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1.
BMC Res Notes ; 14(1): 412, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758882

RESUMO

OBJECTIVE: This study aimed to determine the prevalence of A. baumannii in children aged less than 1 year admitted with a clinical diagnosis of whooping cough. RESULTS: A total of 225 nasopharyngeal samples from children under 1 year old hospitalized with clinical diagnosis of whooping cough were studied from January 2010 to July 2012. The presence of A. baumannii was detected in 20.89% (47/225) of the nasopharyngeal swab samples. Among the 47 patients with A. baumannii: 5 were diagnosed with A. baumannii monoinfection, 17 co-infection with bacteria, 7 co-infection with virus and 18 co-infection with bacteria + virus. It was observed that 51.6% (116/225) were children between 29 days and 3 months old, this same group had the highest overall prevalence with 53.3%. The most common co-infecting pathogens were Bordetella pertussis in 55.3%, Adenovirus in 42.6% and Mycoplasma pneumoniae in 23.4%.


Assuntos
Acinetobacter baumannii , Coqueluche , Bordetella pertussis , Criança , Pré-Escolar , Humanos , Lactente , Mycoplasma pneumoniae , Peru/epidemiologia , Coqueluche/diagnóstico , Coqueluche/epidemiologia
2.
Zhonghua Yi Xue Za Zhi ; 101(44): 3650-3654, 2021 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-34823282

RESUMO

Objective: To investigate the clinical epidemiological characteristics of children with pertussis and the infection of their close contacts. Methods: The clinical data of children with pertussis and the etiological detection results of close contacts in Shenzhen Children's Hospital from 2015 to 2018 were collected and descriptive epidemiological analysis was carried out. Results: The cases of pertussis from 2015 to 2018 were reported as 504, 425, 796 and 991 respectively, with a total of 2 716 cases. The most cases was in May in 2015 (72 cases), in August in 2016 and 2018 (68 cases and 144 cases), and in July in 2017 (115 cases). A total of 1 517 male and 1 199 female children were reported from 2015 to 2018, the ratio of male-to-female was 1.3∶1. The proportion of children under 1 year old was 79.7% (2 165/2 716), of which 74.4% (1 610/2 165) was less than 6 months old. Among the reported cases, 1 605 (59.1%) were treated as outpatients, aged M(Q1,Q3) 5 (3, 11) months, and 1 111 (40.9%) were hospitalized, aged 4 (2, 7) months. There were 876 outpatients (54.4%) and 734 inpatients (45.6%) under 6 months of age, 575 outpatients (63.5%) and 331 inpatients (36.5%) between 6 months and 2 years of age, and 154 outpatients (77.0%) and 46 inpatients (23.0%) with above 2 years old, respectively. There were statistically significant differences between the two treatment methods in different age groups (P<0.001). The average hospitalization time of inpatients under 6 months of age was (8.5±3.9) days, that of inpatients between 6 months and 2 years of age was (7.1±3.7) days, and that of inpatients above 2 years old was (6.8±3.3) days. The difference was statistically significant (P<0.001). The etiological test results of pertussis were collected from 617 close contacts of 270 reported cases, the positive detection rate of mothers was the highest (34.9%). Conclusions: From 2015 to 2018, the number of reported cases of pertussis in our hospital fluctuated and increased year by year, with high incidence in summer, mainly in children under 1 year old, and more males than females. Outpatient treatment was more than inpatient treatment, its age was obviously older than the latter. The younger the children, the higher the proportion of hospitalization, and with the increase of the age, the hospitalization time was obviously shortened. Among the close family contacts, the mother might be the main source of pertussis infection in children.


Assuntos
Coqueluche , Criança , Feminino , Hospitalização , Humanos , Incidência , Lactente , Pacientes Internados , Masculino , Estações do Ano , Coqueluche/epidemiologia
3.
Arch Razi Inst ; 76(3): 411-419, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824734

