ReviewImpact of anti-vaccine movements on pertussis control: the untold story
Section snippets
Methods
We searched the literature, studied English translations of contemporary news stories, and analysed country-specific incidence of pertussis, whole-cell vaccine coverage, and vaccination schedules from data compiled by the US Centers for Disease Control and Prevention, and by WHO. We also studied books and other publications intended for lay audiences written by advocates against vaccination. From available relevant data, we compared the pertussis experiences of two groups of countries.
Group I
Group 1: countries with sustained use of whole-cell pertussis vaccines
Hungary—Hungary's pertussis-control programme has been exemplary.6 Surveillance, including mandatory reporting, began in 1931. Immunisation with whole-cell pertussis vaccine has continued without interruption since 1955. Vaccine coverage with three primary and two booster doses has been nearly 100%. Reported incidences fell from more than 100 per 100 000 in the prevaccine era to less than one per 100 000 after vaccination, where they have remained for almost 30 years (figure 1).
The former East
Discussion
Our findings provide strong evidence of a causal relation between movements against whole-cell pertussis vaccine and pertussis epidemics, based on Hill's criteria:30 strength of association (eg, incidence ratios exceeding 100 to 1, Sweden vs Norway; 150 to 20 comparing peak incidence for Sweden in 1990 during antivaccine era vs Sweden in 1972 with highest whole-cell vaccine coverage); consistency of findings under different surveillance systems, time periods, and populations; specificity of
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