American Journal of Epidemiology Vol. 155, No. 10 : 891-896
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Epidemiology of Pertussis in a West African Community before and after Introduction of a Widespread Vaccination Program
1 Unité de Recherche sur les Maladies Infectieuses et Parasitaires, Institut de Recherche pour le Développement, Dakar, Senegal.
2 National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA.
3 Unité INSERM 330, Université Victor Segalen Bordeaux 2, Bordeaux, France.
4 Unité de Recherche sur les Maladies Infectieuses et Parasitaires, Institut de Recherche pour le Développement, Montpellier, France.
The control of pertussis remains a worldwide concern. Little has been documented about its epidemiology in Africa. The authors have studied pertussis in a prospective cohort of children in a rural West African community over a 13-year period comprising time before and after introduction of a vaccination program. Children under age 15 years who were residents of the Niakhar study area in Senegal were followed prospectively between January 1984 and December 1996 for the occurrence of pertussis. Morbidity and mortality rates were extremely high before the launch of immunization. Crude incidence was 183 per 1,000 child-years at risk under age 5 years, with a 2.8% case-fatality rate. After the introduction of the vaccination program, overall incidence dropped rapidly and dramatically—by 27% after 3 years and 46% after 6 years. The decline in incidence involved all age groups but was most substantial in the group under age 5 years and was particularly pronounced in unvaccinated infants. The median age of acquisition of the disease rose steadily with population vaccine coverage. This study shows the tremendous magnitude of the disease burden in children and the rapid decline after vaccination, and it suggests a strong herd-immunity effect.
mortality; population surveillance; vaccination; whooping cough
Abbreviations: DTPwc-IPV, diphtheria and tetanus toxoids—whole-cell pertussis vaccine—inactivated poliomyelitis vaccine; EPI, Expanded Programme on Immunization
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