RESUMO

Despite the availability of a vaccine, pertussis is still a worldwide health problem. Outer membrane vesicles (OMVs) in gram-negative bacteria can stimulate the immune system due to several outer membrane proteins and are very good candidates in vaccine development. OMVs obtained from Bordetella pertussis contain several antigens, which are considered immunogenic, and could make them a potential candidate for vaccine production. The current study aimed to compare the current OMV extraction method (with ultracentrifuge) and a modified extraction method (without ultracentrifuge) and to evaluate the physicochemical properties as well as the expression of their main virulence factors. Vaccinal strain BP134 grown on Bordet Gengo agar were inoculated in Modified Stainer-Scholte medium for mass cultivation. OMVs were prepared using two different methods. They were then stained and examined with a transmission electron microscope. Protein contents were measured by the Bradford method, and then the protein profile was evaluated by SDS-PAGE. The presence of immunogenic antigens was detected by Western blotting. The size and shape of the OMVs obtained from the modified method without the use of ultracentrifuge were similar to the current method and had a size between 40 and 200 nm. The total protein yields of the OMV isolated using the current and modified methods were 800 and 600 µg/ml, respectively. Evaluating the protein profile of extracted OMVs showed the presence of different proteins. Finally, the presence of PTX, PRN, and FHA was observed in OMVs extracted from both methods. Comparison of the two OMV extraction methods showed that the obtained vesicles have a suitable and similar shape and size as well as the expression of three important pathogenic factors as immunogens. Despite the relatively low reduction in protein yield as the modified method does not require ultracentrifuge, this extraction method can be used as a suitable alternative for extracting the outer membrane vesicles from B. pertussis, especially in developing countries. It should be noted that further experiments including immunogenicity determination of OMVs obtained as vaccine candidates in animal models are required.


Assuntos
Doenças dos Roedores , Coqueluche , Animais , Western Blotting/veterinária , Bordetella pertussis , Camundongos , Camundongos Endogâmicos BALB C , Vacina contra Coqueluche , Coqueluche/veterinária
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(4): 638-642, 2021 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814443

RESUMO

Objective: To understand the seroepidemiological characteristics of pertussis in healthy population in Ningbo, and estimate the overall incidence of pertussis. Methods: A cross-sectional survey method was used in this study. A total of 1 206 healthy residents in 9 age groups were stratified randomly selected from 3 counties of Ningbo. Serum samples were collected from the subjects, and the pertussis toxin immunoglobulin G antibody (PT-IgG) levels were measured quantitatively by enzyme-linked immunosorbent assay (ELISA). Results: The mean PT-IgG seropositive rate in the subjects was 0.91% (95%CI:0.45%-1.63%) with a geometric mean titer (GMT) of 3.10 (95%CI:2.86-3.36) IU/ml. The seropositive rates ranged from 0.00% to 1.68%, and the GMTs ranged from 2.08 IU/ml to 5.28 IU/ml in 9 age groups. The incidence rate of pertussis was estimated to be 4 572.81 per 100 000 in age group ≥5 years (95%CI:1 807.30 per 100 000-9 348.12 per 100 000), and the peak of estimated incidence rates were found in age group 5- years (9 301.62 per 100 000, 95%CI:1 121.77 per 100 000-33 154.68 per 100 000) and age group ≥50 years old (8 967.02 per 100 000, 95%CI: 1 059.45 per 100 000-31 845.94 per 100 000). Conclusions: The actual incidence of pertussis was high in Ningbo in 2019. As a result of waning immunity after vaccination, pertussis can occur in adolescents and adults. The pertussis surveillance should be strengthened and the pertussis vaccination strategy should be improved.


Assuntos
Coqueluche , Adolescente , Adulto , Anticorpos Antibacterianos , Bordetella pertussis , Pré-Escolar , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Humanos , Pessoa de Meia-Idade , Toxina Pertussis , Estudos Soroepidemiológicos , Coqueluche/epidemiologia
5.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(5): 839-843, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34622602

RESUMO

Objective: To compare the clinical manifestations of pertussis in children of different ages and different immunization statuses in Wenzhou, and to explore the limitations of diagnostic criteria for pertussis. Methods: The clinical data of 288 children diagnosed with pertussis at Yuying Children's Hospital & the Second Affiliated Hospital of Wenzhou Medical University from October 2017 to December 2019 were retrospectively analyzed. The clinical characteristics of children of different ages and different immunization statuses were analyzed. Their clinical data were compared to relevant diagnostic criteria of pertussis in children of different ages according to the Recommendations for Diagnosis and Treatment of Chinese Children with Pertussis and the diagnosis conformity rate was analyzed. Results: Among the 288 children, 124 cases (43.06%) were 3 months old or younger, and 164 cases (288, 56.94%) were >3 months old. Among patients≤3 months of age, cyanosis, three-depression sign, face redness, dyspnea and peripheral blood lymphocyte ratio were significantly higher than those of patients >3 months of age. They also had higher incidence of pneumonia, higher proportion of developing severe pertussis, and longer stay at the hospital. All these findings showed statistically significant difference ( P<0.05). 83 children were fully immunized (receiving the full course of vaccination), and 205 were not fully immunized (not receiving the full course of vaccination or being unvaccinated). The proportion of children presenting cyanosis, shortness of breath, three depression sign and face redness in the incomplete immunization group was higher than that in the complete immunization group. In the incomplete immunization group, the proportion of lymphocytes was higher, the level of C-reactive protein (CRP) was lower, and the length of hospitalization was longer than those of the complete immunization group. All the differences were statistically significant ( P<0.05). Among patients aged ≤3 months, the conformity rate of diagnosis (112/114, 90.32%) upon admission was higher than that among patients aged >3 months (119/164, 72.56%). Among patients aged ≤3 months, 41.94% (52/124, while 54.03% (67/124) of the patients aged ≤3 months had WBC count <20×10 9 L -1. Conclusion: Pertussis in children ≤3 months of age in Wenzhou City were more serious, showing higher rate of diagnosis conforming to the recommended clinical diagnostic criteria than that in children >3 months old. The WBC threshold in routine blood test of ≤3 months old could be lowered appropriately and the current diagnostic criteria still needed improvement.


