Impact of childhood and maternal vaccination against diphtheria, tetanus, and pertussis in Colombia

Date Icon Publish Date
  • María Cristina Hoyos
    National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellin, Antioquia, Colombia.
    https://orcid.org/0000-0001-9579-2335
  • Doracelly Hincapié-Palacio
    National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellin, Antioquia, Colombia.
    https://orcid.org/0000-0002-7476-0411
  • Jesus Ochoa
    National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellin, Antioquia, Colombia.
    https://orcid.org/0000-0002-9233-2330
  • Alba León
    School of Medicine, University of Antioquia, Medellin, Antioquia, Colombia.

ABSTRACT

Background: In Latin America, there are few studies of the impact of vaccination against diphtheria, tetanus, and pertussis. We estimate the impact of infant and maternal vaccination on the incidence of these diseases in Colombia.

Design and methods
: an interrupted time series study analyzing the incidence before and after of vaccination with DwPT (1975-2018) and with Tdap in pregnant women (2008-2018). A segmented regression model with negative binomial distribution estimated the change in level and trend of the predicted incidence ratio after vaccination in relation to the incidence if vaccination had not been started (IRR), using a Prais Winsten regression.

Results:
 The pertussis IRR decreased immediately after the start of childhood vaccination (0.91, p=0.51), but this was only significant (1.01, p<0.001) along with the trend per year, after the start of maternal vaccination (0.98, p<0.001). In the absence of vaccination, the incidence would not have been reduced. Neonatal tetanus had the highest rate of change with significant reduction -1.69 – CI 95%: -2.91, -0.48). The trend after vaccination was the highest with an annual reduction of 19% (0.81, p=0.001). The change in incidence of diphtheria was significant, although slow (-0.02 – CI 95%: -0.04, -0.004). The sustained effect in the post-vaccination period was smaller (0.95, p=0.79).

Conclusions:
 Childhood and maternal vaccination markedly reduced the incidence of pertussis and neonatal tetanus. It is necessary to maintain optimal vaccination coverage and surveillance, within an integrated elimination plan, which prevents the resurgence of these diseases.

AUTHOR BIOGRAPHIES

Doracelly Hincapié-Palacio, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellin, Antioquia

Msc; PhD is a professor and researcher in Epidemiology at the National School of Public Health – University of Antioquia. His research interests are vaccine-preventable diseases, mathematical models and epidemiological surveillance.

Jesus Ochoa, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellin, Antioquia

Msc; PhD is a professor and researcher in epidemiology at the National School of Public Health – University of Antioquia. His research interests are vaccine-preventable diseases, hospital infection control and epidemiological surveillance.

Alba León , School of Medicine, University of Antioquia, Medellin, Antioquia

Msc in Biostatistics is a professor and researcher in health information systems and epidemiology at the School of Medicine – University of Antioquia. His research interests are statistical analysis in epidemiology

REFERENCES

Dinleyici EC, Borrow R, Safadi MAP, et al. Vaccines and routine immunization strategies during the COVID-19 pandemic. Hum Vaccin Immunother 2021;17:400-7. DOI: https://doi.org/10.1080/21645515.2020.1804776

Mezones-Holguin E, Al-Kassab-Cordova A, Maguina JL, Rodriguez-Morales AJ. Vaccination coverage and preventable diseases in Peru: Reflections on the first diphtheria case in two decades during the midst of COVID-19 pandemic. Travel Med Infect Dis 2020;40:101956. DOI: https://doi.org/10.1016/j.tmaid.2020.101956

Clarke K, MacNeil A, Hadler S, et al. Global epidemiology of diphtheria, 2000–2017. Emerg Infect Dis 2019;25:1834-42. DOI: https://doi.org/10.3201/eid2510.190271

Burgess C, Gasse F, Steinglass R, et al. Eliminating maternal and neonatal tetanus and closing the immunity gap. Lancet 2017;389:1380-1. DOI: https://doi.org/10.1016/S0140-6736(17)30635-9

Ministerio de Salud y Protección Social. [Historia del Programa Ampliado de Inmunizaciones PAI en Colombia, 1979-2009].[in Spanish]. Ministerio de Salud Social: Bogotá; 2010.

Vizzotti C, Juarez MV, Bergel E, et al. Impact of a maternal immunization program against pertussis in a developing country. Vaccine 2016;34:6223-8. DOI: https://doi.org/10.1016/j.vaccine.2016.10.081

Carrasquilla G, Porras A, Martinez S, et al. Incidence and mortality of pertussis disease in infants <12 months of age following introduction of pertussis maternal universal mass vaccination in Bogota, Colombia. Vaccine 2020;38:7384-92. DOI: https://doi.org/10.1016/j.vaccine.2020.07.046

Hincapie-Palacio D, Hoyos MC, Ochoa J, et al. Effect of maternal immunization against pertussis in Medellin and the metropolitan area, Colombia, 2016-2017. Vaccine 2018;36:3984-91. DOI: https://doi.org/10.1016/j.vaccine.2018.05.020

Moron-Duarte LS, Castillo-Pabon JO. [The process of eliminating neonatal Tetanus in Colombia, 1989-2005].[Article in Spanish with English abstract]. Rev Salud Publica 2014;16:744-52. DOI: https://doi.org/10.15446/rsap.v16n5.51678

Alvis N, de La Hoz F, Gamboa O, et al. [Epidemiological and economic impact of tetanus vaccination in Colombian adults].[Article in Spanish with English abstract]. Rev Panam Salud Publica 2011;30:209-16. DOI: https://doi.org/10.1590/S1020-49892011000900004

Landazabal Garcia N, Burgos Rodriguez MM, Pastor D. Diphtheria outbreak in Cali, Colombia. Epidemiol Bull 2001;22:2.

