variety of topics, including cancer, diabetes, asthma, and drug policy. The Center has close ties with Children's Hospital Boston For more information, visit the DACP Web site: www.hms.harvard.edu/ambulatory/.