Assuntos
Coqueluche , Criança , Pré-Escolar , Hospitalização , Humanos , Incidência , Lactente , Estudos Retrospectivos , Vacinação , Coqueluche/diagnóstico , Coqueluche/epidemiologia
6.
BMC Infect Dis ; 21(1): 1057, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641796

RESUMO

BACKGROUND: Some children hospitalized for severe pertussis need intensive care; moreover, some children die because of deterioration alone or in combination with other complications. The purpose of this study was to identify the mortality risk factors among hospitalized children with severe pertussis. METHODS: This study evaluated the medical records of 144 hospitalized children with severe pertussis at the Guangzhou Women and Children's Medical Centre between January 2016 and December 2019. RESULTS: The median age of patients was 2 months (IQR 1-4 months), with 90.3% of the patients aged < 6 months and 56.9% of the patients aged < 3 months. A total of 38 patients were admitted to intensive care unit (ICU), 13 patients died, and the mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for 76.9% of the deaths. On the multivariate analysis, the independent risk factors for death were WBC > 70.0 × 109/L (odds ratio [OR], 230.66; 95% confidence interval [CI], 5.16-10,319.09 P = 0.005) and pulmonary hypertension (PH) (OR 323.29; 95% CI 16.01-6529.42; P < 0.001). CONCLUSION: Severe pertussis mainly occurred in children aged < 3 months. The mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for the majority of the deaths. We recommend the first dose of diphtheria-tetanus-pertussis (DTP) should be advanced to the age of 2 months or even 6 weeks. The presence of a WBC > 70.0 × 109/L and PH were the prognostic independent variables associated with death.


Assuntos
Coqueluche , Criança , Criança Hospitalizada , Cuidados Críticos , Feminino , Hospitalização , Humanos , Lactente , Fatores de Risco , Coqueluche/complicações , Coqueluche/epidemiologia
7.
Intern Med ; 60(19): 3081-3086, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34602522

RESUMO

Objective This study aimed to elucidate the effects of early macrolide administration on genetically confirmed pertussis-induced cough in adolescents and adults. Methods This single-center, retrospective cohort study examined the effects of the early administration of macrolides and antitussive agents on cough secondary to pertussis. We divided the patients into two groups based on the median duration from the beginning of the cough to the initiation of macrolide administration: early macrolide administration group (EMAG) and non-early macrolide administration group (NEMAG). The clinical improvement of cough was defined as maintaining a cough awareness score of ≤3 points for 3 consecutive days. Patients The medical records of 40 patients diagnosed with pertussis (≥12 years old) who were able to maintain a cough diary and received no other antibiotics aside from macrolides were included in the study. A diagnosis of pertussis was made using the loop-mediated isothermal amplification (LAMP) test. Results The EMAG (24 patients) showed a significantly shorter total cough period than the NEMAG [16 patients; 20.0 (95% confidence interval (CI), 16-28) vs. 30.5 (95% CI, 27-40) days; log-rank test, p=0.002]. There was no significant difference in the post-administration cough periods between the EMAG and NEMAG [11.0 (95% CI, 7-19) vs. 13.0 (95% CI, 5-23) days; log-rank test, p=0.232]. Antitussive agents did not affect the cough. Conclusion The early administration of macrolides, but not antitussive agents, is effective for treating pertussis. Therefore, macrolides should be administered as soon as possible for this disease.


