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1.
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
2.
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
3.
Medicine (Baltimore) ; 98(16): e15281, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008974

RESUMO

BACKGROUND: Due to the resurgence of pertussis, many countries have revised the pertussis immunization schedules and recommended booster doses of pertussis component vaccine for adolescents and adults. Here we aim to investigate the effectiveness and safety of pertussis component vaccines in adolescents and adults. METHODS: Based on a prospectively registered protocol, we reviewed the literature and selected trials in adolescents and adults using pertussis component vaccine. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses. RESULTS: A total of 17 clinical trials were included. At post-vaccination with pertussis component vaccine, the vaccine protective rate of pertussis reached 88.89%, the vaccine response rate of pertussis antibodies in most trials were above 85%, and the antibody titers at post-vaccination were higher than at pre-vaccination. Reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine was associated with significantly higher incidences of nausea [RR = 1.26, 95%CI:1.01, 1.57] and vomiting [RR = 2.08, 95%CI:1.21, 3.58] in acellular pertussis vaccines combined with tetanus and diphtheria (Tdap) group than diphtheria tetanus-toxoid vaccines (Td) group. Higher dose of diphtheria toxoid and adjuvant in dTap might cause higher incidence of fever. CONCLUSIONS: Except for significant difference in gastrointestinal reaction (nausea, vomiting), acellular pertussis component vaccines are quite safe and has short-term effectiveness for the adolescents and adults. The adverse event of acellular pertussis component vaccine is similar to or safer than that of placebo or other vaccines without pertussis component.


Assuntos
Imunização Secundária , Vacina contra Coqueluche/uso terapêutico , Coqueluche/prevenção & controle , Adolescente , Adulto , Humanos , Imunização Secundária/efeitos adversos , Imunização Secundária/métodos , Vacina contra Coqueluche/administração & dosagem , Vacina contra Coqueluche/efeitos adversos , Resultado do Tratamento , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-30769767

RESUMO

Background: Pregnant women should receive two vaccines during pregnancy due to maternal-foetal complications and risks as well as the influenza and pertussis vaccinations. The goal was to evaluate vaccination coverage against influenza and pertussis in pregnant women, following midwife professional advice during the pregnancy follow-up; Methods: Prospective cohort study of 1017 pregnancies during the vaccination campaign in 2015⁻2016. To estimate the degree of consistency between the coverage declared by mothers and that registered in the Nominal Vaccination Registry (NVR), we used the Cohen's kappa index (k); Results: 95.4% were registered in the NVR. Vaccination coverage recorded against influenza was 64.2% (95% CI: 61.2⁻67.2), and 89.8% (95% CI: 87.9⁻91.7) against pertussis. The coverage of the pregnant women interviewed was 61.7% (95% CI: 58.1⁻67.3)) for influenza and 92.3% (95% CI: 91.4⁻95.3) for pertussis. Subsequent interviews of 67.2% of the women produced a kappa agreement index between the data obtained from interviews and those recorded in the NVR of 0.974 (IC95%: 98.0⁻99.6) for influenza, and 0.921 (IC95%: 98.1⁻99.7) for pertussis. The women identified midwives as the main source of vaccination information and advice 88.4% (IC95%: 85.8⁻90.9); Conclusions: The NVR is an effective platform for estimating immunisation coverage in pregnant women. The degree of agreement between declared vaccinations and registered vaccinations was high for both vaccines.


Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Vacina contra Coqueluche/uso terapêutico , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes , Cobertura Vacinal/estatística & dados numéricos , Coqueluche/prevenção & controle , Adulto , Feminino , Humanos , Programas de Imunização , Gravidez , Estudos Prospectivos , Sistema de Registros , Espanha
6.
Paediatr Respir Rev ; 29: 68-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29914744

RESUMO

In the last twenty years, despite high vaccination coverage, epidemics of pertussis are occurring in both developing and developed countries. Many reasons could explain the pertussis resurgence: the increasing awareness of the disease, the availability of new diagnostic tests with higher sensitivity, the emergence of new Bordetella pertussis (B. pertussis) strains different from those contained in the current vaccines, the asymptomatic transmission of B. pertussis in adolescents and adults and the shorter duration of protection given by the acellular pertussis (aP) vaccine. New preventive strategies have already been implemented, such as booster doses of aP vaccine in adolescents and adults, maternal immunisation during pregnancy and the "cocooning" strategy, but more are still needed. Knowing what is new about this old disease is necessary to reduce its incidence and to protect infants too young to be vaccinated, which have the highest risk of complications and death.


