title: Assessing the Evidence for Maternal Pertussis Immunization: A Report From the Bill & Melinda Gates Foundation Symposium on Pertussis Infant Disease Burden in Low- and Lower-Middle-Income Countries.
abstract: Implementation of effective interventions has halved maternal and child mortality over the past 2 decades, but less progress has been made in reducing neonatal mortality. Almost 45% of under-5 global mortality now occurs in infants <1 month of age, with approximately 86% of neonatal deaths occurring in low- and lower-middle-income countries (LMICs). As an estimated 23% of neonatal deaths globally are due to infectious causes, maternal immunization (MI) is one intervention that may reduce mortality in the first few months of life, when direct protection often relies on passively transmitted maternal antibodies. Despite all countries including pertussis-containing vaccines in their routine childhood immunization schedules, supported through the Expanded Programme on Immunization, pertussis continues to circulate globally. Although based on limited robust epidemiologic data, current estimates derived from modeling implicate pertussis in 1% of under-5 mortality, with infants too young to be vaccinated at highest risk of death. Pertussis MI programs have proven effective in reducing infant pertussis mortality in high-income countries using tetanus-diphtheria-acellular pertussis (Tdap) vaccines in their maternal and infant programs; however, these vaccines are cost-prohibitive for routine use in LMICs. The reach of antenatal care programs to deliver maternal pertussis vaccines, particularly with respect to infants at greatest risk of pertussis, needs to be further evaluated. Recognizing that decisions on the potential impact of pertussis MI in LMICs need, as a first step, robust contemporary mortality data for early infant pertussis, a symposium of global key experts was held. The symposium reviewed current evidence and identified knowledge gaps with respect to the infant pertussis disease burden in LMICs, and discussed proposed strategies to assess the potential impact of pertussis MI.
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Ajoke
authors.initials: A
authors.lastname: Sobanjo-Ter Meulen
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Duclos
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Westmead, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McIntyre
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Kristen D C
authors.initials: KD
authors.lastname: Lewis
authors.affiliation: Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Van Damme
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: O'Brien
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D017281:Cost of Illness; D003906:Developing Countries; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage / Q000276:immunology*; D005260:Female; D014943:Global Health; D006291:Health Policy; D006801:Humans; D007112:Immunity, Maternally-Acquired; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D014611:Vaccination / Q000379:methods; D014917:Whooping Cough / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: infants; maternal immunization; neonates; pertussis; vaccines