Vaccinate teenagers against pertussis?

Adolescents can be immunized against pertussis; just last month, the Food and Drug Administration put its seal of approval on not one but two such vaccines-Adacel (Sanofi Pasteur) and Booxtrix (GlaxoSmithKline). Whether all teenagers should be vaccinated is another question, however, and one of supreme interest to pediatricians.

Cost-effectiveness analyses are performed to answer that kind of question, and the June 2005 issue of Pediatrics contains just such an examination. The authors used a computer simulation to evaluate the potential health benefits, risks, and costs of a national pertussis vaccination program for adolescents alone, or for adolescents and adults. Data on disease prevalence, vaccine efficacy and adverse effects, and vaccine cost were fed into the model.

The authors found that, from a societal perspective, one-time adolescent vaccination would prevent 36% of projected pertussis cases, with mostly mild adverse events. Assuming the cost of vaccination to be $15 and 76% of the teenage population is covered, one-time adolescent vaccination would cost $1,100 per case prevented, or $20,000 per quality-adjusted life-year-amounts considered sufficiently cost-effective by many researchers. Adult vaccination strategies, the authors found, were more costly and less effective than adolescent strategies.

The conclusion? Given the model's assumptions, routine pertussis vaccination of adolescents will result in net health benefits to that age group, and may be relatively cost-effective. The impact that adolescent immunization would have on pertussis in infants wasn't examined.

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