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The Global Pertussis Initiative: Process Overview

Plotkin, Stanley MD*†

The Pediatric Infectious Disease Journal: May 2005 - Volume 24 - Issue 5 - p S7-S9
doi: 10.1097/01.inf.0000160707.44131.ae
Introductory Articles

In 2001, the Global Pertussis Initiative was established as a scientific forum to analyze the status of pertussis globally and to evaluate various immunization strategies to improve disease control. Thirty-seven multidisciplinary experts from 17 countries participated.

The initiative was conducted in 3 stages: assessment of the international epidemiology, diagnosis, health and economic burden, and prevention and treatment of pertussis; evaluation and prioritization of 7 immunization strategies to address the problems; and identification of solutions to surmount potential barriers to the implementation of these strategies. A health-economic model, created for the Initiative, analyzed the cost-effectiveness of the selected immunization strategies. Discussion, debate, and consensus were facilitated via a roundtable meeting, teleconferences and use of a closed, interactive website, allowing the participants to share data, knowledge, experience, and opinion. This article describes the processes undertaken to conduct the Initiative.

From the *University of Pennsylvania, Philadelphia, PA; and †sanofi pasteur, Doylestown, PA

Address for correspondence: Stanley Plotkin, MD, sanofi pasteur, 4650 Wismer Road, Doylestown, PA 18901. E-mail Stanley.Plotkin@sanofipasteur.com.

The Global Pertussis Initiative (GPI) was established in 2001 to assess the problems posed by pertussis around the world and evaluate potential immunization strategies beyond infancy to improve disease control.

The GPI comprised 37 experts in different aspects of pertussis. The group was divided into 3 regional subgroups, North America, Europe and International, and was overseen by a 5-person Steering Committee (Table 1).

TABLE 1

TABLE 1

The Initiative was undertaken in 3 stages (Fig. 1). A closed GPI Roundtable Meeting in June 2002 was a key part of the overall process.

FIGURE 1.

FIGURE 1.

At each of the 3 stages, draft documents were generated based on standard frameworks developed by the Steering Committee. These statements were posted on a dedicated, password-protected Internet site, enabling other participants to provide additional information and comment on the statements, which were revised accordingly. After a final review by the participants, a vote was taken to establish the level of agreement with each statement and to comment on the quality of the supporting evidence.

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OBJECTIVES OF THE GLOBAL PERTUSSIS INITIATIVE

The increasing concern that pertussis is a growing health problem that could be addressed through new or improved immunization strategies was the fundamental issue that resulted in the formation of the GPI. The objectives of the Initiative are outlined in Table 2.

TABLE 2

TABLE 2

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STEERING COMMITTEE

A Chairman oversaw the Initiative. In addition, each of the 3 regional subgroups, North America, Europe and International, had a representative on the Steering Committee, and a fourth member represented the health economists and developed a mathematical model to analyze the potential cost effectiveness of immunization strategies beyond the currently recommended schedules (Table 1).1

The Chairman and regional Steering Committee members were appointed to take responsibility for driving the process at the global and regional levels, respectively.

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REGIONS AND REGIONAL REPRESENTATIVES

The Initiative participants were divided into 3 regions: North America, Europe, and International. Each of the 3 regions undertook the second and third stages of the initiative separately (Fig. 1).

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WEBSITE

A closed, password-protected website was used to simplify the exchange of opinions and ideas. The reasons for using the website were to: facilitate ongoing exchange of ideas; provide an archived record of discussions; assist the provision and exchange of data and reference sources; allow voting on level of agreement; limit potential communication barriers (eg, time zones, language); and facilitate time management for participants.

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SCIENTIFIC SECRETARIAT

PAREXEL, a medical education company, was appointed to coordinate the activities of the GPI as the scientific secretariat. It was responsible for all logistic organization of the process, as well as maintaining the Internet site.

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STAGE 1: EVALUATION OF THE GLOBAL PROBLEMS POSED BY BORDETELLA PERTUSSIS

The Initiative participants initially embarked on a comprehensive review of the international literature on pertussis. The review was divided into 17 topics that were used for reference during stages 2 and 3. The results of this literature review are summarized in this supplement.2–10

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STAGE 2: ASSESSMENT AND PROPOSAL OF POTENTIAL IMMUNIZATION STRATEGIES

Having evaluated the scale of the problems associated with pertussis worldwide, the Steering Committee developed a list of potential immunization strategies to address these problems.