Assuntos
Coqueluche , Adolescente , Adulto , Antibacterianos/uso terapêutico , Bordetella pertussis , Criança , Tosse/tratamento farmacológico , Humanos , Macrolídeos , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Estudos Retrospectivos , Coqueluche/tratamento farmacológico , Coqueluche/epidemiologia
8.
J Med Microbiol ; 70(10)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34668853

RESUMO

Whooping cough (pertussis) is a highly contagious respiratory bacterial infection caused by Bordetella pertussis and is an important cause of morbidity and mortality worldwide, particularly in infants. Bordetella parapertussis can cause a similar, but usually less severe pertussis-like disease. Bordetella pertussis has a number of virulence factors including adhesins and toxins which allow the organism to bind to ciliated epithelial cells in the upper respiratory tract and interfere with host clearance mechanisms. Typical symptoms of pertussis include paroxysmal cough with characteristic whoop and vomiting. Severe complications and deaths occur mostly in infants. Laboratory confirmation can be performed by isolation, detection of genomic DNA or specific antibodies. Childhood vaccination is safe, effective and remains the best control method available. Many countries have replaced whole-cell pertussis vaccines (wP) with acellular pertussis vaccines (aP). Waning protection following immunisation with aP is considered to be more rapid than that from wP. Deployed by resource-rich countries to date, maternal immunisation programmes have also demonstrated high efficacy in preventing hospitalisation and death in infants by passive immunisation through transplacental transfer of maternal antibodies.


Assuntos
Bordetella parapertussis/imunologia , Bordetella pertussis/imunologia , Vacina contra Coqueluche/imunologia , Fatores de Virulência/imunologia , Coqueluche/prevenção & controle , Humanos , Lactente
9.
BMC Health Serv Res ; 21(1): 1165, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706728

RESUMO

INTRODUCTION: The occurrence of the immunopreventable diseases in a population global reality. OBJECTIVE: To discriminate the direct costs of the hospitalizations from the immunopreventable diseases in the Unified Health System (SUS), in Brazil and their areas, between 2008 and 2018. METHODS: A population, observational, descriptive and retrospective study, with data from the information supplied by the DATASUS website, these data were collected during the 2019. RESULTS: It was identified 457,479 hospitalizations in the period; with a total of 2,450,870 days of hospital stay, with total costs of R$389,243,264.85. Only the disease mumps presented a growing tendency in whole areas; the chickenpox was decreasing; the illness whooping cough, yellow fever and tetanus were stationary in this period. CONCLUSIONS: The costs related to immunopreventable diseases were relevant in all the Brazil areas, with tendencies different between the geographic areas and between the several illnesses analysed.


Assuntos
Efeitos Psicossociais da Doença , Coqueluche , Brasil/epidemiologia , Hospitalização , Humanos , Estudos Retrospectivos
10.
Vaccine ; 39(44): 6545-6552, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34598822

RESUMO

BACKGROUND: Exploring factors that affect immune responses to immunizations in infants born to women immunized with tetanus-diphtheria-acellular-pertussis (Tdap) in pregnancy compared with unimmunized women is important in designing immunization programs. METHODS: Individual-participant data meta-analysis of 8 studies reporting post-immunization immunoglobulin G (IgG) levels to vaccine antigens in infants born to either women immunized with Tdap in pregnancy or unimmunized women, using mixed-effects models. RESULTS: In infants of Tdap-immunized women, two-fold higher levels of anti-pertussis toxin (PT) and anti-diphtheria-toxoid (DT) IgG pre-primary immunization were associated with 9% and 10% lower post-primary immunization levels, (geometric mean ratio [GMR], PT: 0.91; 95% CI, 0.88-0.95,n = 494, DT: 0.9; 0.87-0.93,n = 519). Timing of immunization in pregnancy did not affect post-primary immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-primary immunization anti-B. pertussis and anti-DT levels. In infants of Tdap-immunized women, two-fold higher levels of anti-PT and anti-filamentous haemagglutinin (FHA) IgG pre-primary immunization were associated with lower post-booster immunization levels, (GMR, PT: 0.91; 0.85-0.97,n = 224, FHA: 0.92; 0.85-0.99,n = 232). Timing of immunization in pregnancy did not affect post-booster immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-booster immunization anti-PT, anti-pertactin (PRN), anti-TT and anti-DT IgG levels. In infants of unimmunized women, two-fold higher IgG levels of some vaccine antigens pre-primary immunization were associated with 8-17% lower post-primary immunization levels (GMR, PT 0.92, 95% CI:0.88-0.97, n = 373; FHA:0.88, 95% CI:0.85-0.92,n = 378; PRN:0.84, 95% CI:0.81-0.88, n = 367; TT:0.88, 95% CI:0.83-0.93, n = 241; DT: 0.83, 95% CI:0.79-0.87,n = 278). Two-fold higher levels of anti-FHA IgG pre-primary immunization were associated with 8% lower post-booster immunization levels (GMR, 0.92; 95% CI: 0.86-0.99,n = 138). DISCUSSION: Increased IgG levels pre-primary immunization is associated with reduced post-primary and post-booster immunization levels for some antigens in infants of women immunized or unimmunized in pregnancy, but their clinical significance is uncertain.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche , Anticorpos Antibacterianos , Formação de Anticorpos , Vacina contra Difteria, Tétano e Coqueluche , Feminino , Humanos , Imunização Secundária , Lactente , Gravidez , Coqueluche/prevenção & controle
11.
Rev Chilena Infectol ; 38(3): 362-369, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34479293