Assuntos
Imunização Secundária/métodos , Vacina contra Coqueluche/uso terapêutico , Vacinação/métodos , Vacinas Acelulares/uso terapêutico , Coqueluche/prevenção & controle , Adolescente , Adulto , Antibacterianos/uso terapêutico , Epidemias , Família , Feminino , Humanos , Imunidade Materno-Adquirida , Lactente , Recém-Nascido , Gravidez , Cobertura Vacinal , Coqueluche/tratamento farmacológico , Coqueluche/epidemiologia
7.
Vaccine ; 37(2): 217-218, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-29129454

RESUMO

In 2017, the World Health Organization (WHO) published an updated document aimed at facilitating the understanding of the immunological basis of pertussis vaccines and their use. The document "The Immunological Basis for Immunization Series: Pertussis Vaccines" is freely available on the WHO website. The main purpose of the module is to provide national immunization managers and vaccination professionals with an overview of the scientific basis of vaccination against pertussis and the immunological basis for the WHO position on pertussis vaccines. The Immunological Basis for Immunization Series was initially developed in 1993. Since then the series was regularly updated and extended. They reflect the biological differences in immune responses to the individual pathogens and the differing strategies employed to create the best possible level of protection that can be provided by vaccination. We invite the immunization community to use these references, and we hope the updated pertussis vaccine module will be a valuable resource.


Assuntos
Esquemas de Imunização , Vacina contra Coqueluche/uso terapêutico , Vacinação , Coqueluche/prevenção & controle , Organização Mundial da Saúde , Bordetella pertussis , Saúde Global , Humanos , Vacina contra Coqueluche/administração & dosagem , Coqueluche/imunologia
8.
Vaccine ; 36(52): 7936-7942, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30448334

RESUMO

BACKGROUND: In Russia as in other countries introduction of infant vaccination against pertussis in 1950s led to dramatic decrease of whooping cough. The current vaccination schedule includes a 3-dose infant series and toddler booster; the pre-school booster was cancelled in 1980s and never reintroduced. Whole-cell vaccines, and in a smaller proportion acellular vaccines are used for all doses. However, pertussis incidence in urban settings is high with highest burden in school children. We conducted a study of seroprevalence of recent pertussis infection to estimate the duration of protection from the 4-dose series. MATERIALS AND METHODS: Sera sample from 395 St Petersburg children aged ≥3 years and <14 years were tested for pertussis toxin antibodies using a commercial PT ELISA test. Only children with completed 4-dose vaccination course were included in the study. Age-specific seroprevalence of recent pertussis infection was analyzed for trends. RESULTS: Children fully vaccinated against pertussis at 3 years old had significant delays in infant vaccination schedule: only 83.5% received at least one dose of pertussis vaccine at 6 months of age and 25.6% received their toddler booster before 24 months-old. Overall, 10.6% of children demonstrated the serological signs of the infection in the last 12 months. A clear trend (r2 = 0.692) of increasing proportion of infection in the last 12 months was observed in children who had received their last dose of vaccine 6 years and more prior to the study. CONCLUSION: Our study demonstrates that Russian children become susceptible to infection at or soon after entering school. The results confirm the waning of vaccine-elicited immunity around school-age and support the need for a booster dose at that age.