The resulting draft regional strategy summaries formed the basis for the Initiative's proposed strategies, which are discussed in more detail in this supplement.11–14

All GPI participants were invited to a Roundtable Meeting in Paris, France, on June 1–2, 2002. This closed meeting was part of the overall process and was convened to meet the following objectives: to share global pertussis expertise; to consolidate and conclude findings of the web-based activities, including definition of the problem presented by pertussis and choice of strategy (or strategies) for each region; to explore potential barriers to implementation of the proposed strategies; to define areas of agreement and dissension.

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STAGE 3: FORMULATION OF SOLUTIONS TO POTENTIAL IMPLEMENTATION BARRIERS

Based on the proposed immunization strategies chosen for each region and the discussions surrounding the potential barriers to implementation of these strategies, each of the 3 regions compiled an implementation action plan.

The GPI participants also developed a research agenda of areas where further clarification would assist in the development of optimized disease control programs. This and the implementation action plans are discussed further in this supplement.12–14

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CONCLUSION

Based on a thorough literature review and a series of structured discussions among the GPI participants, a series of documents was produced, which have been used as the primary source material in the preparation of the papers in this supplement. The supplement papers were drafted by the GPI participants and were reviewed via the website by all 37 participants. The amended papers were approved by the entire GPI membership before submission for publication. An additional synopsis of the GPI was prepared in the same way and provides a summary of the key outcomes of the Initiative.15

Australia, Canada, France and Germany have already implemented, or are in the process of implementing, some of the immunization schedules proposed by the GPI.12–14 By monitoring the changing epidemiology of pertussis in these countries, the effectiveness of the new programs can be assessed; this should facilitate the expansion of immunization schedules in other countries and thus significantly improve pertussis disease control.

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REFERENCES

1. Caro J, Getsios D, El-Hadi W, Payne K, O'Brien JA. Pertussis immunization of adolescents in the United States: an economic evaluation. Pediatr Infect Dis J. 2005;24(suppl):S75–S82.
2. Caro J, Getsios D, Payne K, Annemans L, Neumann PJ, Trindade E. Economic burden of pertussis and the impact of immunization. Pediatr Infect Dis J. 2005;24(suppl):S48–S54.
3. Cherry JD, Grimprel E, Guiso N, Heininger U, Mertsola J. Defining pertussis epidemiology: clinical, microbiologic and serologic perspectives. Pediatr Infect Dis J. 2005;24(suppl):S25–S34.
4. Greenberg D, Wirsing von König CH, Heininger U. Health burden of pertussis in infants and children. Pediatr Infect Dis J. 2005;24(suppl):S39–S43.
5. Rothstein E, Edwards K. Health burden of pertussis in adolescents and adults. Pediatr Infect Dis J. 2005;24(suppl):S44–S47.
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7. Tan T, Trindade E, Skowronski D. Epidemiology of pertussis. Pediatr Infect Dis J. 2005;24(suppl):S10–S19.
8. Van Rie A, Wendelboe AM, Englund JA. Role of maternal pertussis antibodies in infants. Pediatr Infect Dis J. 2005;24(suppl):S62–S65.
9. Wendelboe AM, Van Rie A, Salmaso S, Englund JA. Duration of immunity against pertussis after natural infection or vaccination. Pediatr Infect Dis J. 2005;24(suppl):S58–S61.
10. Wirsing von König CH. Use of antibiotics in the prevention and treatment of pertussis. Pediatr Infect Dis J. 2005A;24(suppl):S66–S68.
11. Forsyth K, Tan T, Wirsing von König CH, Caro J, Plotkin S. Potential strategies to reduce the burden of pertussis. Pediatr Infect Dis J. 2005;24(suppl):S69–S74.
12. Tan TQ, Halperin S, Cherry JD, et al. Pertussis immunization in the Global Pertussis Initiative North American region: recommended strategies and implementation considerations. Pediatr Infect Dis J. 2005;24(suppl):S83–S86.
13. Wirsing von König CH, Campins-Marti M, Finn A, Guiso N, Mertsola J, Liese J. Pertussis immunization in the Global Pertussis Initiative European region: recommended strategies and implementation considerations. Pediatr Infect Dis J. 2005;24(suppl):S87–S92.
14. Forsyth K, Nagai M, Lepetic A, Trindade E. Pertussis immunization in the Global Pertussis Initiative international region: recommended strategies and implementation considerations. Pediatr Infect Dis J. 2005;24(suppl):S93–S97.
15. Forsyth K, Campins-Marti M, Caro J, et al. New pertussis vaccination strategies beyond infancy: recommendations by the Global Pertussis Initiative. Clin Infect Dis. 2004;39:1802–1809.
Keywords:

pertussis; review

© 2005 Lippincott Williams & Wilkins, Inc.