RESUMO

BACKGROUND: Since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. AIM: To study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. METHODS: We conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. RESULTS: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). DISCUSSION: Most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Vacina contra Coqueluche , Gravidez , Gestantes , Uruguai , Vacinação , Coqueluche/prevenção & controle
12.
Indian Pediatr ; 58(8): 709-717, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34465657

RESUMO

OBJECTIVE: To estimate the disease and economic burden of pertussis amongst hospitalised infants in India. DESIGN: Multicentric hospital-based surveillance study. PARTICIPANTS: Hospitalised infants with clinical suspicion of pertussis based on predefined criteria. OUTCOME MEASURES: Proportion of infants with laboratory-confirmed pertussis, economic burden of pertussis amongst hospitalised infants. RESULTS: 693 clinically suspected infants were recruited of which 32 (4.62%) infants had laboratory-confirmed pertussis. Progressive cough with post-tussive emesis (50%) and pneumonia (34%) were the common clinical presentations; apnea in young infants was significantly associated with pertussis. Infants with pertussis were more likely to be younger (median age 102.5 days vs.157 days) and born preterm (42.9% vs 24.5%). Almost 30% infants with pertussis had not received vaccine for pertussis with 50% of these infants aged less than 2 months. Pertussis was associated with higher costs of hospitalisation, pharmacy and loss of working days by caregivers as compared to non-pertussis cases. CONCLUSIONS: Younger infants, those born preterm and those inadequately immunised against pertussis are at higher risk of pertussis infection. Timely childhood immunisation and introduction of maternal immunisation for pertussis can help in reducing the disease burden.


Assuntos
Coqueluche , Idoso de 80 Anos ou mais , Criança , Hospitalização , Hospitais , Humanos , Lactente , Recém-Nascido , Vacina contra Coqueluche , Atenção Terciária à Saúde , Vacinação , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
13.
Euro Surveill ; 26(37)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34533118

RESUMO

BackgroundBordetella pertussis is the main agent of whooping cough. Vaccination with acellular pertussis vaccines has been largely implemented in high-income countries. These vaccines contain 1 to 5 antigens: pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN) and/or fimbrial proteins (FIM2 and FIM3). Monitoring the emergence of B. pertussis isolates that might partially escape vaccine-induced immunity is an essential component of public health strategies to control whooping cough.AimWe aimed to investigate temporal trends of fimbriae serotypes and vaccine antigen-expression in B. pertussis over a 23-year period in France (1996-2018).MethodsIsolates (n = 2,280) were collected through hospital surveillance, capturing one third of hospitalised paediatric pertussis cases. We assayed PT, FHA and PRN production by Western blot (n = 1,428) and fimbriae production by serotyping (n = 1,058). Molecular events underlying antigen deficiency were investigated by genomic sequencing.ResultsThe proportion of PRN-deficient B. pertussis isolates has increased steadily from 0% (0/38) in 2003 to 48.4% (31/64) in 2018 (chi-squared test for trend, p < 0.0001), whereas only 5 PT-, 5 FHA- and 9 FIM-deficient isolates were found. Impairment of PRN production was predominantly due to IS481 insertion within the prn gene or a 22 kb genomic inversion involving the prn promoter sequence, indicative of convergent evolution. FIM2-expressing isolates have emerged since 2011 at the expense of FIM3.ConclusionsB. pertussis is evolving through the rapid increase of PRN-deficient isolates and a recent shift from FIM3 to FIM2 expression. Excluding PRN, the loss of vaccine antigen expression by circulating B. pertussis isolates is epidemiologically insignificant.


