Epidemiological and Economic Effects of Priming With the Whole-Cell Bordetella pertussis Vaccine

IMPORTANCE Current acellular pertussis vaccinesmay not protect against transmission of Bordetella pertussis. OBJECTIVE To assess whether a priming dose of whole-cell pertussis (wP) vaccine is cost-effective at reducing pertussis infection in infants. DESIGN, SETTING, AND PARTICIPANTS Mathematical model of pertussis transmission fit to US incidence data in a simulation of the US population. In this simulation study conducted from June 2014 to May 2015, the population was divided into 9 age groups corresponding to the current pertussis vaccination schedule and fit to 2012 pertussis incidence. INTERVENTIONS Inclusion of a priming dose of wP vaccine into the current acellular pertussis vaccination schedule. MAIN OUTCOMES AND MEASURES Reductions in symptomatic pertussis incidence by age group, increases in wP vaccine-related adverse effects, and quality-adjusted life-years owing to changing vaccine schedule. RESULTS Switching to a wP-priming vaccination strategy could reduce whooping cough incidence by up to 95%(95% CI, 91-98), including 96%(95% CI, 92-98) fewer infections in neonates. Although there may be an increase in the number of vaccine adverse effects, we nonetheless estimate a 95% reduction in quality-adjusted life-years lost with a switch to the combined strategy and a cost reduction of 94%(95% CI, 91-97), saving more than $142 million annually. CONCLUSIONS AND RELEVANCE Our results suggest that an alternative vaccination schedule including 1 dose of wP vaccine may be highly cost-effective and ethically preferred until next-generation pertussis vaccines become available.