Friday, June 22, 2012

NSW Extends Free Pertussis Vaccine for New Mothers

About a month ago, Phil Plait wrote about the Victoria, Australia, Ministry of Health's decision to end a program that provides pertussis vaccine boosters for free to carers of newborns in an effort to protect infants from what can be, for them, a deadly disease. The reason cited was that the program did not "get the clinical result required". This move by the state of Victoria led Toni McCaffery, whose infant daughter, Dana, was killed by pertussis, to create a petition to the Premiers and Health Ministers of Australia to ask the states to continue to provide free pertussis vaccines to adults caring for newborns to help cocoon these infants until they are old enough to be vaccinated.

Well, the state of New South Wales has listened, to a degree.

The NSW Ministry of Health instituted a program in 2009 to provide free pertussis vaccines to adults who cared for newborns in response to a major outbreak of whooping cough that affected most of Australia. The cocooning strategy is relatively new, with little research on how effective it is at protecting infants not yet old enough to be vaccinated. Despite this lack of evidence, over recent years it has become readily apparent that adults are common vectors of the disease; symptoms in adults are generally milder and may be mistaken for nothing more than a very persistent cough or cold. It therefore made sense to try to immunize those adults closest to newborns and who would be most likely to spread the disease to this vulnerable population.

Extended several times, the program was set to end in NSW on June 30 of this year. A combination of factors influenced this decision: reports of new cases of pertussis have been waning compared to last year (though around 500 new cases are still being reported each month); there was no evidence submitted by vaccine manufacturers that immunizing adults was effective for protecting infants (note, that this is not the same as "evidence that the program is ineffective"); and, budgetary considerations required a closer look at how government assets were used.

Whereas the free boosters for parents program is set to end on June 30, 2012 in Victoria (PDF), with nothing to replace it, NSW is planning to continue offering free boosters to mothers of newborns within the first two weeks after giving birth. It looks like new fathers, grandparents and other adults, as well as mothers after the two-week period, will need to pay out of pocket if they want the pertussis booster. This program will, according to the news release from the health ministry, "continue until more definitive evidence becomes available about the effectiveness of vaccinating adults to protect new babies".

I'm glad to hear that the NSW government listened to parents and health care professionals, refocusing their immunization program for caregivers of newborns to mothers while actively evaluating the effectiveness of the program, rather than, like the state of Victoria, simply dispensing with the program for lack of evidence either way. My only concern is that their study of the program over the coming months or years may not be able to adequately account for possible reduced booster uptake among adult caregivers other than the mother. If these adults do not receive a booster in a timely fashion due to the cost of the vaccine, the overall risk to the infants will be greater. Education of expecting parents and their extended families is vital to protecting those who cannot protect themselves from a deadly disease.

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