Assuntos
Bordetella pertussis , Coqueluche , Proteínas da Membrana Bacteriana Externa/genética , Bordetella pertussis/genética , Criança , França/epidemiologia , Humanos , Toxina Pertussis , Vacina contra Coqueluche , Fatores de Virulência de Bordetella/genética , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
14.
Bull World Health Organ ; 99(9): 627-639, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475600

RESUMO

Objective: To analyse subnational inequality in diphtheria-tetanus-pertussis (DTP) immunization dropout in 24 African countries using administrative data on receipt of the first and third vaccine doses (DTP1 and DTP3, respectively) collected by the Joint Reporting Process of the World Health Organization and the United Nations Children's Fund. Methods: Districts in each country were grouped into quintiles according to the proportion of children who dropped out between DTP1 and DTP3 (i.e. the dropout rate). We used six summary measures to quantify inequalities in dropout rates between districts and compared rates with national dropout rates and DTP1 and DTP3 immunization coverage. Findings: The median dropout rate across countries was 2.4% in quintiles with the lowest rate and 14.6% in quintiles with the highest rate. In eight countries, the difference between the highest and lowest quintiles was 14.9 percentage points or more. In most countries, underperforming districts in the quintile with the highest rate tended to lag disproportionately behind the others. This divergence was not evident from looking only at national dropout rates. Countries with the largest inequalities in absolute subnational dropout rate tended to have lower estimated national DTP1 and DTP3 immunization coverage. Conclusion: There were marked inequalities in DTP immunization dropout rates between districts in most countries studied. Monitoring dropout at the subnational level could help guide immunization interventions that address inequalities in underserved areas, thereby improving overall DTP3 coverage. The quality of administrative data should be improved to ensure accurate and timely assessment of geographical inequalities in immunization.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Difteria/prevenção & controle , Programas de Imunização/estatística & dados numéricos , Tétano/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Coqueluche/prevenção & controle , África , Criança , Feminino , Disparidades em Assistência à Saúde , Humanos , Imunização , Lactente , Masculino , Pobreza , Fatores Socioeconômicos
15.
BMC Infect Dis ; 21(1): 897, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479491

RESUMO

BACKGROUND: Maternal immunization confers passive immunity to the fetus by transplacental antibody transfer. Infants may be better protected against pertussis if the mother received a diphtheriae, tetanus and acellular pertussis (Tdap) vaccination in the second trimester of pregnancy compared to the third trimester. This study evaluates IgG antibody concentrations in term and preterm infants at birth and 2 months after birth after maternal Tdap-vaccination between 200 and 240 w of gestation vs third trimester Tdap-vaccination. Further aims are assessing the determinants that underlie acceptance of second trimester maternal Tdap-vaccination as well as the tolerability of vaccination. METHODS: This prospective cohort study consists of two parts. In the acceptance part, pregnant women complete a questionnaire on determinants that underlie acceptance of a second trimester Tdap-vaccination, which is offered subsequently between 200 and 240 w of gestation. Vaccinated women complete an additional questionnaire on vaccination tolerability. Vaccinated women may also participate in the immunogenicity part, in which blood is drawn from mother at delivery and from infant at birth and 2 months after birth. Women are also eligible for the immunogenicity part if they received a Tdap-vaccination between 200 and 240 w of gestation via the national immunization program and get hospitalized for an imminent preterm delivery. Blood sampling continues until 60 term and 60 preterm mother-infant-pairs have been included. Pertussis-specific IgG antibody concentrations are determined in serum using a fluorescent bead-based multiplex immunoassay. For term infants, non-inferiority in IgG antibody concentrations against pertussis toxin (anti-PT) will be assessed referred to a historical control group in which mothers were Tdap-vaccinated between 300 and 320 w of gestation. For preterm infants, non-inferiority of anti-PT IgG concentrations is referred to as 85% of infants having ≥ 20 international units/mL at 2 months after birth. DISCUSSION: This study investigates acceptance, tolerability and immunogenicity regarding maternal Tdap-immunization between 200 and 240 w of gestation. Its results provide insight into the effects of second trimester Tdap-vaccination on IgG antibody concentrations in term and preterm infants before primary infant vaccinations. Results on acceptance and tolerability guide antenatal care providers in communication with pregnant women and maintain the safety of second trimester Tdap-vaccination. TRIAL REGISTRATION: EU Clinical Trials Register, 2018-002976-41, retrospectively registered 24 July 2019, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-002976-41 .