Assuntos
Vacina contra Coqueluche/uso terapêutico , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adolescente , Anticorpos Antibacterianos/sangue , Bordetella pertussis , Criança , Pré-Escolar , Estudos Transversais , Suscetibilidade a Doenças , Feminino , Humanos , Esquemas de Imunização , Imunização Secundária , Imunoglobulina G/sangue , Masculino , Vacina contra Coqueluche/administração & dosagem , Federação Russa/epidemiologia , Estudos Soroepidemiológicos , Vacinação/estatística & dados numéricos , Vacinas Acelulares/administração & dosagem , Vacinas Acelulares/uso terapêutico
9.
Vaccine ; 36(48): 7270-7275, 2018 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-30337176

RESUMO

Pertussis is a vaccine-preventable disease that causes morbidity and mortality, particularly in infants and children <5 years of age. The Global Pertussis Initiative (GPI) recommendations represent a systematic evaluation and prioritization of strategies to prevent pertussis-related infant and child deaths, reduce global disease burden and prevent resurgence through vaccination strategies and public health policies at national, regional and local levels. The GPI recommendations are based on clinical trials and observational and surveillance data, which are essential in the planning, implementation and evaluation of vaccination practices and best use of available resources. Many low- and middle-income countries (LMIC) continue to use whole-cell pertussis (wP) vaccines for primary vaccination, while most high-income countries have replaced wP with the less-reactogenic acellular pertussis (aP) vaccines. This present manuscript pertains to discussions held during the GPI's meeting on November 11-13, 2016, in Cape Town, Republic of South Africa. The GPI recommends that LMIC aim for high coverage of infant series pertussis vaccines as a priority. In LMIC and countries with constrained vaccine funding, if wP vaccines are currently used, wP should continue to be used. Furthermore, given that protection against disease and death due to pertussis in neonates is a key priority of the GPI, it recommends that ap immunization in pregnancy should be implemented as a priority in all countries if resources allow. Given that surveillance and epidemiology data on which to base vaccine decisions are important, the GPI also suggests that, in areas where wP vaccines are implemented, standardization and calibration of wP vaccines are checked, considering the many different manufacturers and variable standards of production and quality control. In addition, as immunity to pertussis wanes following the primary infant series of vaccination, the GPI further recommends that toddlers, adolescents, healthcare and childcare workers receive booster vaccine doses, where resources allow.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Saúde Global , Vacina contra Coqueluche/administração & dosagem , Guias de Prática Clínica como Assunto , Vacinação/economia , Coqueluche/prevenção & controle , Pré-Escolar , Congressos como Assunto , Monitoramento Epidemiológico , Humanos , Imunização Secundária , Lactente , Vacina contra Coqueluche/economia , Vacina contra Coqueluche/uso terapêutico , Pobreza , África do Sul , Coqueluche/epidemiologia
10.
Rev Med Suisse ; 14(624): 1884-1886, 2018 Oct 24.
Artigo em Francês | MEDLINE | ID: mdl-30375788

RESUMO

Pertussis is a serious health issue in infants < 3 months. Too young to be vaccinated, they are at higher risk of developing pertussis and vulnerable to severe complications. Two vaccine strategies exist to prevent infant pertussis. The older « cocooning ¼ strategy involves vaccinating parents and close contacts, indirectly protecting newborns. The more effective strategy is to immunize women during pregnancy, providing infants passive protection by transplacental transfer of pertussis antibodies. However, some women and their caregivers are worried about receiving the vaccine during pregnancy. We review the effectiveness, safety, timing and implementation of pertussis antenatal immunization. The aim is to remind practitioners of current recommendations with supporting data. This can be used to reassure future parents and enable informed decisions.


Assuntos
Vacina contra Coqueluche , Coqueluche , Feminino , Humanos , Lactente , Recém-Nascido , Mães , Vacina contra Coqueluche/uso terapêutico , Gravidez , Vacinação , Coqueluche/prevenção & controle
11.
Prim Care ; 45(3): 423-431, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30115332

RESUMO

Bordetella pertussis can cause serious and potentially fatal complications, especially in very young infants. Early diagnosis and treatment of pertussis with a macrolide antibiotic, such as azithromycin, before the paroxysmal stage of disease can help mitigate complications and reduce the spread of this highly contagious disease.


