Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.518
Filtrar
1.
Ig Sanita Pubbl ; 75(4): 317-325, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31887737

RESUMO

The possible risk of hyperimmunization after tetanus vaccination is currently discussed after the National Vaccine Prevention Plan 2017-2019 confirmed the recommendation of a booster dose every ten years. Due to the ubiquitous nature of tetanus spores and the inability to obtain herd-immunity through vaccination, efforts to reduce the incidence of tetanus aim at eliminating the disease. The only way to prevent infection is vaccination followed by recommended periodic booster doses. Between 2012 and 2016, Italy notified 45% (252/564) of all cases reported by the 26 EU Member States, most of them in the over 65 age group, generally women in the rural areas. The recommendation of the antipertussis vaccine, combined with anti-tetanus, in pregnancy and the indications for antitetanic prophylaxis by vaccination or specific immunoglobulins in emergency setting, gives rise to doubts about the risk of hyperimmunization. Studies generally agree on the safety of diphtheria-tetanus-pertussis combined vaccines during the third trimester of pregnancy, and the time elapsed since the previous tetanus vaccination seems not to be related to significant differences in the incidence of adverse events or obstetrical complications. In the emergency wards, given the relatively high incidence of tetanus in Italy, the risk/benefit ratio often leads to prefer vaccination to no-intervention. The administration of tetanus immunoglobulins in subjects not vaccinated in the last 10 years seems justified by the epidemiology of tetanus in Italy.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Difteria/prevenção & controle , Imunização Secundária/efeitos adversos , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Anticorpos Antibacterianos/imunologia , Difteria/imunologia , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Itália , Tétano/imunologia , Coqueluche/imunologia
2.
Pan Afr Med J ; 34: 65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762929

RESUMO

Introduction: On April 17/2017 Janamora district, Amhara regional state health officials reported an increasing number of people with a cough. The objectives of this study was to investigate the outbreak, describe risk factors and implement control measures. Methods: We conducted a community based unmatched 1:1 case-control study April 22-May 10, 2017. We used a probable case definition (≥2 weeks cough with vomiting, apnea, or inspiratory whoop) to identify suspected pertussis cases. Neighbors of cases were considered as controls. We conducted a door-to-door active case search and reviewed medical records, assessed vaccination status by parental interview or vaccination card. We implemented multivariable logistic regression to identify independent factors associated with the outbreak. Results: We investigated 60 cases and 60 controls. Most (68.3%) of the cases were under the age of 15. The majority (86.6%) of pertussis suspected cases, and 83.4% controls had not received any pertussis vaccine. The overall attack rate was 0.13% and the case fatality rate was 3.3%. The age-specific attack rate for under-five children was 0.33%. Females were more likely to have pertussis (AOR: 2.91; 95% CI: 1.17-7.22), contact with pertussis suspected person (AOR: 6.29; 95% CI: 2.53-15.62) and living in a relatively poorly ventilated house (AOR: 3.01; 95% CI: 1.17-7.70) were also significant risk factors of pertussis. Conclusion: Weak supplementary immunization activities might have contributed to the outbreak. Treating household contacts and integration of diagnostic laboratory test of pertussis into the local health system is of paramount importance to detect outbreaks early on.


Assuntos
Surtos de Doenças , Vacina contra Coqueluche/administração & dosagem , Vacinação/estatística & dados numéricos , Coqueluche/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Coqueluche/prevenção & controle , Adulto Jovem
3.
Emerg Microbes Infect ; 8(1): 1711-1720, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31769735

RESUMO

Among the factors associated with the resurgence of whooping cough, special emphasis has been given to pathogen adaptation after the introduction of the acellular vaccine (ACV). To assess the impact of the vaccine transition strategy from whole-cell vaccine (WCV) to ACV on population dynamics of Bordetella pertussis in Barcelona (Spain), we studied 339 isolates collected from 1986 to 2015 by PFGE and multi-locus variable-number tandem repeat analysis (MLVA). Additionally, allelic variants for the pertussis toxin and its promoter, pertactin, type 3 fimbriae and fimbrial serotyping were assessed to determine its antigenic drift. A shift was observed in the B. pertussis population as well as in its antigenic profile concurrently with the introduction of ACV in Barcelona. Four out of the five most prevalent PFGE profiles were replaced by new profiles following the ACV introduction. MLVA type 27 was the dominant genotype, and its frequency increased from 25% to 79.3% after WCV replacement. Antigen typing demonstrated the emergence of prn2, ptxP3, fim3-2 and a shift from the fimbriae 3 to the fimbriae 2 serotypes after the ACV introduction. Our findings support the presence of population and antigenic dynamic changes in B. pertussis likely driven by the introduction of ACV.


