Whooping cough immunity lasts longer than previously thought
Friday, October 30th, 2009
The eradication of vaccine-preventable infectious diseases remains an important public health priority. To achieve this goal, the level of immunity afforded needs to be high and long-lasting. For whooping cough (pertussis), one of the leading causes of mortality in infants, immunity has been shown to wane in some individuals. The epidemiological impacts of this observation depend critically on the duration of protective immunity in the entire population, which remains notoriously difficult to estimate. Immunity to whooping cough lasts at least 30 years on average, much longer than previously thought, according to a new study. Once thought to be under control following widespread childhood vaccination, whooping cough has been on the rise since the 1980s in the United States and other countries. Several explanations have been proposed for the surprising increase in cases, and one leading idea is that the immunity enjoyed by vaccinated or previously exposed people is waning. It has been documented that, in some individuals, immunity has waned over time, but details of how long protection typically lasts and how its waning affects disease transmission have not been clear.
To try to answer these questions, researchers used mathematical models to explore various scenarios and compared the predictions generated by those models to data on whooping cough incidence. They constructed two different models based on assumptions of the effects of pertussis exposure on a person whose immunity has lapsed and that person’s relative contribution to transmission. Then they compared the models’ predictions to whooping cough incidence data from England and Wales from both the pre-vaccine era (1945-1957) and the vaccine era (1958-1972). In particular, they looked for matches in two key measures: the number of years between big outbreaks and the frequency of “extinctions” – periods of time when no whooping cough cases were reported in the population.
The analysis revealed that, on average, whooping cough immunity lasts at least 30 years and perhaps as long as 70 years after natural infection. This is surprising because clinical epidemiologists currently believe the duration of pertussis immunity is somewhere between four and 20 years. In addition, repeat infections appear to contribute relatively little to the transmission cycle. And when people whose immunity has waned are re-exposed to whooping cough, they rarely become infected. In fact, their immunity to the disease may be boosted by re-exposure. Still, the researchers are cautious about drawing conclusions about current day vaccination practices from their study of historical data. It is worth pointing out that in the past 20 years or so, the nature of the vaccines that have been used has changed quite fundamentally. The data used in the study are from a time when a whole-cell vaccine was in use; now an acellular vaccine, which stimulates a different part of the immune system, is typically used, especially in North America.
Estimating the Duration of Pertussis Immunity Using Epidemiological Signatures. PLoS Pathog 5(10): e1000647 doi:10.1371/journal.ppat.1000647
Case notifications of pertussis have shown an increase in a number of countries with high rates of routine pediatric immunization. This has led to significant public health concerns over a possible pertussis re-emergence. A leading proposed explanation for the observed increase in incidence is the loss of immunity to pertussis, which is known to occur after both natural infection and vaccination. Little is known, however, about the typical duration of immunity and its epidemiological implications. Here, we analyze a simple mathematical model, exploring specifically the inter-epidemic period and fade-out frequency. These predictions are then contrasted with detailed incidence data for England and Wales. We find model output to be most sensitive to assumptions concerning naturally acquired immunity, which allows us to estimate the average duration of immunity. Our results support a period of natural immunity that is, on average, long-lasting (at least 30 years) but inherently variable.
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