The Impact of Adolescent Pertussis Immunization, 2004-2009: Lessons from Australia/L'impact De la Vaccination Contre la Coqueluche Chez Les Adolescents, 2004-2009: Les Lecons Donnees Par l'Australie/ Estudio En Centros De Atencion Al Paciente Para El Diagnostico De Sarampion: Deteccion De Anticuerpos IgM Y Acido Nucleico Viral Especificos del Sarampion
Bibliographic record
Abstract
Introduction Australia has seen large numbers of pertussis notifications in adolescents and adults over the past 10 to 15 years, as have some North American and European countries with long-standing high coverage for diphtheria-tetanus-pertussis (DTP) vaccines in childhood immunization programmes. (1-3) DTP vaccines have been in general use in Australia since the 1950s, (4-6) but because of concern about the possible adverse effects of the whole-cell pertussis component, (7) during the 1970s and 1980s DTP vaccine was frequently substituted with diphtheria-tetanus (DT) vaccine, and this led to a partially immunized cohort. (8) Members of this cohort, which was also the last to not be eligible to receive the pre-school DTP booster added to the immunization schedule in 1994, (9) figured prominently in successive epidemics between 1993 and 2002. A similar cohort effect has been observed in Canada. (3) School outbreaks were also frequent at this time. (10) Acellular vaccines replaced the Australian-manufactured whole-cell vaccine for booster doses in 1997 and for all doses in 1999, and 95% coverage with three doses of this new vaccine (at 2, 4 and 6 months) by 2 years of age was attained within 4 years. (11) The availability of a well formulated triple vaccine with an acellular pertussis component (Boostrix [Tdap], GlaxoSmithKline, Brentford, England) and the recognition that pertussis incidence in adolescents was increasing prompted the National Immunisation Programme to begin using Tdap on 1 January 2004 instead of the reduced antigen diphtheria-tetanus (Td) booster dose previously recommended at age 15 to 17 years). (12) Delivery of Tdap vaccine was primarily school-based, with limited doses also available in primary care. Although several countries, including Canada, France, Germany and the United States of America, have added an adolescent booster dose to their list of recommended immunizations, reports of the impact of adolescent pertussis vaccine programmes has been limited to early and/or regional data. (13-17) The aim of this study was to compare the long-term impact of the approaches used in Australia--vaccinating a one-year age cohort versus the entire high school, with and without continued immunization of high school entrants--in the context of known historical differences in pertussis epidemic cycles by region. (6) Our findings have implications for countries considering the introduction of Tdap boosters for children and adolescents 10 to 18 years of age. Methods We conducted a series of ecologic analyses of trends in pertussis notifications by age group, using relative incidence by time period, epidemic cycle and estimated vaccine coverage, to compare notification rates in relevant age cohorts. Data sources and methods of estimation for these analyses are described in the following sections. Vaccine coverage Immunization programme managers from each Australian state and territory provided coverage data from school-based delivery programmes for the period between January 2004 and December 2009. No data were available on vaccines administered outside the school setting, but these were thought to represent a small proportion of the doses administered. Pertussis notification before and after Tdap Notifications to the National Notifiable Diseases Surveillance System with an onset date between 1 January 1999 and 31 December 2009 were eligible for this analysis. Pertussis cases are notifiable in every Australian jurisdiction under public health legislation. The criteria for notification are nationally uniform and include a combination of clinical, epidemiological and laboratory evidence. Laboratory evidence rests on culture of Bordetella pertussis or on the detection of B. pertussis by nucleic acid testing or single point serology. Since 1993, all public and private laboratories have been required to notify all persons testing positive on diagnostic tests for pertussis to public health authorities. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".