Assuntos
Coqueluche/diagnóstico , Antibacterianos/uso terapêutico , Humanos , Vacina contra Coqueluche/administração & dosagem , Vacina contra Coqueluche/uso terapêutico , Prognóstico , Coqueluche/tratamento farmacológico , Coqueluche/prevenção & controle
12.
J Control Release ; 286: 167-178, 2018 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-30048656

RESUMO

Worldwide resurgence of whooping cough calls for improved, next-generation pertussis vaccines that induce broad and long-lasting immunity. A mucosal pertussis vaccine based on outer membrane vesicles (omvPV) is a promising candidate. Further, a vaccine that is stable outside the cold chain would be of substantial advantage for worldwide distribution and application. A vaccine formulated as a powder could both stabilize the vaccine as well as make it suitable for pulmonary vaccination. To that end, we developed a spray dried omvPV with improved stability compared to the liquid omvPV formulation. Spray drying did not affect the structural integrity of the omvPV. The antigenicity of Vag8, a major antigen in omvPV was diminished slightly and an altered tryptophan fluorescence indicated some changes in protein structure. However, when administered via the pulmonary route in mice after reconstitution, spray dried omvPV showed comparable immune responses and protection against challenge with live B. pertussis as liquid omvPV. Mucosal IgA and Th17 responses were established in addition to broad systemic IgG and Th1/Th17 responses, indicating the induction of an effective immunity profile. Overall, a spray dried omvPV was developed that maintained effective immunogenic properties and has an improved storage stability.


Assuntos
Antígenos de Bactérias/administração & dosagem , Bordetella pertussis/imunologia , Vacina contra Coqueluche/administração & dosagem , Coqueluche/prevenção & controle , Animais , Antígenos de Bactérias/química , Antígenos de Bactérias/imunologia , Antígenos de Bactérias/uso terapêutico , Bordetella pertussis/química , Dessecação , Vias de Administração de Medicamentos , Estabilidade de Medicamentos , Feminino , Temperatura Alta , Pulmão/imunologia , Camundongos Endogâmicos BALB C , Tamanho da Partícula , Vacina contra Coqueluche/química , Vacina contra Coqueluche/imunologia , Vacina contra Coqueluche/uso terapêutico , Pós , Células Th1/imunologia , Células Th17/imunologia , Vacinação , Coqueluche/imunologia
13.
Vaccine ; 36(35): 5294-5303, 2018 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-30055969

RESUMO

In the UK, it is recommended that pregnant women receive the influenza and pertussis vaccination. However, uptake of these vaccinations in certain UK regions remains low. Previous studies show that pregnant women use the internet to access health information, yet it has not been previously explored whether the use of social networking sites (SNS) influences decisions about maternal vaccination uptake. The aim of this study was to determine, if the use of SNS to gain information on pregnancy vaccinations, is associated with women's uptake of the influenza and pertussis vaccines during pregnancy. This is a cross-sectional study with data collected using an online questionnaire posted on Mumsnet (an online parenting site), from 3rd to 24th August 2017. Women were included if they lived in the UK, were over 32 weeks pregnant, or had given birth in the last year. Participants were questioned about their pregnancy vaccination uptake, general SNS use and, their SNS use in relation to gathering information on vaccinations during pregnancy. The data was analysed using chi-square test, and univariable and multivariable logistic regression. Out of a sample of 308 participants, 305 (99.3%) of women reported using SNS and 64/308 (20.8%) of women reported using SNS to gather information on vaccinations during pregnancy. Women who reported using SNS to gather information on pregnancy vaccinations were 58% (adjusted odds ratio 0.42; 95% CI 0.21-0.87) less likely to receive the pertussis vaccination during pregnancy. However, the association was not statistically significant for the influenza vaccination (adjusted odds ratio 0.64; 95% CI 0.37-1.11). The study showed many women use SNS to gather information on pregnancy vaccinations, and this is negatively associated with their likelihood of receiving the pertussis vaccine. Future studies are needed to analyse the accuracy and quality of the vaccination information, which women find on SNS.


