Effectiveness and cost-effectiveness of different immunization strategies against whooping cough to reduce child morbidity and mortality.
BACKGROUND
In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations.


METHODS
Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system.


RESULTS
There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used.


CONCLUSIONS
From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated.
Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain. Electronic address: amado.riverosantana@sescs.es.
Amado
A
Rivero-Santana
Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain.
Leticia
L
Cuéllar-Pompa
Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Health Technology Assessment Agency (AETS), Health Institute Carlos III (ISCIII), C/Sinesio Delgado, 4, 28029 Madrid, Spain; Health Research Institute of the University Hospital La Princesa, C/ Diego León, 62, 28006 Madrid, Spain.
Luis M
LM
Sánchez-Gómez
Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
Lilisbeth
L
Perestelo-Pérez
Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain.
Pedro
P
Serrano-Aguilar
D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D010567:Pertussis Vaccine / Q000191:economics / Q000627:therapeutic use*; D011247:Pregnancy; D015397:Program Evaluation; D014917:Whooping Cough / Q000191:economics / Q000401:mortality / Q000517:prevention & control*
D010567:Pertussis Vaccine
Adolescent; Adult; Diphtheria–tetanus–pertussis vaccine; Health personnel; Immunization; Whooping cough