Assuntos
Variação Antigênica , Vacinas Bacterianas/imunologia , Bordetella pertussis/imunologia , Coqueluche/microbiologia , Proteínas da Membrana Bacteriana Externa/administração & dosagem , Proteínas da Membrana Bacteriana Externa/genética , Proteínas da Membrana Bacteriana Externa/imunologia , Vacinas Bacterianas/administração & dosagem , Vacinas Bacterianas/genética , Bordetella pertussis/genética , Genótipo , Humanos , Repetições Minissatélites , Dinâmica Populacional , Espanha , Fatores de Virulência de Bordetella/administração & dosagem , Fatores de Virulência de Bordetella/genética , Fatores de Virulência de Bordetella/imunologia , Coqueluche/prevenção & controle
4.
BMC Infect Dis ; 19(1): 919, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664950

RESUMO

BACKGROUND: Pertussis causes severe disease in young unvaccinated infants, with preterms potentially at highest risk. We studied pertussis in hospitalized infants as related to gestational age (GA) and vaccination history. METHODS: Medical record data of 0-2y old patients hospitalized for pertussis during 2005-2014 were linked to vaccination data. Multivariable logistic regression was used to study the association between GA and vaccination history on the clinical disease course. We compared vaccine effectiveness (VE) against hospitalization for pertussis between term and preterm infants (i.e., <37w GA) using the screening method as developed by Farrington. RESULTS: Of 1187 records, medical data from 676 were retrieved. Of these, 12% concerned preterms, whereas they are 8% of Dutch birth cohorts. Median age at admission was 3 m for preterms and 2 m for terms (p < 0.001). Preterms more often had received pertussis vaccination (62% vs 44%; p = 0.01) and more often had coinfections (37% vs 21%; p = 0.01). Preterms tended more often to have complications, to require artificial respiration or to need admittance to the intensive care unit (ICU). Preterms had longer ICU stays (15d vs 9d; p = 0.004). Vaccinated preterms and terms had a lower median length of hospital stay and lower crude risks of apneas and the need for artificial respiration, additional oxygen, and ICU admittance than those not vaccinated. After adjustment for presence of coinfections and age at admittance, these differences were not significant, except the lower need of oxygen treatment in vaccinated terms. Effectiveness of the first vaccination against pertussis hospitalizations was 95% (95% CI 93-96%) and 73% (95% CI 20-91%) in terms and preterms, respectively. Effectiveness of the second dose of the primary vaccination series was comparable in both groups (86 and 99%, respectively). CONCLUSIONS: Infants hospitalized for pertussis suffer from severe disease. Preterms were overrepresented, with higher need for intensive treatment and less VE of first vaccination. These findings stress the need for alternative prevention, in particular prenatal vaccination of mothers, to reduce pertussis in both groups.


Assuntos
Criança Hospitalizada , Recém-Nascido Prematuro , Vacina contra Coqueluche/uso terapêutico , Coqueluche/prevenção & controle , Coqueluche/terapia , Apneia/etiologia , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Hospitalização , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Modelos Logísticos , Masculino , Mães , Países Baixos , Vacina contra Coqueluche/efeitos adversos , Gravidez , Respiração Artificial , Estudos Retrospectivos , Resultado do Tratamento , Vacinação/efeitos adversos
5.
Praxis (Bern 1994) ; 108(13): 859-862, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31571544

RESUMO

Vaccination During Pregnancy Abstract. Vaccinations administered to women during pregnancy can provide protection against serious infectious diseases for the mother, for the newborn, or both. Two vaccines are routinely recommended during pregnancy: Influenza and Pertussis. While the influenza vaccine protects mainly the pregnant mother, who is at an increased risk for severe affection, the pertussis vaccine is an effective protection to infants who are at particularly high risk of pertussis complications and mortality in the first three months of life.