Ministerio de Salud y Protección Social. [Guia completa Programa Ampliado de Inmunizaciones PAI 2000].[in Spanish]. Ministerio de Salud Social: Bogotá; 2000.

Ministerio de Salud y Protección Social. [Lineamiento Estratégico para la Introducción de la Vacuna TdaP (Tétanos – Difteria – Tos ferina acelular) en el Esquema del Programa Ampliado de Inmunizaciones 2013].[in Spanish]. Ministerio de Salud Social: Bogotá; 2013. Available from: www.ins.gov.co

Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol 2017;46:348-55.

Instituto Nacional de Salud. [Datos Eventos de interés en Salud Pública 2019 [cited 2019 Noviembre 2019].[in Spanish]. Ministerio de Salud Social: Bogotá; 2019. Accessed: 2 Febraury 2021.

Departamento Nacional de Salud y Ministerio de Salud. [Estudio Nacional de salud 1990. Documento General Tome I].[in Spanish]. Editorial Presencia Ltda., Bogotá: 1990.

Instituto Nacional de Salud. [Difteria: Informe de evento Instituto Nacional de Salud].[in Spanish]. Instituto Nacional de Salud: Bogotá; 2015.

Instituto Nacional de Salud. [Tosferina. Informe de evento Instituto Nacional de Salud].[in Spanish]. Instituto Nacional de Salud: Bogotá; 2018.

Instituto Nacional de Salud. [Tetanos: Informe de evento Instituto Nacional de Salud].[in Spanish]. Instituto Nacional de Salud: Bogotá; 2018.

Ministerio de Salud y Protección Social. [Coberturas de vacunación Municipales: Programa Ampliado de Inmunizaciones].[in Spanish]. Ministerio de Salud y Protección Social: Bogota; 2021. Available from: https://www.minsalud.gov.co/salud/publica/Vacunacion/Paginas/pai.aspx

Departamento Nacional de Estadísticas DANE. [Demografía y Población 2020].[in Spanish]. Accessed: 15 February 2020. Available from: https://www.dane.gov.co/

Cavada Ch G. Prais-Winsten regression: lineal trends assessment. Rev Chil Endocrinol Diabetes 2015;8:1.

Prais GJ, Winsten CB. Trend estimates and serial correlation. Cowles Commission Discussion Paper, Stat No 383, University of Chicago; 1954.

Salinas-Rodríguez A, Manrique, B, Sosa S. [Análisis estadístico para datos de conteo: aplicaciones para el uso de los servicios de salud].[Article in Spanish]. Salud Publica Mexico 2009;51:5. DOI: https://doi.org/10.1590/S0036-36342009000500007

Xiao H, Augusto O, Wagenaar BH. Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses. International J Epidemiol 2021;50:1011-5. DOI: https://doi.org/10.1093/ije/dyaa148

Departamento Nacional de Planeación (DPN). [Documento CONPESS 3338 de 2005].[in Spanish]. Departamento Nacional de Planeación: Bogotá; 2005.

Narváez J, Osorio MB, Castañeda-Orjuela C, et. al. Is Colombia reaching the goals on infant immunization coverage? A quantitative survey from 80 municipalities. Vaccine 2017;35:1501-8. DOI: https://doi.org/10.1016/j.vaccine.2017.01.073

Esposito S, Stefanelli P, Fry NK, et al. Pertussis prevention: Reasons for resurgence, and differences in the current acellular pertussis vaccines. Front Immunol 2019;10:1344. DOI: https://doi.org/10.3389/fimmu.2019.01344

Fullen AR, Yount KS, Dubey P, Deora R. Whoop! There it is: The surprisin resurgence of pertussis. PLoS Pathog 2020;16:e1008625. DOI: https://doi.org/10.1371/journal.ppat.1008625

Kandeil W, van den Ende C, Bunge EM, et al. A systematic review of the burden of pertussis disease in infants and the effectiveness of maternal immunization against pertussis. Expert Rev Vaccines 2020;19:621-38. DOI: https://doi.org/10.1080/14760584.2020.1791092

Vygen-Bonnet S, Hellenbrand W, Garbe E, et al. Safety and effectiveness of acellular pertussis vaccination during pregnancy: a systematic review. BMC Infect Dis 2020;20:136. DOI: https://doi.org/10.1186/s12879-020-4824-3

Liu TC, Zhang J, Liu SQ, et al. Evaluation of immunisation strategies for pertussis vaccines in Jinan, China – an interrupted time-series study. Epidemiol Infect 2020;148:e26. DOI: https://doi.org/10.1017/S0950268820000102

World Health Organization. Diphtheria vaccine: WHO position paper – August 2017. Available from: https://apps.who.int/iris/handle/10665/258683

World Health Organization. Tetanus vaccines: WHO position paper 2017. Available from: https://www.who.int/publications/i/item/tetanus-vaccines-who-position-paper-february-2017

Our most popular topics on Journal of Public Health Research

Leave a Reply

Your email address will not be published.