Assuntos
Vacinas contra Influenza/uso terapêutico , Vacinação/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Influenza Humana/imunologia , Influenza Humana/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Vacina contra Coqueluche/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes , Inquéritos e Questionários
14.
NASN Sch Nurse ; 33(5): 272-278, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29863960

RESUMO

After a decade of decreases in the incidence of vaccine-preventable diseases, in the late 1980s the incidence began to increase. Four vaccine preventable diseases, including pertussis, caused major epidemics, and children were the most vulnerable during these outbreaks. Due to waning immunity, genomic changes, and inadequate herd immunity in adults, infants and children are at risk for contracting pertussis. Pertussis is a vaccine-preventable disease. Pertussis is difficult to diagnose early because the presentation is similar to common problems such as bronchitis or upper respiratory infections. School nurses should be able to identify signs and symptoms in the earliest stage possible to prevent transmission and refer for treatment early. The purpose of this article is to provide school nurses with information to understand the disease and identify individuals infected with pertussis.


Assuntos
Vacina contra Coqueluche/uso terapêutico , Coqueluche/prevenção & controle , Surtos de Doenças , Humanos , Segurança , Serviços de Enfermagem Escolar , Estados Unidos/epidemiologia , Coqueluche/epidemiologia , Coqueluche/enfermagem
15.
PLoS One ; 13(6): e0199180, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29906276

RESUMO

BACKGROUND: Studies of vaccine effectiveness (VE) rely on accurate identification of vaccination and cases of vaccine-preventable disease. In practice, diagnostic tests, clinical case definitions and vaccination records often present inaccuracies, leading to biased VE estimates. Previous studies investigated the impact of non-differential disease misclassification on VE estimation. METHODS: We explored, through simulation, the impact of non-differential and differential disease- and exposure misclassification when estimating VE using cohort, case-control, test-negative case-control and case-cohort designs. The impact of misclassification on the estimated VE is demonstrated for VE studies on childhood seasonal influenza and pertussis vaccination. We additionally developed a web-application graphically presenting bias for user-selected parameters. RESULTS: Depending on the scenario, the misclassification parameters had differing impacts. Decreased exposure specificity had greatest impact for influenza VE estimation when vaccination coverage was low. Decreased exposure sensitivity had greatest impact for pertussis VE estimation for which high vaccination coverage is typically achieved. The impact of the exposure misclassification parameters was found to be more noticeable than that of the disease misclassification parameters. When misclassification is limited, all study designs perform equally. In case of substantial (differential) disease misclassification, the test-negative design performs worse. CONCLUSIONS: Misclassification can lead to significant bias in VE estimates and its impact strongly depends on the scenario. We developed a web-application for assessing the potential (joint) impact of possibly differential disease- and exposure misclassification that can be modified by users to their own study scenario. Our results and the simulation tool may be used to guide better design, conduct and interpretation of future VE studies.


Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/epidemiologia , Vacina contra Coqueluche/uso terapêutico , Projetos de Pesquisa , Coqueluche/epidemiologia , Viés , Criança , Humanos , Influenza Humana/prevenção & controle , Modelos Estatísticos , Resultado do Tratamento , Vacinação/métodos , Coqueluche/prevenção & controle
16.
Microb Genom ; 4(5)2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29771235

