Estimating the Population-Level Effectiveness of Vaccination Programs in the Netherlands

Maarten van Wijhe, Scott A. McDonald, Hester E. de Melker, Maarten J. Postma, Jacco Wallinga

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: There are few estimates of the effectiveness of long-standing vaccination programs in developed countries. To fill this gap, we investigate the direct and indirect effectiveness of childhood vaccination programs on mortality at the population level in the Netherlands.

Methods: We focused on three communicable infectious diseases, diphtheria, pertussis, and poliomyelitis, for which we expect both direct and indirect effects. As a negative control, we used tetanus, a noncommunicable infectious disease for which only direct effects are anticipated. Mortality data from 1903 to 2012 were obtained from Statistics Netherlands. Vaccination coverage data were obtained from various official reports. For the birth cohorts 1903 through 1975, all-cause and cause-specific childhood mortality burden was estimated using restricted mean lifetime survival methods, and a model was used to describe the prevaccination decline in burden. By projecting model results into the vaccination era, we obtained the expected burden without vaccination. Program effectiveness was estimated as the difference between observed and expected mortality burden.

Results: Each vaccination program showed a high overall effectiveness, increasing to nearly 100% within 10 birth cohorts. For diphtheria, 14.9% (95% uncertainty interval [UI] = 12.3%, 17.6%) of mortality burden averted by vaccination was due to indirect protection. For pertussis, this was 32.1% (95% UI = 31.3%, 32.8%). No indirect effects were observed for poliomyelitis or tetanus with −2.4% (UI = −16.7%, 7.1%) and 0.6% (UI = −17.9%, 10.7%), respectively.

Conclusion: Vaccination programs for diphtheria and pertussis showed substantial indirect effects, providing evidence for herd protection.
Original languageEnglish
JournalEpidemiology
Volume29
Issue number2
Pages (from-to)215-223
Number of pages9
ISSN1044-3983
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

Wijhe, Maarten van ; McDonald, Scott A. ; de Melker, Hester E. ; Postma, Maarten J. ; Wallinga, Jacco. / Estimating the Population-Level Effectiveness of Vaccination Programs in the Netherlands. In: Epidemiology. 2018 ; Vol. 29, No. 2. pp. 215-223.
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title = "Estimating the Population-Level Effectiveness of Vaccination Programs in the Netherlands",
abstract = "Background: There are few estimates of the effectiveness of long-standing vaccination programs in developed countries. To fill this gap, we investigate the direct and indirect effectiveness of childhood vaccination programs on mortality at the population level in the Netherlands.Methods: We focused on three communicable infectious diseases, diphtheria, pertussis, and poliomyelitis, for which we expect both direct and indirect effects. As a negative control, we used tetanus, a noncommunicable infectious disease for which only direct effects are anticipated. Mortality data from 1903 to 2012 were obtained from Statistics Netherlands. Vaccination coverage data were obtained from various official reports. For the birth cohorts 1903 through 1975, all-cause and cause-specific childhood mortality burden was estimated using restricted mean lifetime survival methods, and a model was used to describe the prevaccination decline in burden. By projecting model results into the vaccination era, we obtained the expected burden without vaccination. Program effectiveness was estimated as the difference between observed and expected mortality burden.Results: Each vaccination program showed a high overall effectiveness, increasing to nearly 100{\%} within 10 birth cohorts. For diphtheria, 14.9{\%} (95{\%} uncertainty interval [UI] = 12.3{\%}, 17.6{\%}) of mortality burden averted by vaccination was due to indirect protection. For pertussis, this was 32.1{\%} (95{\%} UI = 31.3{\%}, 32.8{\%}). No indirect effects were observed for poliomyelitis or tetanus with −2.4{\%} (UI = −16.7{\%}, 7.1{\%}) and 0.6{\%} (UI = −17.9{\%}, 10.7{\%}), respectively.Conclusion: Vaccination programs for diphtheria and pertussis showed substantial indirect effects, providing evidence for herd protection.",
author = "Wijhe, {Maarten van} and McDonald, {Scott A.} and {de Melker}, {Hester E.} and Postma, {Maarten J.} and Jacco Wallinga",
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Estimating the Population-Level Effectiveness of Vaccination Programs in the Netherlands. / Wijhe, Maarten van; McDonald, Scott A.; de Melker, Hester E.; Postma, Maarten J.; Wallinga, Jacco.

