Pertussis infant morbidity and mortality trends after universal maternal immunisation in Mexico: An ecological database study with time-series analysis

Abstract

Introduction: Pertussis is a highly contagious infectious disease caused by Bordetella pertussis and a leading cause of infant mortality in Mexico. The Tetanus-diphtheria-acellular pertussis (Tdap) vaccine was recommended in the Mexican Immunisation Programme for pregnant women in 2013. We describe pertussis morbidity and mortality trends in infants 2 and 12 months of age), before and after maternal Tdap immunisation implementation in Mexico.

Methods: An ecological retrospective database study was performed in the Mexican National and Workers Social Security Institutes (IMSS; ISSSTE). Data were collected on confirmed pertussis ambulatory cases, hospitalisations, and deaths, plus vaccination coverage (Tdap; Diphtheria-tetanus-acellular pertussis [DTPa]) and population estimates. Descriptive and regression time-trend analyses were performed for pertussis morbidity and mortality in infants between pre- (2010-2012) and post- (2014-2018) maternal Tdap immunisation periods.

Results: Around 1 million infants a year are covered in IMSSISSSTE databases. Average full primary infant DTPa vaccine coverage was 71.4-72.7 nationally. Since 2013, annual maternal Tdap vaccine coverage ranged from 70-93. Between 2010-2018, 2,024 pertussis cases, 2,518 hospitalisations and 71 deaths were reported in infants. Among infants 0-2 months old (maternal immunisation target group), there was a significant decrease, post-maternal vaccination, in pertussis incidence (49.9, p 0.000), hospitalisation (70.0, p 0.000) and mortality (82.4, p 0.003). In infants 0-12 months old, pertussis hospitalisations (28.9, p 0.000) and mortality (36.2, p 0.059) decreased, but incidence increased (61.8, p 0.000).

Conclusion: After maternal immunisation was implemented, there was a decreasing trend in incidence, hospitalisation and death due to pertussis in infants 0-2 months old. Increases in incidence reported in 0-12-month-olds are likely due to major changes in diagnosis and reporting introduced during the study period as well as limited vaccination and health coverage in some states. These findings confirm the important contribution of the Tdap maternal immunisation programme in reducing pertussis disease burden, particularly severe disease, among infants in Mexico.