Assuntos
Vacinas contra Influenza , Vacina contra Coqueluche , Complicações Infecciosas na Gravidez , Coqueluche , Feminino , Humanos , Lactente , Recém-Nascido , Vacinas contra Influenza/administração & dosagem , Vacina contra Coqueluche/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Vacinação , Coqueluche/prevenção & controle
6.
MMWR Morb Mortal Wkly Rep ; 68(40): 885-892, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600186

RESUMO

INTRODUCTION: Vaccinating pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can reduce influenza and pertussis risk for themselves and their infants. METHODS: Surveillance data were analyzed to ascertain influenza-associated hospitalization among pregnant women and infant hospitalization and death associated with influenza and pertussis. An Internet panel survey was conducted during March 27-April 8, 2019, among women aged 18-49 years who reported being pregnant any time since August 1, 2018. Influenza vaccination before or during pregnancy was assessed among respondents with known influenza vaccination status who were pregnant any time during October 2018-January 2019 (2,097). Tdap receipt during pregnancy was assessed among respondents with known Tdap status who reported a live birth by their survey date (817). RESULTS: From 2010-11 to 2017-18, pregnant women accounted for 24%-34% of influenza-associated hospitalizations per season among females aged 15-44 years. From 2010 to 2017, a total of 3,928 pertussis-related hospitalizations were reported among infants aged <2 months (annual range = 262-743). Maternal influenza and Tdap vaccination coverage rates reported as of April 2019 were 53.7% and 54.9%, respectively. Among women whose health care providers offered vaccination or provided referrals, 65.7% received influenza vaccine and 70.5% received Tdap. The most commonly reported reasons for nonvaccination were believing the vaccine is not effective (influenza; 17.6%) and not knowing that vaccination is needed during each pregnancy (Tdap; 37.9%), followed by safety concerns for the infant (influenza =15.9%; Tdap = 17.1%). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Many pregnant women do not receive the vaccines recommended to protect themselves and their infants, even when vaccination is offered. CDC and provider organizations' resources are available to help providers convey strong, specific recommendations for influenza and Tdap vaccination that are responsive to pregnant women's concerns.


Assuntos
Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adolescente , Adulto , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Lactente , Recém-Nascido , Vacinas contra Influenza/administração & dosagem , Pessoa de Meia-Idade , Gravidez , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos , Adulto Jovem
7.
BMC Infect Dis ; 19(1): 805, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521116

RESUMO

BACKGROUND: Early Childhood Education Centre (ECEC) staff are strongly recommended to receive several immunizations including influenza and pertussis. However, evidence regarding the uptake is either old or lacking across all Australian States/Territories. This study aimed to explore the attitudes and barriers around ECEC staff vaccination and the immunisation policy/practices employed at their workplaces. METHODS: An online cross-sectional survey was undertaken of staff members (administrators and childcare center staff) in early 2017. We compared the individual's knowledge, attitude and practices as well as the centre's policy and practice variables between the vaccinated and unvaccinated respondents. A logistic model was used to identify the factors associated with uptake of the different vaccines. RESULTS: A total of 575 ECEC staff completed the survey. Sixty percent reported being aware of the recommendations about staff immunisation. While participants did acknowledge that they could spread diseases if unvaccinated (86%), 30% could not recall receiving a dTpa in the last 10 years. Private centres were less likely to provide free or onsite vaccination compared to other categories of centres. Less than half reported receiving any encouragement to get the influenza vaccine and only 33% reported that their centre provides onsite influenza vaccination. Regarding the introduction of mandatory policies, 69% stated that they would support a policy. CONCLUSION: Employers should consider supporting methods to maximize vaccination of their employees including providing free onsite vaccination. Participants were open to idea of mandatory vaccination; however, this needs to be explored further to determine how vaccine costs and access issues could be resolved.


Assuntos
Creches , Comportamentos Relacionados com a Saúde , Influenza Humana/prevenção & controle , Percepção , Professores Escolares/psicologia , Vacinação/psicologia , Coqueluche/prevenção & controle , Adulto , Austrália , Criança , Pré-Escolar , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Vacinas contra Influenza/economia , Vacinas contra Influenza/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vacina contra Coqueluche/uso terapêutico , Inquéritos e Questionários , Vacinação/economia , Local de Trabalho
8.
Emerg Microbes Infect ; 8(1): 1416-1427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543006

