Acellular pertussis vaccine booster combined with diphtheria and tetanus toxoids for adolescents

Immunity to pertussis 5 years after booster immunization during adolescence

BACKGROUND

We conducted a 5-year follow-up study on the persistence of pertussis-specific antibody and cell-mediated immunity after booster immunization of adolescents aged 11-13 years with a tricomponent acellular pertussis vaccine (Boostrix; trials diphtheria-tetanus-acellular pertussis [Tdap]-004/030).

METHODS

Cellular and humoral immunity to pertussis toxin (PT), filamentous hemagglutinin, and pertactin were measured in adolescents (age, 16 years) 5 years after booster immunization. Similar investigations were performed for control adolescents who had received only diphtheria and tetanus booster vaccination.

RESULTS

Five years after pertussis booster vaccination, the geometric mean concentrations of immunoglobulin G (IgG) elicited by each of the 3 pertussis vaccine antigens decreased from 1-month and 3-year postvaccination levels, but with the exception of PT IgG, were still higher than the prevaccination levels. PT IgG levels were undetectable in 28% of the subjects, but 44% of those subjects still tested positive for cell-mediated immunity to PT. Filamentous hemagglutinin IgG and pertactin IgG levels were significantly higher in Tdap-boosted adolescents than in the control subjects. Antibody concentrations at 1 month after vaccination strongly predicted antibody persistence. Cell-mediated immunity levels to PT, filamentous hemagglutinin, and pertactin persisted above the prebooster levels measured 5 years earlier.

CONCLUSIONS

The results of the present study of adolescents indicate that the interval between acellular pertussis booster immunizations might be extended beyond 5 years.

Pertussis in adolescents

Pertussis is a highly communicable respiratory infection caused by Bordetella pertussis. In spite of the widespread availability of effective vaccines and high levels of vaccination coverage, a significant resurgence in pertussis has been observed during the past 2 decades. The increase in reported cases is due in large part to infection in adolescents and adults, and waning immunity plays an important role. Pertussis in adolescents and adults often goes unrecognized because a persistent, uncharacteristic cough might be the only clinical presentation. Pneumonia is the most frequent complication. Culture and polymerase chain reaction are helpful in establishing the diagnosis if a specimen can be obtained early in the course of the illness. Serology is useful when the diagnosis is not suspected until a later stage. Treatment with a macrolide antibiotic is recommended for affected individuals, as well as for all household and other close contacts. Universal immunization is necessary for disease control. Immunization should begin in infancy and should continue with booster doses through adulthood. Two adolescent and adult formulations of acellular pertussis vaccine are licensed in North America and Europe. Both are combined with an adult formulation of diphtheria and tetanus toxoids. In the US, Adacel (Sanofi Pasteur, Toronto, Ontario, Canada) is licensed for use in individuals aged 11 to 64 y while Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium) is licensed for use in individuals aged 10 to 18 y. These vaccines are safe, immunogenic, and well tolerated. Routine vaccination of adolescents and adults is required for optimal control of pertussis.

Comparison of the safety and immunogenicity of concomitant and sequential administration of an adult formulation tetanus and diphtheria toxoids adsorbed combined with acellular pertussis (Tdap) vaccine and trivalent inactivated influenza vaccine in adults

The annual contact for influenza vaccination provides an opportunity to ensure that adults have received other recommended vaccines such as Tdap. Healthy 19-64 year-olds were randomized to receive concomitant administration of Tdap and influenza vaccines or influenza vaccine followed (in 4-6 weeks by) Tdap. 720 participants were enrolled. No clinically relevant between-group differences were observed in the rates or severities of erythema, swelling, or pain at the Tdap injection site. Injection-site pain was the most commonly reported adverse event (66.6% concomitant administration group versus 60.8% sequential administration group); most pain was graded as mild and resolved by day 3. Seroprotection and seroresponse rates for all influenza strains were comparable between the two groups. For diphtheria and tetanus, seroprotection rates and post-vaccination GMTs were non-inferior in the concomitant administration group compared to the sequential administration group. A trend for lower antibody responses to pertussis antigens PT, FHA, and FIM was observed after concomitant administration and, for PRN, this difference failed the non-inferiority criteria. While there is a small diminution in antibody response to tetanus and pertussis antigens, concomitant administration of Tdap and influenza vaccine was well tolerated and immunogenic and may offer practical advantages including convenience, compliance, and cost-savings.

Safety of reduced-antigen-content tetanus-diphtheria-acellular pertussis vaccine in adolescents as a sixth consecutive dose of acellular pertussis-containing vaccine

OBJECTIVE

The safety of a booster dose of a reduced-antigen-content tetanus-diphtheria-acellular pertussis (Tdap) vaccine was evaluated in adolescents previously vaccinated with five doses of acellular pertussis-containing vaccine.

