Elsevier

The Lancet

Volume 351, Issue 9099, 31 January 1998, Pages 356-361
The Lancet

Review
Impact of anti-vaccine movements on pertussis control: the untold story

https://doi.org/10.1016/S0140-6736(97)04334-1Get rights and content

Summary

To assess the impact of anti-vaccine movements that targeted pertussis whole-cell vaccines, we compared pertussis incidence in countries where high coverage with diphtheria-tetanus-pertussis vaccines (DTP) was maintained (Hungary, the former East Germany, Poland, and the USA) with countries where immunisation was disrupted by antivaccine movements (Sweden, Japan, UK, The Russian Federation, Ireland, Italy, the former West Germany, and Australia). Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements. Comparisons of neighbouring countries with high and low vaccine coverage further underscore the efficacy of these vaccines. Given the safety and cost-effectiveness of whole-cell pertussis vaccines, our study shows that, far from being obsolete, these vaccines continue to have an important role in global immunisation.

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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