RESUMO

Pertussis caused by Bordetella pertussis, remains a public health problem worldwide, despite high vaccine coverage in infants and children in many countries. Iran has been using whole cell vaccine for the last 50 years with more than 95% vaccination rate since 1988 and has experienced pertussis resurgence in recent years. Here, we sequenced 55 B. pertussis isolates mostly collected from three provinces with the highest number of pertussis cases in Iran, including Tehran, Mazandaran, and Eastern-Azarbayjan from the period of 2008-2016. Most isolates carried ptxP3/prn2 alleles (42/55, 76%), the same genotype as isolates circulating in acellular vaccine-administrating countries. The second most frequent genotype was ptxP3/prn9 (8/55, 14%). Only three isolates (5%) were ptxP1. Phylogenetic analysis showed that Iranian ptxP3 isolates can be divided into eight clades (Clades 1-8) with no temporal association. Most of the isolates from Tehran grouped together as one distinctive clade (Clade 8) with six unique single nucleotide polymorphisms (SNPs). In addition, the prn9 isolates were grouped together as Clade 5 with 12 clade-supporting SNPs. No pertactin deficient isolates were found among the 55 Iranian isolates. Our findings suggest that there is an ongoing adaptation and evolution of B. pertussis regardless of the types of vaccine used.


Assuntos
Bordetella pertussis/genética , Evolução Molecular , Genoma Bacteriano , Vacina contra Coqueluche/administração & dosagem , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Alelos , Proteínas da Membrana Bacteriana Externa , Bordetella pertussis/classificação , Bordetella pertussis/isolamento & purificação , Genômica , Genótipo , Geografia , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Filogenia , Polimorfismo de Nucleotídeo Único , Fatores de Virulência de Bordetella , Sequenciamento Completo do Genoma , Coqueluche/microbiologia
9.
BMC Health Serv Res ; 19(1): 616, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477095

RESUMO

BACKGROUND: In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy. METHODS: Gynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists' journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer's Exact or t-tests. Variables associated with gynaecologists' self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses. RESULTS: Of 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage. CONCLUSIONS: The large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists' confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Coqueluche/prevenção & controle , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
10.
Int J Infect Dis ; 89: 96-101, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493522

RESUMO

OBJECTIVE: As the current recommendation of administering Tdap (tetanus-diphtheria-acellular pertussis) to all pregnant women has not been widely implemented in the United Arab Emirates (UAE), we aimed to ascertain the prevalence of pertussis seronegativity during pregnancy. METHODS: IgG antibodies against Bordetella pertussis toxin (PT) were measured in 213 women attending the antenatal clinic at Oasis hospital, Al Ain, UAE. Results were compared by maternal age, nationality and gestational age with the Kruskal-Wallis test for IgG-PT levels and the Chi-squared test for serology status. RESULTS: The mean age±SD of the participants was 30.4±5.6 years, mean gestational age±SD of 25.5±3.3 weeks. Serum concentration of IgG-PT <10IU/ml were found in 160 out of 213 women (75%; 95% confidence interval 69%, 81%). There was no significant difference in the geometric mean of serum IgG-PT concentration across maternal age (P=0.80) or nationality (P=0.90). There were no differences in the prevalence of seronegativity with maternal age (P=0.65) or nationality (P=0.90). CONCLUSION: With a high prevalence of pertussis seronegativity in pregnant women, there is a potential benefit of introducing pertussis vaccination during pregnancy into our national immunization program.


Assuntos
Complicações na Gravidez/sangue , Coqueluche/sangue , Adulto , Anticorpos Antibacterianos/sangue , Bordetella pertussis/imunologia , Feminino , Idade Gestacional , Humanos , Programas de Imunização , Imunoglobulina G/sangue , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/microbiologia , Complicações na Gravidez/prevenção & controle , Emirados Árabes Unidos , Vacinação/métodos , Coqueluche/diagnóstico , Coqueluche/microbiologia , Coqueluche/prevenção & controle , Adulto Jovem
11.
Int J Infect Dis ; 87: 75-83, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31369823

RESUMO

Pertussis is a highly infectious respiratory disease caused by Bordetella pertussis. Infants and young children are particularly at risk of severe and life-threatening disease. Infectious older individuals may transmit Bordetella pertussis to unprotected infants. Pertussis control measures have even failed in some countries with high pertussis vaccination coverage rates, leading to increased incidence rates. In 2014, this caused the World Health Organization to declare pertussis resurgent in some countries and led to recommendations regarding pertussis surveillance and national immunization programs. Despite the resurgence of pertussis, epidemiology of the disease in Southeast Asia has received little attention. In this narrative review, we describe pertussis surveillance systems, control measures, epidemiologic trends, and region-specific pertussis research in Southeast Asia. We also make recommendations for the intensification of pertussis surveillance and research in the region.