RESUMO

Bordetella pertussis, the causative agent of whooping cough, has experienced a resurgence in the past 15 years, despite the existence of both whole-cell and acellular vaccines. Here, we performed whole genome sequencing analysis of 149 clinical strains, provided by the National Institute of Infectious Diseases (NIID), Japan, isolated in 1982-2014, after Japan became the first country to adopt acellular vaccines against B. pertussis. Additionally, we sequenced 39 strains provided by the Konan Kosei Hospital in Aichi prefecture, Japan, isolated in 2008-2013. The genome sequences afforded insight into B. pertussis genome variability and population dynamics in Japan, and revealed that the B. pertussis population in Japan was characterized by two major clades that divided more than 40 years ago. The pertactin gene was disrupted in about 20 % of the 149 NIID isolates, by either a deletion within the signal sequence (ΔSS) or the insertion of IS element IS481 (prn :: IS481). Phylogeny suggests that the parent clones for these isolates originated in Japan. Divergence dating traced the first generation of the pertactin-deficient mutants in Japan to around 1990, and indicated that strains containing the alternative pertactin allele prn2 may have appeared in Japan around 1974. Molecular clock data suggested that observed fluctuations in B. pertussis population size may have coincided with changes in vaccine usage in the country. The continuing failure to eradicate the disease warrants an exploration of novel vaccine compositions.


Assuntos
Bordetella pertussis/classificação , Bordetella pertussis/genética , Bordetella pertussis/isolamento & purificação , Vacina contra Coqueluche/uso terapêutico , Filogenia , Alelos , Proteínas da Membrana Bacteriana Externa/genética , Biodiversidade , Elementos de DNA Transponíveis/genética , Genes Bacterianos/genética , Variação Genética , Humanos , Japão/epidemiologia , Polimorfismo de Nucleotídeo Único , Dinâmica Populacional , Deleção de Sequência , Vacinas Acelulares/uso terapêutico , Fatores de Virulência de Bordetella/genética , Sequenciamento Completo do Genoma
17.
Epidemiol Infect ; 146(7): 858-866, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29655385

RESUMO

Data on the impact of the recently recommended maternal pertussis vaccination are promising, but still insufficient to universalise this approach. We thus compared the epidemiological data prior to the implementation of this vaccination strategy in Argentina (2012) with the figures reported after 2012. During that 2010-2016 period, two outbreaks occurred, one in 2011 and another in 2016. In the former, the incidence was 6.9/100 000 inhabitants and the case-fatality rate 2.6%. Thereafter, a decline in incidence was detected until 2014. During 2015 and 2016 an increase in the incidence transpired, but this rise was fortunately not accompanied by one in the case fatality ratio. Indeed, in 2016 the case fatality ratio was the lowest (0.6%). Moreover, during the 2016 outbreak, the incidence (3.9/100 000 inhabitants) and the case severity detected in the most vulnerable population (infants 0-2 months) were both lower than those in 2011. Consistent with this pattern, in 2016, in the most populated province of Argentina (Buenos Aires), the case percentage with laboratory-positive results indicating a high number of symptoms (59.1% of the total cases) diminished compared with that detected in the 2011 outbreak without maternal immunisation (71.9%). Using the mathematical model of pertussis transmission we previously designed, we assessed the effect of vaccination during pregnancy on infant incidence. From comparisons between the epidemiological data made through calculations, emerged the possibility that vaccinating women during pregnancy would benefit the infants beyond age 2 months, specifically in the 2-12-month cohort.


Assuntos
Imunidade Materno-Adquirida , Imunização , Vacina contra Coqueluche/uso terapêutico , Coqueluche/epidemiologia , Argentina/epidemiologia , Humanos , Incidência , Modelos Teóricos , Vacinação , Coqueluche/microbiologia
18.
Vaccine ; 36(19): 2687-2693, 2018 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-29627238

