Original Title: Efectividad y coste-efectividad de diferentes estrategias de inmunización frente a la tos ferina para reducir el riesgo de morbi-mortalidad infantil

Authors' objectives: To report on the current state of scientific knowledge on the effectiveness, safety and cost-effectiveness of different vaccination strategies (adults and adolescents, pregnant women, cocooning, and vaccination of health workers) against pertussis to reduce infant morbidity and/or mortality.

Authors' results and conclusions: RESULTS: Forty three studies were included. Regarding secondary studies, a systematic review, a systematic review of economic evaluations [27] and five reports with recommendations on immunization against pertussis were included: four reports by the Centers for Disease Control and Prevention (CDC), from the Department of Health of the Government of the United States, and a report by the World Health Organization (WHO). Regarding the primary studies, three interrupted time series studies were obtained that evaluated the indirect effect of vaccination of adolescents on children younger than one year, with no significant results except in a region analyzed in one of such studies. No studies were obtained that directly evaluate the effect on morbidity and/or mortality of children through vaccination during pregnancy, cocoon strategy or vaccination of healthcare personnel. Only one study was obtained that analyzes the effectiveness of postpartum vaccination of the mother, that yielded no significant results, while the CDC report mentions another study with the same objective, unpublished, that obtained significant results. As for the safety of the vaccine in pregnant women TDPA, the search yielded four studies that provided data in this regard, and no serious adverse effects have been observed, although the level of evidence that represent these studies is low. Seven studies were included that develop mathematical models to predict the effect of different vaccination strategies. As for economic evaluations, in addition to the thirteen studies included in the review obtained, five other studies were obtained. In addition, the CDC report described an unpublished work on decision analysis and costeffectiveness of different vaccination strategies, whose results have been obtained and evaluated. The results are favorable to vaccination of adolescents and adults, although there is a high degree of uncertainty about the parameters used. CONCLUSIONS: There is no valid scientific knowledge about the effectiveness of different vaccination strategies on final outcomes clinically relevant for children (morbidity and mortality). Although the Tdap is a vaccine that has not caused significant security problems, no comparative information is available and valid from quality studies. Economic evaluations available, based on modeling in the absence of information from clinical trials, suggest the cost-effectiveness of some vaccination strategies, but these are heterogeneous, show inconsistencies, and, moreover, their results are not directly transferable to the Spanish context. The recommendations in favor of these immunization practices conducted by the Centers for Disease Control and Prevention (U.S.) are based on indirect evidence on intermediate outcome measures of effectiveness and, in the case of prenatal vaccination safety, in studies with a low methodological quality.

Authors' methods: Systematic review of the literature. Electronic databases Medline, PREMEDLINE, Embase, CRD, Cochrane Central, and Trip Database from 1990 to October 2012 were consulted (see search strategy in Appendix). A manual search of reference lists of retrieved articles was also conducted. No restrictions to search were established by type of study design or language of publication. Inclusion criteria were: secondary studies (systematic reviews, clinical practice guidelines or health institutions reports with recommendations based on systematic reviews), randomized controlled trials (RCTs), observational studies or economic evaluations, where the intervention consisted of administration of Tdap vaccine to adolescents, adults, pregnant women, families/carers of the child or medical personnel, and outcome measures were incidence rates of the disease, and/or hospitalizations, complications or death (from pertussis) of children under 1 year. The methodological quality of included effectiveness studies was assessed with the criteria of the Scottish Intercollegiate Guidelines Network (SIGN) and the criteria proposed by the Cochrane Effective Practice and Organisation of Care Review Group (EPOC) were used. The scientific validity and quality of economic evaluations was assessed by the tool proposed by López-Bastida et al.

Project Status: Completed

Year Published: 2012

URL for published report: https://sescs.es/efectividad-y-coste-efectividad-de-diferentes-estrategias-de-inmunizacion-frente-a-la-tos-ferina/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es