In: Epidemiology, Vol. 29, No. 2, 2018, p. 215-223.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Estimating the Population-Level Effectiveness of Vaccination Programs in the Netherlands

AU - Wijhe, Maarten van

AU - McDonald, Scott A.

AU - de Melker, Hester E.

AU - Postma, Maarten J.

AU - Wallinga, Jacco

PY - 2018

Y1 - 2018

N2 - Background: There are few estimates of the effectiveness of long-standing vaccination programs in developed countries. To fill this gap, we investigate the direct and indirect effectiveness of childhood vaccination programs on mortality at the population level in the Netherlands.Methods: We focused on three communicable infectious diseases, diphtheria, pertussis, and poliomyelitis, for which we expect both direct and indirect effects. As a negative control, we used tetanus, a noncommunicable infectious disease for which only direct effects are anticipated. Mortality data from 1903 to 2012 were obtained from Statistics Netherlands. Vaccination coverage data were obtained from various official reports. For the birth cohorts 1903 through 1975, all-cause and cause-specific childhood mortality burden was estimated using restricted mean lifetime survival methods, and a model was used to describe the prevaccination decline in burden. By projecting model results into the vaccination era, we obtained the expected burden without vaccination. Program effectiveness was estimated as the difference between observed and expected mortality burden.Results: Each vaccination program showed a high overall effectiveness, increasing to nearly 100% within 10 birth cohorts. For diphtheria, 14.9% (95% uncertainty interval [UI] = 12.3%, 17.6%) of mortality burden averted by vaccination was due to indirect protection. For pertussis, this was 32.1% (95% UI = 31.3%, 32.8%). No indirect effects were observed for poliomyelitis or tetanus with −2.4% (UI = −16.7%, 7.1%) and 0.6% (UI = −17.9%, 10.7%), respectively.Conclusion: Vaccination programs for diphtheria and pertussis showed substantial indirect effects, providing evidence for herd protection.

AB - Background: There are few estimates of the effectiveness of long-standing vaccination programs in developed countries. To fill this gap, we investigate the direct and indirect effectiveness of childhood vaccination programs on mortality at the population level in the Netherlands.Methods: We focused on three communicable infectious diseases, diphtheria, pertussis, and poliomyelitis, for which we expect both direct and indirect effects. As a negative control, we used tetanus, a noncommunicable infectious disease for which only direct effects are anticipated. Mortality data from 1903 to 2012 were obtained from Statistics Netherlands. Vaccination coverage data were obtained from various official reports. For the birth cohorts 1903 through 1975, all-cause and cause-specific childhood mortality burden was estimated using restricted mean lifetime survival methods, and a model was used to describe the prevaccination decline in burden. By projecting model results into the vaccination era, we obtained the expected burden without vaccination. Program effectiveness was estimated as the difference between observed and expected mortality burden.Results: Each vaccination program showed a high overall effectiveness, increasing to nearly 100% within 10 birth cohorts. For diphtheria, 14.9% (95% uncertainty interval [UI] = 12.3%, 17.6%) of mortality burden averted by vaccination was due to indirect protection. For pertussis, this was 32.1% (95% UI = 31.3%, 32.8%). No indirect effects were observed for poliomyelitis or tetanus with −2.4% (UI = −16.7%, 7.1%) and 0.6% (UI = −17.9%, 10.7%), respectively.Conclusion: Vaccination programs for diphtheria and pertussis showed substantial indirect effects, providing evidence for herd protection.

U2 - 10.1097/EDE.0000000000000778

DO - 10.1097/EDE.0000000000000778

M3 - Journal article

VL - 29

SP - 215

EP - 223

JO - Epidemiology

JF - Epidemiology

SN - 1044-3983

IS - 2

ER -