Assuntos
Coqueluche/epidemiologia , Ásia Sudeste/epidemiologia , Bordetella pertussis/genética , Bordetella pertussis/isolamento & purificação , Humanos , Programas de Imunização , Vacina contra Coqueluche/administração & dosagem , Coqueluche/microbiologia , Coqueluche/prevenção & controle
12.
Adv Exp Med Biol ; 1183: 35-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31376138

RESUMO

Bordetella pertussis produces several toxins that affect host-pathogen interactions. Of these, the major toxins that contribute to pertussis infection and disease are pertussis toxin, adenylate cyclase toxin-hemolysin and tracheal cytotoxin. Pertussis toxin is a multi-subunit protein toxin that inhibits host G protein-coupled receptor signaling, causing a wide array of effects on the host. Adenylate cyclase toxin-hemolysin is a single polypeptide, containing an adenylate cyclase enzymatic domain coupled to a hemolysin domain, that primarily targets phagocytic cells to inhibit their antibacterial activities. Tracheal cytotoxin is a fragment of peptidoglycan released by B. pertussis that elicits damaging inflammatory responses in host cells. This chapter describes these three virulence factors of B. pertussis, summarizing background information and focusing on the role of each toxin in infection and disease pathogenesis, as well as their role in pertussis vaccination.


Assuntos
Toxina Adenilato Ciclase/toxicidade , Bordetella pertussis/patogenicidade , Toxina Pertussis/toxicidade , Fatores de Virulência de Bordetella/toxicidade , Adenilil Ciclases/fisiologia , Toxinas Bacterianas , Bordetella pertussis/enzimologia , Bordetella pertussis/genética , Proteínas Hemolisinas/fisiologia , Humanos , Fatores de Virulência , Coqueluche/microbiologia , Coqueluche/prevenção & controle
13.
Adv Exp Med Biol ; 1183: 53-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31432398

RESUMO

Despite widespread vaccination, B. pertussis remains one of the least controlled vaccine-preventable diseases. Although it is well known that acellular and whole cell pertussis vaccines induce distinct immune functionalities in memory cells, much less is known about the role of innate immunity in this process. In this review, we provide an overview of the known differences and similarities in innate receptors, innate immune cells and inflammatory signalling pathways induced by the pertussis vaccines either licensed or in development and compare this to primary infection with B. pertussis. Despite the crucial role of innate immunity in driving memory responses to B. pertussis, it is clear that a significant knowledge gap remains in our understanding of the early innate immune response to vaccination and infection. Such knowledge is essential to develop the next generation of pertussis vaccines with improved host defense against B. pertussis.


Assuntos
Bordetella pertussis/imunologia , Imunidade Inata , Vacina contra Coqueluche/imunologia , Coqueluche/prevenção & controle , Anticorpos Antibacterianos , Bordetella pertussis/patogenicidade , Humanos , Vacina contra Coqueluche/administração & dosagem , Vacinação , Coqueluche/imunologia , Coqueluche/microbiologia
14.
Adv Exp Med Biol ; 1183: 115-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31432399

RESUMO

Effective diphtheria, tetanus toxoids, whole-cell pertussis (wP) vaccines were used for massive immunization in the 1950s. The broad use of these vaccines significantly reduced the morbidity and mortality associated with pertussis. Because of reports on the induction of adverse reactions, less-reactogenic acellular vaccines (aP) were later developed and in many countries, especially the industrialized ones, the use of wP was changed to aP. For many years, the situation of pertussis seemed to be controlled with the use of these vaccines, however in the last decades the number of pertussis cases increased in several countries. The loss of the immunity conferred by the vaccines, which is faster in the individuals vaccinated with the acellular vaccines, and the evolution of the pathogen towards geno/phenotypes that escape more easily the immunity conferred by the vaccines were proposed as the main causes of the disease resurgence. According to their composition of few immunogens, the aP vaccines seem to be exerting a greater selection pressure on the circulating bacterial population causing the prevalence of bacterial isolates defective in the expression of vaccine antigens. Under this context, it is clear that new vaccines against pertussis should be developed. Several vaccine candidates are in preclinical development and few others have recently completed phaseI/phaseII trials. Vaccine candidate based on OMVs is a promising candidate since appeared overcoming the major weaknesses of current aP-vaccines. The most advanced development is the live attenuated-vaccine BPZE1 which has successfully completed a first-in-man clinical trial.