STUDY DESIGN

Adolescents (n = 319) previously vaccinated with either 5 doses of diphtheria-tetanus-acellular pertussis (DTaP) (n = 193) or 4 doses of DTaP plus another acellular pertussis-containing vaccine received one dose each of Tdap and hepatitis A vaccine in a double-blinded, randomized, crossover trial. Rates of adverse events (AEs) after vaccination with Tdap versus hepatitis A and rates of local AEs among adolescents vaccinated with Tdap (sixth acellular pertussis-containing vaccine dose) versus rates in these same individuals after vaccination with their fifth DTaP dose were assessed.

RESULTS

After Tdap, pain (63.6%), redness (51.7%), and swelling (41.4%) were the most frequently reported AEs. Large injection site swelling (swelling > 100 mm, arm circumference increase > 50 mm or diffuse swelling interfering with daily activities) occurred in three adolescents and resolved without sequelae. After the sixth dose of acellular pertussis-containing vaccine, adolescents reported more pain and less redness and swelling compared with incidences of these AEs reported when these same individuals received their fifth DTaP dose.

CONCLUSIONS

These results suggest that Tdap is well tolerated as a sixth consecutive dose of acellular pertussis-containing vaccine.

Outbreak of pertussis in a neonatal intensive care unit--Louisiana, 2004

BACKGROUND

On November 12, 2004, a 5-month-old infant, admitted in the neonatal intensive care unit (NICU) of a Louisiana regional hospital since birth, was diagnosed with pertussis. Measures to prevent further transmission, in the NICU and beyond, were immediately put into place.

METHODS

Exposed contacts were identified among other patients of the NICU, health care workers, and family members. All were offered pertussis testing and prophylactic treatment.

RESULTS

The source of the outbreak was not identified. Despite the immediate implementation of control measures, a total of 37 additional NICU patients, 198 health care workers, and 15 family members were identified as potentially exposed contacts. Three more infants were diagnosed with pertussis, one of them after having been transferred to the NICU of another hospital in the state.

CONCLUSION

The source of this outbreak was believed to be an adult, either a hospital worker or an outside visitor. The incident clearly illustrates the infection control challenges for hospital units serving newborns and young infants in an era of changing epidemiology of pertussis.

Update on adolescent immunization: review of pertussis and the efficacy, safety, and clinical use of vaccines that contain tetanus-diphtheria-acellular pertussis

Adolescents, who comprise 14% of the US population, are historically resistant to receiving health care. As a result, adolescents have low immunization rates and are becoming more susceptible to diseases that are preventable by vaccine, such as pertussis. The incidence of pertussis has increased during the past 25 years, with a notable shift in incidence from young children to adolescents and young adults. New vaccines that provide protection against pertussis for use in adolescents have been proven to be safe, effective, and cost-beneficial. Regional epidemics among infants and other vulnerable populations can be reduced or eliminated with improved immunity in adolescents.

Reduced-Antigen, Combined Diphtheria, Tetanus, and Acellular Pertussis Vaccine (Boostrix???)

Reduced-antigen, combined diphtheria, tetanus, and acellular pertactin-containing pertussis vaccine (dTpa; Boostrix) contains reduced quantities of the same toxoids/antigens found in a diphtheria, tetanus, and acellular pertussis vaccine (DTPa; Infanrix) used for the primary immunization series in children. A single dose of dTpa (Boostrix) is indicated for booster vaccination against diphtheria, tetanus, and pertussis in individuals aged >or=4 years in Europe and Canada, in individuals aged >or=10 years in Australia, and in adolescents aged 10-18 years in the US.A single booster dose of dTpa (Boostrix) was safe and highly immunogenic for all its component toxoids/antigens when administered to adults, adolescents (including those previously unvaccinated), and children aged >or=4 years in clinical trials conducted in various countries worldwide. It was also well tolerated, as was a second (repeat) dose administered to a small number of adolescents who had previously received the vaccine as a preschool booster. Vaccinees generally reported a low incidence of severe/grade 3, solicited, local and general adverse events during the 1-month postvaccination period.Current recommendations for dTpa usage vary from country to country; they include one dose only in adolescence or adulthood (e.g. Australia, Canada, France, Switzerland, and the US), one dose at preschool age and one in adolescence (Germany), and one dose in adolescence followed by regular (10-year) doses during adulthood (Austria). Available data support the use of dTpa (Boostrix) in place of the combined diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) or DTPa booster dose in preschool children and/or the reduced-antigen, combined diphtheria, tetanus vaccine (Td) booster dose in adolescents, as well as in place of a regular Td booster dose in adults who have not previously received the vaccine.