RESUMO

BACKGROUND: In Flanders, Belgium, pertussis vaccination is recommended since 2013 and available free-of-charge in every pregnancy between 24 and 32 weeks of gestation. Influenza vaccination is recommended for more than 10 years with a co-payment system in the second or third trimester of pregnancy, when pregnancy coincides with the influenza season. This study aims to estimate the coverage of pertussis and influenza vaccination during pregnancy in 2016 and to determine predictors for missing vaccination. METHODS: Postpartum women were visited at home for a vaccination coverage survey using an Expanded Program on Immunization (EPI)-based two-stage cluster sampling design. Predictors for missed vaccination were identified using a multiple logistic regression model. RESULTS: Among 481 participating women, 69.3% were vaccinated against pertussis and 47.2% were vaccinated against influenza. Moreover, 65.3% of pertussis vaccine recipients and 96.9% of influenza vaccine recipients were vaccinated within the recommended gestational window. Surprisingly, among women who were completely informed (i.e. on disease-associated risks, maternal vaccination costs and recommendations), still 12.4% were unvaccinated against pertussis and 23.9% against influenza. In the final models, the only common predictor of missing maternal pertussis and influenza vaccination was multiparity. Significant predictors of maternal pertussis vaccination were family income (less likely if unknown or low (< €3000) than if moderate (€3001-€4000)) and hospital of delivery (less likely if >800 annual deliveries than <800). Significant predictors of maternal influenza vaccination, though with less straight-forward associations, were maternal ethnicity and educational level, involvement of a gynaecologist in pregnancy follow-up, and characteristics of the hospital of delivery. CONCLUSION: In Flanders, more than two-third of pregnant women receives pertussis vaccination but less than half of them receives the influenza vaccine. Further improvement for both maternal vaccination programs can be achieved by targeting the underserved populations and diminishing vaccination hurdles.


Assuntos
Vacinas contra Influenza/uso terapêutico , Vacina contra Coqueluche/uso terapêutico , Cobertura Vacinal/estatística & dados numéricos , Adulto , Bélgica , Feminino , Inquéritos Epidemiológicos , Humanos , Programas de Imunização , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes , Fatores Socioeconômicos
19.
Sci Transl Med ; 10(434)2018 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-29593103

RESUMO

The resurgence of pertussis over the past decades has resulted in incidence levels not witnessed in the United States since the 1950s. The underlying causes have been the subject of much speculation, with particular attention paid to the shortcomings of the latest generation of vaccines. We formulated transmission models comprising competing hypotheses regarding vaccine failure and challenged them to explain 16 years of highly resolved incidence data from Massachusetts, United States. Our results suggest that the resurgence of pertussis is a predictable consequence of incomplete historical coverage with an imperfect vaccine that confers slowly waning immunity. We found evidence that the vaccine itself is effective at reducing overall transmission, yet that routine vaccination alone would be insufficient for elimination of the disease. Our results indicated that the core transmission group is schoolchildren. Therefore, efforts aimed at curtailing transmission in the population at large, and especially in vulnerable infants, are more likely to succeed if targeted at schoolchildren, rather than adults.


Assuntos
Vacina contra Coqueluche/uso terapêutico , Humanos , Vacina contra Coqueluche/imunologia , Estados Unidos , Vacinação/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos
20.
Vaccine ; 36(9): 1160-1166, 2018 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-29395520

RESUMO

The recent resurgence of pertussis in England and Wales has been marked by infant deaths and rising cases in teens and adults. To understand which age cohorts are most responsible for these trends, we employed three separate statistical methods to analyze high-resolution pertussis reports from 1982 to 2012. The fine-grained nature of the time-series allowed us to describe the changes in age-specific incidence and contrast the transmission dynamics in the 1980s and during the resurgence era. Our results identified infants and school children younger than 10 years of age as a core group, prior to 2002: pertussis incidence in these populations was predictive of incidence in other age groups. After 2002, no core groups were identifiable. This conclusion is independent of methodology used. Because it is unlikely that the underlying contact patterns substantially changed over the study period, changes in predictability likely result from the introduction of more stringent diagnostics tests that may have inadvertently played a role in masking the relative contributions of core transmission groups.


Assuntos
Coqueluche/epidemiologia , Coqueluche/transmissão , Criança , Pré-Escolar , Surtos de Doenças , Inglaterra/epidemiologia , Humanos , Imunização/estatística & dados numéricos , Esquemas de Imunização , Lactente , Vacina contra Coqueluche/administração & dosagem , Vacina contra Coqueluche/uso terapêutico , País de Gales/epidemiologia , Coqueluche/prevenção & controle
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