Assuntos
Bordetella pertussis/imunologia , Imunização , Vacina contra Coqueluche/administração & dosagem , Coqueluche/prevenção & controle , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Humanos , Imunização/tendências , Vacina contra Coqueluche/imunologia , Vacinação/tendências
15.
Adv Exp Med Biol ; 1183: 127-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321754

RESUMO

Pertussis is a vaccine-preventable disease. Despite the high vaccination coverage among children, pertussis is considered a re-emerging disease for which identification, prevention and control strategies need to be improved. To control pertussis it is important to maintain a high vaccination coverage to protect the age groups considered at high risk for the disease. Laboratory confirmation of Bordetella pertussis infection together with a differential diagnostic test for other Bordetellae are prerequisite for a correct and timely diagnosis of pertussis. Moreover, investigations of antimicrobial susceptibility and whole genome sequencing may permit to monitor the circulation of antimicrobials resistant and/or vaccine-escape strains. Finally, the preventive framework should no longer consider pertussis exclusively as a childhood infectious disease, since adults may play a role in transmission events.


Assuntos
Bordetella pertussis/genética , Bordetella pertussis/isolamento & purificação , Vacina contra Coqueluche/administração & dosagem , Coqueluche/prevenção & controle , Adulto , Bordetella pertussis/imunologia , Criança , Genoma Bacteriano , Humanos , Vacinação/métodos , Sequenciamento Completo do Genoma
16.
Adv Exp Med Biol ; 1183: 1-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321755

RESUMO

The evolution of Bordetella pertussis from a common ancestor similar to Bordetella bronchiseptica has occurred through large-scale gene loss, inactivation and rearrangements, largely driven by the spread of insertion sequence element repeats throughout the genome. B. pertussis is widely considered to be monomorphic, and recent evolution of the B. pertussis genome appears to, at least in part, be driven by vaccine-based selection. Given the recent global resurgence of whooping cough despite the wide-spread use of vaccination, a more thorough understanding of B. pertussis genomics could be highly informative. In this chapter we discuss the evolution of B. pertussis, including how vaccination is changing the circulating B. pertussis population at the gene-level, and how new sequencing technologies are revealing previously unknown levels of inter- and intra-strain variation at the genome-level.


Assuntos
Bordetella pertussis/genética , Genoma Bacteriano , Vacina contra Coqueluche/administração & dosagem , Sequenciamento Completo do Genoma , Coqueluche/microbiologia , Bordetella pertussis/efeitos dos fármacos , Genômica/métodos , Humanos , Filogenia , Coqueluche/imunologia , Coqueluche/prevenção & controle
17.
Adv Exp Med Biol ; 1183: 151-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31359365

RESUMO

Pertussis is an endemic highly infectious vaccine-preventable disease. The disease is a major cause of childhood morbidity and mortality. In the most recent years, the re-emergence of pertussis occurred, and many efforts were done to identify the possible causes. Certainly, more effective laboratory methods have a role in making the diagnosis easier. However, sub-optimal efficacy of available vaccines as well as their limited duration of protection could explain the resurgence of the disease. Many forms and clinical features of the disease, ranging from the most classical to atypical and very nuanced forms, have been reported. There are many aspects that influence the clinical features of the pathology, such as a previous immunization or infection, patient's age, gender and antibiotic treatment. A prompt suspect and a rapid diagnosis of pertussis is fundamental for an appropriate clinical management and for preventing pertussis complications, especially in children. However, under a clinical point of view, pertussis is often difficult to be diagnosed. A prompt treatment may decrease the duration and severity of cough; the cornerstone drugs are the macrolides. Although prompt diagnosis and effective therapy are important for pertussis control, only with a broad vaccination coverage will be possible to reduce circulation of Bordetella pertussis.