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche , Anticorpos Antibacterianos , Estudos de Coortes , Feminino , Humanos , Imunização , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Vacinação , Coqueluche/prevenção & controle
16.
Eur J Obstet Gynecol Reprod Biol ; 265: 212-216, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34534737

RESUMO

OBJECTIVE: Pertussis is an important cause of morbidity and mortality in infants under two months of age and these high risk babies are dependent on maternally derived antibodies until completion of their first immunization series. This study aimed to evaluate the vaccine response of late preterm and term newborns as well as their mothers who underwent combined tetanus-diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy. STUDY DESIGN: A total of 70 pregnant women were administered Tdap vaccine (Boostrix®, GSK) between 27 and 33 gestational weeks of pregnancy. The IgG antibodies against pertussis toxin (PT) and filamentous hemagglutinin (FHA) in maternal blood before vaccination and in both maternal and umbilical cord blood after vaccination were evaluated using the in-house ELISA method. The geometric mean concentrations (GMC) and placental transfer ratios of antibodies were measured. RESULTS: Participants' with a mean age of 29.59 ± 4.70 years received Tdap vaccine at an average 28.6 ± 1.31 gestational weeks. Average pre and post vaccination levels of anti-PT IgG GMCs and anti-FHA IgG GMCs were 8.01 IU/ml vs 39.48 IU/ml (p = 0.001) and 122.24 IU/ml vs 183.97 IU/ml (p < 0.001), respectively. The anti-PT and anti-FHA IgG GMCs of cord blood after vaccination was 25.15 IU/ml and 118.77 IU/ml, respectively (p < 0.001 and p = 0.064). Placental transfer ratios of anti-PT ve anti-FHA IgG antibodies were detected as 0.65 and 0.62, respectively. CONCLUSION: Immunization of pregnant women with Tdap at the third trimester results in high maternal and infant antibody levels. Maternal immunization during each pregnancy seems to be the best strategy in revealing the highest maternal and infant antibodies and in narrowing the gap between birth and immune system maturation in infants. Pregnant women in our country should also get the Tdap vaccine during pregnancy especially in the early third trimester.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Tétano , Coqueluche , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Mães , Placenta , Gravidez , Toxoides , Turquia , Coqueluche/prevenção & controle , Adulto Jovem
17.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493555

RESUMO

We report a case of a previously fit woman who presented at 26 weeks into her fourth pregnancy with a dry cough. Following a nasopharyngeal swab, she was diagnosed with a pertussis infection, and treated with antibiotics. A chest X-ray showed right atrial dilatation and an echocardiogram was scheduled outpatient. However, after re-presenting with worsening cough and dyspnoea, an inpatient echocardiogram was performed which suggested elevated pulmonary pressures with significant tricuspid regurgitation, as confirmed by subsequent cardiac catheterisation. She had an elective caesarean section at 34 weeks and underwent repeat right heart catheterisation which revealed persistent, and likely pre-existing, pulmonary arterial hypertension. This case highlights the importance of thorough assessment of non-obstetric symptoms in pregnancy in formulating alternative differentials, even after a diagnosis has been made, to prevent potentially life-threatening conditions from being missed. It also shows that although often associated, respiratory and cardiac causes may coexist separately.


Assuntos
Hipertensão Pulmonar , Insuficiência da Valva Tricúspide , Coqueluche , Cesárea , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Gravidez , Coqueluche/complicações , Coqueluche/diagnóstico , Coqueluche/tratamento farmacológico
18.
Vaccine ; 39(40): 5839-5844, 2021 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-34465476

RESUMO

BACKGROUND: Low vaccination rates and under-detection of pertussis infections in adolescents and young adults have an impact on the transmission of pertussis to infants. In this study, the proportion of adolescents and young adults with IgG antibodies against B. pertussis antigens, representing recent infection or vaccination, was estimated in a population-based probabilistic survey in Mexico. METHODS: Sera and data from 1,581 subjects, including 1,102 adolescents and 479 young adults (10-19 and 20-25 years old, respectively) randomly selected from Mexico's 2012 National Health and Nutrition Survey, were analyzed. IgG antibodies against pertussis toxin (PT) were measured with the CDC/FDA ELISA. A subset of 234 samples was additionally tested with Bp-IgG PT ELISA kit (EUROIMMUN AG, Lubeck, Germany). Threshold values from corresponding test kits were used to identify recent infection or vaccination. RESULTS: Overall anti-PT IgG seroprevalence was 3.9% (95% CI: 2.3-6.3); 3.1% (95% CI: 1.9-5.0) in adolescents, and 4.9% (95% CI: 2.2-11) in young adults. Seroprevalence did not significantly vary by sex, socioeconomic status, region or rural/urban location. Compared to the CDC/FDA ELISA, the EUROIMMUN test showed a 76% sensitivity and 88% specificity. The weighted estimates represent a considerable burden of recent infection in adolescents and young adults; however, most adolescents and adults were seronegative and, therefore, susceptible to pertussis infection. CONCLUSION: Since booster vaccination to B. pertussis after toddlerhood is not recommended in the Mexican national policy, anti-PT IgG seropositivity may be reasonably attributed to recent infection. Assessing pertussis seroprevalence requires careful consideration of the diagnostic test threshold interpretation and epidemiological model used.


Assuntos
Bordetella pertussis , Coqueluche , Adolescente , Humanos , Lactente , México/epidemiologia , Inquéritos Nutricionais , Estudos Soroepidemiológicos , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Adulto Jovem
19.
Vaccine ; 39(41): 6144-6150, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34493409

RESUMO

PURPOSE: Waning of immunity after vaccination with the acellular Pertussis (aP) vaccine has been proposed as one of the main reasons for pertussis resurgence in the US. In this study, we estimated time-varying vaccine effectiveness after 5 doses of aP vaccine. METHODS: We conducted a retrospective cohort study among children 5-9 years old (born between 2008 and 2012) living in King County, Washington, USA, who participated in the Washington State Immunization Information System. We estimated time-varying vaccine effectiveness after 5 doses of aP using smoothed scaled Schoenfeld residuals obtained from fitting Cox proportional hazards models to the data as well as piecewise constant Poisson regression. RESULTS: There were 55 pertussis cases in this cohort, of whom 22 (40%) were fully-vaccinated and 33 (60%) were under-vaccinated. Vaccine effectiveness (VE) remained high for up to 42 months after the fifth dose (VE(t) = 89%; 95% CI: 64%, 97%) as estimated using survival analysis methods and up to 4 years (VE(t) = 93%; 95% CI: 67%, 98%) as estimated using Poisson regression. CONCLUSION: We did not find evidence for waning of vaccine effectiveness for up to four years after 5 doses of aP among 5 -9 years old children in King County, WA.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche , Criança , Pré-Escolar , Humanos , Vacina contra Coqueluche , Estudos Retrospectivos , Vacinação , Washington/epidemiologia , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
20.
Vaccine ; 39(41): 6067-6073, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34511302

RESUMO

BACKGROUND: In the context of reported resurgence of pertussis in the last decade, researchers hypothesized that acellular (aP) pertussis vaccines elicit a shorter-lived protection compared to whole-cell (wP) pertussis vaccines. However, in the studies seeking to demonstrate this hypothesis, exposure to each vaccine type was not concurrent, and contradictory epidemiologic modeling questioned its validity. The context of pertussis vaccination history in Poland, with both vaccine types used concurrently in comparable proportions, provided an opportunity to investigate this hypothesis. We sought to compare waning of protection by primary series vaccine type by measuring anti-pertussis toxin antibody concentrations as proxy for recent infection. MATERIALS AND METHODS: Serological samples from 2,745 children and adolescents aged ≥5 years and <16 years and with completed 5-dose pertussis vaccination series were tested by ELISA for pertussis toxin (PT) antibodies. Participants were stratified by type of priming vaccine (wP or aP). Vaccination timeliness and priming-specific trends in anti-PT antibody levels by time since last vaccine dose were analyzed. RESULTS: A total of 1,161 (42.5%) children received wP vaccines, and 1,314 (48.1%) received aP vaccines for their primary series and toddler booster. Overall, 53.57% of the subjects received doses 2-4 in a timely manner, while only 41.52% received all 5 doses at the recommended intervals. Using GMCs or seropositivity measures, both priming groups showed a re-increase in anti-PT antibody levels signing infection in recent years from 8 years after the school-entry booster onward. Comparisons did not show any significant differences between the two groups in the timing or intensity of this re-increase. CONCLUSION: Our results clearly confirm that vaccine-elicited immunity against pertussis wanes among adolescents even after a complete infant, toddler and school-entry vaccination series. The timing and intensity of the waning of protection appear similar with whole-cell as with acellular pertussis vaccines.


Assuntos
Bordetella pertussis , Coqueluche , Adolescente , Anticorpos Antibacterianos , Humanos , Imunização Secundária , Vacina contra Coqueluche , Polônia , Vacinas Acelulares , Coqueluche/prevenção & controle
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