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The Optimal Strategy for Pertussis Vaccination: A Systematic Review and Meta-analysis of Randomized Control Trials and Real-World Data

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Background: Pertussis is an extremely infectious disease caused by Bordetella Pertussis that results in respiratory infection. Pertussis is endemic worldwide, especially in developing countries. Although routine infant vaccination considerably reduces the number of pertussis cases and the mortality

rate, severe cases and incidence rates have been recorded in infants prior to receiving the primary immunization schedule. Several strategies, cocooning strategies, vaccine during pregnancy, neonatal vaccination, and postpartum immunization, have been suggested to prevent infants before routine vac

cination schedule against pertussis infection. However, the efficacy of the postpartum immunization and cocooning approach remains limited. Therefore, vaccine during pregnancy or at birth could be potential options to solve this major public health issue.Our systematic review and meta-analysis of ra

ndomized control trials (RCTs) and real-world evidence aimed to evaluate the safety, efficacy, immunogenicity, and safety of pertussis vaccination in pregnancy and neonatal vaccination.Method: The databases from Embase, Cochrane database central, and PubMed/Medline were continuously updated from the

beginning until December 2020. RCTs, cohort studies, and case-control studies of infants immunized at birth or whose mothers had been vaccinated in pregnancy compared to control groups (vaccination at 2 or 3 months of age) were included. The number of pertussis cases, three antigen-specific pertuss

is IgG antibody levels (anti-pertussis toxin (anti-PT), anti-pertactin (anti-PRN), and anti-filamentous hemagglutinin (anti-FHA)), and severe adverse events (SAEs) in children before and after the primary vaccination series were examined. Two authors independently obtained data and assessed the qual

ity of the studies. Data extracted included the authors, study period, publication year, inclusion criteria, number of study participants, interventions, primary vaccination schedule, vaccine supplier, and outcome. A meta-analysis was performed using a random-effects model to pool the investigation.

Results: This study examined a total of thirty-two and twenty-nine studies in systematic review and meta-analysis, respectively. In compared to the control groups, pertussis vaccination in pregnancy considerably elevated the all pertussis IgG antibodies concentrations in the umbilical cord and in i

nfants prior to the primary vaccination schedule, anti-PT IgG (standardized mean difference (SMD), 1.51; 95% CI, 1.24 to 1.78), (SMD, 1.48; 95% CI, 1.15 to 1.81); anti-PRN IgG (SMD, 2.23; 95% CI, 1.67 to 2.8), (SMD, 2.09; 95% CI, 1.81 to 2.36); and anti-FHA IgG (SMD, 2.23; 95% CI, 1.62 to 2.84), (SM

D, 2.33; 95% CI, 2.01 to .66), respectively. Furthermore, vaccination in pregnancy lowered the pertussis incidence in infants prior to the primary vaccination schedule (odds ratio, 0.22; 95 percent CI, 0.14-0.33). When compared to those who were not vaccinated, infants who were vaccinated at birth s

howed higher concentration of pertussis anti-FHA IgG (SMD, 0.52; 95 percent CI, 0.33 to 0.71), anti-PT IgG (SMD, 0.55; 95 percent CI, 0.33 to 0.77), and anti-PRN IgG (SMD, 0.27; 95 percent CI, 0.05 to 0.48). Additionally, no significant variations in SAE rates were seen between vaccine in pregnancy

vs control group (risk ratios (RR), 1.18; 95% CI, 0.76-1.82) and neonatal vaccine vs control group (RR), 0.72; 95% CI, 0.34-1.54).Conclusions: Our results indicated that if pregnant women receive the pertussis vaccination during pregnancy, their infants are protected from pertussis before the primar

y vaccination. Cost-effectiveness has been an essential factor in considering maternal vaccination in the national immunization program. Vaccination at birth is another choice for infants whose mothers have not yet got acellular pertussis vaccine in gestational weeks.