Assuntos
Antibacterianos/uso terapêutico , Bordetella pertussis/isolamento & purificação , Macrolídeos/uso terapêutico , Vacina contra Coqueluche/administração & dosagem , Coqueluche/tratamento farmacológico , Criança , Tosse , Humanos , Reação em Cadeia da Polimerase , Profilaxia Pós-Exposição , Coqueluche/diagnóstico , Coqueluche/prevenção & controle
18.
Adv Exp Med Biol ; 1183: 161-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31342457

RESUMO

Vaccines and vaccination against pertussis (whooping cough) have had one of the longest and most complex history, with alternating splendour and public disbelief, enthusiasm and concerns, overall resulting in changes in composition and replacement of vaccines, and associated vaccination strategies, including use of different vaccines in different countries, with no apparent equals for other bacterial vaccines. Of this both frustrating and exciting venue no end has been reached. In this note, I am shortly recapitulating the history of pertussis vaccines, from the inactivated, whole-cell vaccine to the acellular ones, with their merits and limitations, particularly concerning the debated issue of waning immunity, and a glimpse on a new vaccine proposal. Some reflections on the complexity and apparent peculiarity of this field are also made to the final scope of discussing aspects of the evolving strategies of disease control in a high-income country.


Assuntos
Vacina contra Coqueluche/administração & dosagem , Vacinação , Coqueluche/prevenção & controle , Bordetella pertussis , Humanos , Vacinação/tendências
19.
Adv Exp Med Biol ; 1183: 137-149, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31342458

RESUMO

Pertussis is a vaccine preventable disease since late 1940s. However, it is still endemic in all countries and occurs in epidemic cycles. The number of cases/deaths has decreased during the last decade but a high number of deaths persists in Low and Medium Income Countries (LMIC). The epidemiological situation in LMIC is not precisely known due to lack of surveillance and specific diagnostic tools. A pragmatic approach in these countries should be to establish; (i) a hospital-based surveillance in the largest cities of the country with clinicians and nurses trained to detect clinical symptoms, to obtain biological samples for specific analysis and diagnosis; (ii) a reference laboratory as part of an international network of reference laboratories, under quality assurance, and able to perform at least PCR diagnosis and if possible detection of antibiotic resistance. This surveillance network would allow specific diagnosis of pertussis and facilitate the reporting of cases at national level, thereby improving awareness of the disease at clinician, population and decision maker levels. This network could allow a better evaluation of vaccine coverage, timely vaccination and impacts of modification of national vaccine strategy or type of pertussis vaccine used. Collaboration between this network and basic scientists should be strengthened through translational research projects in order to improve fundamental knowledge on pertussis in LMIC and help clinicians' access to specific diagnostic tools.


Assuntos
Bordetella pertussis/genética , Bordetella pertussis/isolamento & purificação , Vacina contra Coqueluche/administração & dosagem , Vigilância da População , Vacinação/métodos , Coqueluche/prevenção & controle , Bordetella pertussis/imunologia , Cidades , Países em Desenvolvimento , Humanos , Reação em Cadeia da Polimerase , Coqueluche/diagnóstico
20.
Adv Exp Med Biol ; 1183: 19-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31342459

RESUMO

Although vaccination has been effective, Bordetella pertussis is increasingly causing epidemics, especially in industrialized countries using acellular vaccines (aPs). One factor behind the increased circulation is the molecular changes on the pathogen level. After pertussis vaccinations were introduced, changes in the fimbrial (Fim) serotype of the circulating strains was observed. When bacterial typing methods improved, further changes between the vaccine and circulating strains, especially among the common virulence genes including pertussis toxin (PT) and pertactin (PRN) were noticed. Moreover, development of genome based techniques including pulsed-field gel electrophoresis (PFGE), multiple-locus variable number tandem repeat analysis (MLVA) and whole-genome sequencing (WGS) have offered a better resolution to monitor B. pertussis strains. After the introduction of aP vaccines, B. pertussis strains that are deficient to vaccine antigens, especially PRN, have appeared widely. On the other hand, antimicrobial resistance to first line drugs (macrolides) against B. pertussis is still low in many countries and therefore no globally evaluated antimicrobial susceptibility test values have been recommended. In this review, we focus on the molecular changes in the bacteria, which have or may have affected the past and current epidemiology of pertussis.


Assuntos
Bordetella pertussis/genética , Vacina contra Coqueluche/administração & dosagem , Coqueluche/prevenção & controle , Proteínas da Membrana Bacteriana Externa , Bordetella pertussis/isolamento & purificação , Humanos , Epidemiologia Molecular , Toxina Pertussis , Coqueluche/imunologia , Coqueluche/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA