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Bijukchhe SM, Gurung M, Pokhrel B, Shakya M, Pant D, Maskey P, Maskey H, Dhakal B, Rajkarkinar S, Bista S, Voysey M, Mujadidi YF, Kim YC, Atherton R, Jones E, Mclean F, Shrestha S, Hill M, Nyland KT, Kelly S, O'reilly P, Sah GP, Basnyat B, Pollard AJ, Shrestha S. Immune responses to typhoid conjugate vaccine in a two dose schedule among Nepalese children <2 years of age. Vaccine 2024; 42:2018-2025. [PMID: 38395723 DOI: 10.1016/j.vaccine.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Previously, the Vi-typhoid conjugate vaccine (Vi-TT) was found to be highly efficacious in Nepalese children under 16 years of age. We assessed the immunogenicity of Vi-TT at 9 and 12 months of age and response to a booster dose at 15 months of age. METHODS Infants were recruited at Patan Hospital, Kathmandu and received an initial dose of Vi-TT at 9 or 12 months of age with a booster dose at 15 months of age. Blood was taken at four timepoints, and antibody titres were measured using a commercial ELISA kit. The primary study outcome was seroconversion (4-fold rise in antibody titre) of IgG one month after both the doses. FINDINGS Fifty children were recruited to each study group.Some visits were disrupted by the COVID19 pandemic and occurred out of protocol windows.Both the study groups attained 100 % IgG seroconversion after the initial dose. IgG seroconversion in the 9-month group was significantly higher than in the 12-month group (68.42 % vs 25.8 %, p < 0.001). Among individuals who attended visits per protocol, IgG seroconversion after the first dose occurred in 100 % of individuals (n = 27/27 in 9-month and n = 32/32 in 12-month group). However, seroconversion rates after the second dose were 80 % in the 9-month and 0 % in the shorter dose-interval 12-month group (p < 0.001) (n = 16/20 and n = 0/8, respectively). INTERPRETATION Vi-TT is highly immunogenic at both 9 and 12 months of age. Stronger response to a booster in the 9-month group is likely due to the longer interval between doses.
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Affiliation(s)
- Sanjeev M Bijukchhe
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal; Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
| | - Meeru Gurung
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Bhishma Pokhrel
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Mila Shakya
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Dikshya Pant
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Pratistha Maskey
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Himang Maskey
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Babita Dhakal
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Shristy Rajkarkinar
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Sabitri Bista
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Merryn Voysey
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Yama F Mujadidi
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Young Chan Kim
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Rachel Atherton
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Jones
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Florence Mclean
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Sonu Shrestha
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Matilda Hill
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Sarah Kelly
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Peter O'reilly
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ganesh Prasad Sah
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Shrijana Shrestha
- Deparment of Paediatrics, Patan Academy of Health Sciences, Kathmandu, Nepal
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Kelly S, Liu X, Theiss-Nyland K, Voysey M, Murphy S, Li G, Nyantaro M, Gurung M, Basnet S, Pokhrel B, Bijukchhe SM, Eordogh A, Gombe B, Kakande A, Kerridge S, Kimbugwe G, Kusemererwa S, Lubyayi L, Luzze H, Mazur O, Mujadidi YF, Nabukenya S, Nagumo WR, Nareeba T, Noristani R, O'Reilly P, Roberts A, Shah G, Shrestha S, Shrestha LP, Thapa SB, Kibengo FM, Sharma AK, Elliott A, Shrestha S, Pollard AJ. Optimising DTwP-containing vaccine infant immunisation schedules (OptImms) - a protocol for two parallel, open-label, randomised controlled trials. Trials 2023; 24:465. [PMID: 37480110 PMCID: PMC10360224 DOI: 10.1186/s13063-023-07477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/26/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Universal immunisation is the cornerstone of preventive medicine for children, The World Health Organisation (WHO) recommends diphtheria-tetanus-pertussis (DTP) vaccine administered at 6, 10 and 14 weeks of age as part of routine immunisation. However, globally, more than 17 unique DTP-containing vaccine schedules are in use. New vaccines for other diseases continue to be introduced into the infant immunisation schedule, resulting in an increasingly crowded schedule. The OptImms trial will assess whether antibody titres against pertussis and other antigens in childhood can be maintained whilst adjusting the current Expanded Programme on Immunisation (EPI) schedule to provide space for the introduction of new vaccines. METHODS The OptImms studies are two randomised, five-arm, non-inferiority clinical trials in Nepal and Uganda. Infants aged 6 weeks will be randomised to one of five primary vaccination schedules based on age at first DTwP-vaccination (6 versus 8 weeks of age), number of doses in the DTwP priming series (two versus three), and spacing of priming series vaccinations (4 versus 8 weeks). Additionally, participants will be randomised to receive their DTwP booster at 9 or 12 months of age. A further sub-study will compare the co-administration of typhoid vaccine with other routine vaccines at one year of age. The primary outcome is anti-pertussis toxin IgG antibodies measured at the time of the booster dose. Secondary outcomes include antibodies against other vaccine antigens in the primary schedule and their safety. DISCUSSION These data will provide key data to inform policy decisions on streamlining vaccination schedules in childhood. TRIAL REGISTRATIONS ISRCTN12240140 (Nepa1, 7th January 2021) and ISRCTN6036654 (Uganda, 17th February 2021).
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Affiliation(s)
- Sarah Kelly
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Xinxue Liu
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Katherine Theiss-Nyland
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Merryn Voysey
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Sarah Murphy
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Grace Li
- Oxford Vaccine Group, University of Oxford, Oxford, UK.
- NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Mary Nyantaro
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Meeru Gurung
- Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Sudha Basnet
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Agnes Eordogh
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Ben Gombe
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | | | | | | | | | - Olga Mazur
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | | | - Walter-Rodney Nagumo
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Rabiullah Noristani
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Peter O'Reilly
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew Roberts
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Ganesh Shah
- Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Sonu Shrestha
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Laxman P Shrestha
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Surya B Thapa
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Arun K Sharma
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Alison Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Paireau J, Guillot S, Aït El Belghiti F, Matczak S, Trombert-Paolantoni S, Jacomo V, Taha MK, Salje H, Brisse S, Lévy-Bruhl D, Cauchemez S, Toubiana J. Effect of change in vaccine schedule on pertussis epidemiology in France: a modelling and serological study. THE LANCET. INFECTIOUS DISEASES 2022; 22:265-273. [PMID: 34672963 DOI: 10.1016/s1473-3099(21)00267-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND In April-May, 2013, France modified its pertussis vaccination schedule, which uses the acellular pertussis vaccine, from three primary doses at 2, 3, and 4 months of age and a first booster at 16-18 months of age (former schedule) to two primary doses at 2 and 4 months of age and a first booster at 11 months of age (new schedule). We aimed to assess the subsequent effect of the vaccine schedule change on pertussis epidemiology in France. METHODS In this modelling study, using data collected between Jan 1, 2012, and Dec 31, 2019, from French national surveillance sources, we analysed the PCR test results of nasopharyngeal swabs collected from symptomatic outpatients aged 2-20 years with suspected pertussis. We developed a negative binomial regression model for the number of confirmed pertussis cases by year and age to assess the relative risks of pertussis depending on vaccine schedule. The linear predictor included the year, the age group, the population size, and a proxy of waning immunity. We tested different models in which waning immunity could vary with vaccine schedule and type of primary vaccine. The models were fitted to the 2012-18 data via Bayesian Markov chain Monte Carlo sampling, and the 2019 data were left out for external model validation. We also compared the anti-pertussis toxin (PT) antibody concentrations in leftover sera from children not tested for pertussis or recent respiratory tract infection aged 2-5 years born before and after the vaccine schedule change. FINDINGS We collected data on 7493 confirmed cases of pertussis. The model that best fitted the 2012-18 epidemiological data supported a faster waning of immunity following vaccination with the new vaccine schedule. 3 years after vaccination, the risk of developing pertussis was 1·7 (95% CI 1·4-2·0) times higher for children vaccinated according to the new schedule than those vaccinated according to the former schedule. The model correctly predicted the age distribution of cases in 2019. Geometric mean concentrations (GMC) of anti-PT IgG were 50% lower in children aged 2 years vaccinated with the new schedule (GMC=5·85 IU/mL [95% CI 4·08-8·39]) than in children of the same age vaccinated with the former schedule (GMC=11·62 IU/mL [95% CI 9·05-14·92]; p=0·0016), and 43% lower in children aged 3 years vaccinated with the new schedule (GMC=3·88 IU/mL [95% CI 2·82-5·34]) than those with the former schedule (GMC=6·80 IU/mL [95% CI 4·77-9·70]; p=0·026). INTERPRETATION A shorter-lived protection induced by the new vaccine schedule recommended in France since 2013 is associated with an increase of pertussis cases in children aged 2-5 years. If similar findings are observed in other countries and clinical trials, these findings should be considered in future pertussis vaccination policies. FUNDING INCEPTION, Labex-IBEID, Institut Pasteur, and Santé Publique France.
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Affiliation(s)
- Juliette Paireau
- Mathematic Modelling of Infectious Diseases Unit, UMR 2000, CNRS, Institut Pasteur, Université de Paris, Paris, France; Direction des Maladies Infectieuses, Santé publique France, Saint Maurice, France
| | - Sophie Guillot
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Université de Paris, Paris, France; National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Université de Paris, Paris, France
| | - Fatima Aït El Belghiti
- Unité des Infections Respiratoires et Vaccination, Santé publique France, Saint Maurice, France
| | - Soraya Matczak
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Université de Paris, Paris, France; Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants malades University Hospital, Université de Paris, AP-HP, Paris, France
| | | | | | - Muhamed-Kheir Taha
- Invasive Bacterial Infection and National Reference Center for Meningococci and Haemophilus influenzae, Institut Pasteur, Université de Paris, Paris, France
| | - Henrik Salje
- Mathematic Modelling of Infectious Diseases Unit, UMR 2000, CNRS, Institut Pasteur, Université de Paris, Paris, France; Department of Genetics, University of Cambridge, UK
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Université de Paris, Paris, France; National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Université de Paris, Paris, France
| | - Daniel Lévy-Bruhl
- Unité des Infections Respiratoires et Vaccination, Santé publique France, Saint Maurice, France
| | - Simon Cauchemez
- Mathematic Modelling of Infectious Diseases Unit, UMR 2000, CNRS, Institut Pasteur, Université de Paris, Paris, France
| | - Julie Toubiana
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Université de Paris, Paris, France; National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Université de Paris, Paris, France; Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants malades University Hospital, Université de Paris, AP-HP, Paris, France.
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Domenech de Cellès M, Magpantay FMG, King AA, Rohani P. The pertussis enigma: reconciling epidemiology, immunology and evolution. Proc Biol Sci 2016; 283:rspb.2015.2309. [PMID: 26763701 DOI: 10.1098/rspb.2015.2309] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pertussis, a highly contagious respiratory infection, remains a public health priority despite the availability of vaccines for 70 years. Still a leading cause of mortality in developing countries, pertussis has re-emerged in several developed countries with high vaccination coverage. Resurgence of pertussis in these countries has routinely been attributed to increased awareness of the disease, imperfect vaccinal protection or high infection rates in adults. In this review, we first present 1980-2012 incidence data from 63 countries and show that pertussis resurgence is not universal. We further argue that the large geographical variation in trends probably precludes a simple explanation, such as the transition from whole-cell to acellular pertussis vaccines. Reviewing available evidence, we then propose that prevailing views on pertussis epidemiology are inconsistent with both historical and contemporary data. Indeed, we summarize epidemiological evidence showing that natural infection and vaccination both appear to provide long-term protection against transmission and disease, so that previously infected or vaccinated adults contribute little to overall transmission at a population level. Finally, we identify several promising avenues that may lead to a consistent explanation of global pertussis epidemiology and to more effective control strategies.
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Affiliation(s)
| | - Felicia M G Magpantay
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aaron A King
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pejman Rohani
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA Odum School of Ecology, University of Georgia, Athens, GA 30602, USA College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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Silfverdal SA, Assudani D, Kuriyakose S, Van Der Meeren O. Immunological persistence in 5 y olds previously vaccinated with hexavalent DTPa-HBV-IPV/Hib at 3, 5, and 11 months of age. Hum Vaccin Immunother 2015; 10:2795-8. [PMID: 25483640 PMCID: PMC5443106 DOI: 10.4161/21645515.2014.970494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The combined diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis/Haemophilus influenza vaccine (DTPa-HBV-IPV/Hib: Infanrix™ hexa, GlaxoSmithKline Vaccines) is used for primary vaccination of infants in a range of schedules world-wide. Antibody persistence after 4 DTPa-HBV-IPV/Hib doses in the first 2 y of life has been documented, but long-term persistence data following the 3, 5, 11–12 months (3–5–11) infant vaccination schedule, employed for example in Nordic countries, are limited. We assessed antibody persistence in 57 5-year-old children who had received either DTPa-HBV-IPV/Hib or DTPa-IPV/Hib (Infanrix™-IPV/Hib, GlaxoSmithKline Vaccines) in the 3–5–11 schedule. Among DTPa-HBV-IPV/Hib recipients, 7/12 retained seroprotective antibody concentrations for diphtheria, 10/12 for tetanus, 5/12 for hepatitis and 10/12 for Hib. Detectable antibodies were observed for 0/12 children for pertussis toxin (PT), 12/12 for filamentous haemagglutinin (FHA) and 8/12 for pertactin (PRN). Among DTPa-IPV/Hib recipients, 28/45 retained seroprotective anti-diphtheria concentrations, 34/44 for tetanus and 40/45 for Hib. Detectable antibodies were observed for 9/45 children for PT, 41/45 for FHA and 34/45 for PRN. Antibody persistence in DTPa-HBV-IPV/Hib and DTPa-IPV/Hib-vaccinees appeared similar in 5 y olds to that previously observed in children of a similar age who had received 4 prior doses of DTPa-HBV-IPV/Hib (or DTPa-IPV/Hib). As in subjects primed with 4 prior doses, we observed that antibodies markedly declined by 5 y of age, calling for the administration of a pre-school booster dose in order to ensure continued protection against pertussis.
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Key Words
- CI, confidence interval
- DTPa-HBV-IPV/Hib, - diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus and Haemophilus influenzae type b vaccine
- DTPa-IPV/Hib, diphtheria-tetanus-acellular pertussis-inactivated poliovirus and Haemophilus influenzae type b vaccine
- FHA, filamentous haemagglutinin
- GMC, geometric mean antibody concentration
- HBs, anti-hepatitis B surface antigen
- Hib, Haemophilus influenzae type b
- NA, not applicable
- PRN, pertactin
- PRP, polyribosylribitol phosphate
- PT, pertussis toxin
- antibody persistence
- booster
- vaccination schedule
- vaccine
- μg/ml, micrograms per milliliter
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Affiliation(s)
- Sven A Silfverdal
- a Department of Clinical Sciences; Pediatrics ; Umeå University ; Umeå , Sweden
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Verdijk P, Rots NY, Bakker WAM. Clinical development of a novel inactivated poliomyelitis vaccine based on attenuated Sabin poliovirus strains. Expert Rev Vaccines 2014; 10:635-44. [DOI: 10.1586/erv.11.51] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Mangal TD, Aylward RB, Grassly NC. The potential impact of routine immunization with inactivated poliovirus vaccine on wild-type or vaccine-derived poliovirus outbreaks in a posteradication setting. Am J Epidemiol 2013; 178:1579-87. [PMID: 24100955 DOI: 10.1093/aje/kwt203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The "endgame" for worldwide poliomyelitis eradication will entail eventual cessation of the use of oral poliovirus vaccine (OPV) in all countries to prevent the reintroduction of vaccine-derived polioviruses--exposing some populations to an unprecedented, albeit low, risk of poliovirus outbreaks. Inactivated poliovirus vaccine (IPV) is likely to play a large part in post--OPV management of poliovirus risks by reducing the consequences of any reintroduction of poliovirus. In this article, we examine the impact IPV would have on an outbreak in a partially susceptible population after OPV cessation, using a mathematical model of poliovirus transmission with a realistic natural history and case reporting. We explore a range of assumptions about the impact of IPV on an individual's infectiousness, given the lack of knowledge about this parameter. We show that routine use of IPV is beneficial under most conditions, increasing the chance of fadeout and reducing the expected prevalence of infection at the time of detection. The duration of "silent" poliovirus circulation prior to detection lengthens with increasing coverage of IPV, although this only increases the expected prevalence of infection at the time of the OPV response if IPV has a very limited impact on infectiousness. Overall, the model predicts that routine use of IPV will be advantageous for the posteradication management of poliovirus.
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Baldo V, Bonanni P, Castro M, Gabutti G, Franco E, Marchetti F, Prato R, Vitale F. Combined hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type B vaccine; Infanrix™ hexa: twelve years of experience in Italy. Hum Vaccin Immunother 2013; 10:129-37. [PMID: 24004825 PMCID: PMC4181021 DOI: 10.4161/hv.26269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Infant vaccination using 2-dose priming at 3 and 5 mo of age with a booster at 11–12 mo of age was pioneered in Italy. The 3-5-11 schedule is now used in a growing number of European countries. Infanrix™ hexa (DTPa-HBV-IPV/Hib, GlaxoSmithKline Vaccines) was first licensed for use in 2000 and has been the only pediatric hexavalent vaccine available since 2005. We reviewed available clinical trial data describing the immunogenicity of DTPa-HBV-IPV/Hib when administered at 3, 5, and 11 mo of age, and conducted an analysis of safety using global and Italian post-marketing surveillance data. In Italy, DTPa-HBV-IPV/Hib has a demonstrated safety record extending over a decade of use, it has been associated with record levels of vaccine coverage, and with sustained disease control in vaccinated cohorts. Hexavalent vaccines will continue to contribute to high vaccine coverage in Italy and across Europe.
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Affiliation(s)
- Vincenzo Baldo
- Department Molecular Medicine; Laboratory of Public Health; University of Padua; Padua, Italy
| | - Paolo Bonanni
- Department of Health Sciences; University of Florence; Florence, Italy
| | | | - Giovanni Gabutti
- O.U. Hygiene and Public Health; Department of Prevention; Chiavarese-Liguria Region, Italy
| | - Elisabetta Franco
- Department of Biomedicine and Prevention; University Tor Vergata; Rome, Italy
| | | | - Rosa Prato
- Department of Medical and Surgical Sciences; University of Foggia; Foggia, Italy
| | - Francesco Vitale
- Department of Sciences for Health Promotion and Mother to Child Care "G.D'Alessandro"; Hygiene section; University of Palermo; Palermo, Italy
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Lungarde K, Blaizeau F, Auger-Aubin I, Floret D, Gilberg S, Jestin C, Hanslik T, Le Goaster C, Lévy-Bruhl D, Blanchon T, Rossignol L. How French physicians manage with a future change in the primary vaccination of infants against diphtheria, tetanus, pertussis and poliomyelitis? A qualitative study with focus groups. BMC FAMILY PRACTICE 2013; 14:85. [PMID: 23782853 PMCID: PMC3691920 DOI: 10.1186/1471-2296-14-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 06/14/2013] [Indexed: 11/18/2022]
Abstract
Background As in other European countries, the French vaccination schedule changes according to epidemiological and socio-economic situations. Further changes are planned for 2013, including the withdrawal of one dose for primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. A partnership between the French Technical Vaccination Committee and the French Institute for Health and Medical Research designed a study to assess primary care physicians’ agreement about this modification. Methods Qualitative study with focus groups and semi-structured interviews in France. Four focus groups were conducted with physicians, supplemented by four individual interviews. Results The physicians of the survey had accepted the suggested vaccination schedule well. A few concerns had been underlined: fear of less follow-up care for infants resulting from the removal of one visit driven by the primary vaccination; fear of loss of vaccine efficacy; suspicion of the existence of financial arguments at the origin of this change; and adjustment to current vaccination schedule. Several suggestions were made: providing strong support from health authorities; developing stable and simple recommendations; providing effective tools for monitoring patient’s vaccination status. Conclusions Physicians’ opinions suggested a good acceptance of a possible change about primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. Physicians’ suggestions resulted from this qualitative study on a new vaccination schedule. It showed how that their involvement was feasible for preparing the implementation of a new vaccination schedule.
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Perplexities of pertussis: recent global epidemiological trends and their potential causes. Epidemiol Infect 2013; 142:672-84. [PMID: 23324361 DOI: 10.1017/s0950268812003093] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent much-publicized increases in pertussis case reports in some countries with high vaccine coverage have raised concerns about its current and future control. The ubiquity of this trend, however, remains unexamined. In an attempt to paint a global picture, we used case counts to determine which countries experienced statistically significant trends in incidence over the past two decades and to map changes in incidence during this period. These data reveal that pertussis resurgence is not a universal phenomenon. The heterogeneity in incidence trends, even in countries with superficially similar demography, socioeconomic conditions and vaccination programmes, is striking and requires explanation. In this opinion piece, we review and assess the multifaceted proposed explanations incorporating evolution, population dynamics, and the details of immunization programmes. While we do not solve the riddle that is pertussis epidemiology, we highlight critical aspects that are likely to hold the key to understanding its worldwide epidemiology.
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Van Der Meeren O, Kuriyakose S, Kolhe D, Hardt K. Immunogenicity of Infanrix™ hexa administered at 3, 5 and 11 months of age. Vaccine 2012; 30:2710-4. [PMID: 22349525 DOI: 10.1016/j.vaccine.2012.02.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/30/2012] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
A pooled analysis of data from four vaccination studies conducted in Europe was undertaken to assess the immunogenicity of Infanrix™ hexa (DTPa-HBV-IPV/Hib, GlaxoSmithKline Biologicals) when administered in a total of 702 healthy infants at 3, 5 and 11-12 months of age. One month after dose 2, between 96.3% and 100% of subjects had seroprotective antibodies against diphtheria, tetanus, hepatitis B and poliovirus types 1, 2 and 3; 91.7% against Hib and ≥99.0% were seropositive for each pertussis antigen. One month after the third dose, 98.9-100% of subjects were seroprotected/seropositive for all vaccine antigens. Geometric mean antibody concentrations/titres for each vaccine antigen increased by 6.7-52.9 fold after the third vaccine dose. No serious adverse events in DTPa-HBV-IPV/Hib recipients were vaccine related. Infanrix™ hexa induces an adequate immune response after 2-dose primary plus booster doses when administered according to a 3, 5 and 11 months schedule.
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Gentile A, Umido V, Czerniuk P, Nacul J, Seigelchifer M, Hilbert AK, Yela U, Herzog C, Aeberhard U, Spyr C. Immunogenicity and reactogenicity of a combined fully liquid DTPw–HepB–Hib pentavalent vaccine in healthy infants: no clinically relevant impact of a birth dose of hepatitis B vaccine. Int J Infect Dis 2011; 15:e24-9. [PMID: 21093342 DOI: 10.1016/j.ijid.2010.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022] Open
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Väkeväinen M, Soininen A, Lucero M, Nohynek H, Auranen K, Mäkelä PH, Williams G, Käyhty H. Serotype-specific hyporesponsiveness to pneumococcal conjugate vaccine in infants carrying pneumococcus at the time of vaccination. J Pediatr 2010; 157:778-83.e1. [PMID: 20547399 DOI: 10.1016/j.jpeds.2010.04.071] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/01/2010] [Accepted: 04/30/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether pneumococcal carriage at the time of 11-valent pneumococcal conjugate vaccine (PCV-11) administration interferes with immune response in infants. STUDY DESIGN A total of 1111 Filipino infants recruited into an immunogenicity and carriage study, nested in an efficacy trial, received PCV-11 or saline solution placebo at 6, 10, and 14 weeks of age. Antibody concentrations to the most frequently carried vaccine serotypes 6B, 19F, and 23F were measured by enzyme immunoassay from sera obtained at 18 weeks and 9 months of age. Serotype-specific antibody concentration was compared between groups of children among PCV-11 recipients stratified according to their carriage status at 6 weeks of age. RESULTS Antibody concentrations to 6B, 19F, and 23F were significantly lower at 18 weeks and 9 months of age among children who were carriers of the specific serotype at 6 weeks of age than among non-carriers of the serotype. The hyporesponsiveness was specific to the carried serotype. The specific antibody concentrations induced by PCV-11 among carriers did not differ significantly from those in placebo recipients, whereas the differences were highly significant among noncarriers. CONCLUSIONS Pneumococcal carriage, prevalent in Filipino infants, interferes with serotype-specific immune response to primary series of PCV and has potential implications for immunization programs.
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Affiliation(s)
- Merja Väkeväinen
- National Institute for Health and Welfare, Helsinki and Oulu, Finland
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Gabutti G, Zepp F, Schuerman L, Dentico P, Bamfi F, Soncini R, Habermehl P, Knuf M, Crovari P. Evaluation of the immunogenicity and reactogenicity of a DTPa-HBV-IPV combination vaccine Co-administered with a hib conjugate vaccine either as a single injection of a hexavalent combination or as two separate injections at 3, 5 and 11 months of age. ACTA ACUST UNITED AC 2009; 36:585-92. [PMID: 15370670 DOI: 10.1080/00365540410017572] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A combined DTPa-HBV-IPV/Hib vaccine containing diphtheria (D), tetanus (T), acellular pertussis (Pa), hepatitis B (HBV) and types 1, 2 and 3 inactivated polioviruses (IPV) extemporaneously mixed with a conjugated Haemophilus influenzae type b (Hib) vaccine (Group 1) was compared to the DTPa-HBV-IPV and Hib vaccines (Group 2) administered separately at 3, 5 and 11 months of age (n = 440). A microneutralization assay was used to detect antibodies against the 3 polio virus types (cut-off 1:8 dil), RIA for anti-HBs antibodies (cut-off 10 mIU/ml) and ELISA for antibodies against all other vaccine antigens (cut-off: 0.1 IU/ml for anti-tetanus and anti-diphtheria antibodies; 5 El.U/ml for antibodies against each of the 3 acellular pertussis antigens and 0.15 microg/ml for anti-PRP antibodies). Similar immune responses were observed in both groups 1 month after dose 2 as well as after dose 3. Six months after dose 2 however, the proportion of subjects maintaining an anti-tetanus antibody concentration > or = 0.1 IU/ml was lower in Group 2 and a slight group difference in favour of Group 1 was also observed for anti-PRP, anti-diphtheria and anti-polio type 1 antibody persistence prior to the third dose. The overall incidence of local and general solicited symptoms was similar in both groups. One subject discontinued study vaccination following an SAE considered to be related to vaccination. The DTPa-HBV-IPV/Hib combined vaccine is immunogenic and well tolerated when administered according to a 3, 5 and 11 month vaccination schedule and can therefore be considered as a feasible alternative to the separate administration of the pentavalent DTPa-HBV-IPV and the monovalent Hib vaccines.
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MESH Headings
- Antibodies, Bacterial/analysis
- Antibodies, Bacterial/immunology
- Antibodies, Viral/analysis
- Antibodies, Viral/immunology
- Bacterial Capsules
- Confidence Intervals
- Diphtheria-Tetanus-Pertussis Vaccine
- Enzyme-Linked Immunosorbent Assay
- Female
- Follow-Up Studies
- Germany
- Haemophilus Vaccines/administration & dosage
- Haemophilus Vaccines/adverse effects
- Haemophilus Vaccines/immunology
- Hepatitis B Vaccines
- Humans
- Immunity, Cellular/physiology
- Immunization Schedule
- Infant
- Injections, Intramuscular
- Italy
- Male
- Poliovirus Vaccine, Inactivated
- Polysaccharides, Bacterial/administration & dosage
- Polysaccharides, Bacterial/adverse effects
- Polysaccharides, Bacterial/immunology
- Probability
- Risk Assessment
- Vaccination/methods
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/adverse effects
- Vaccines, Combined/immunology
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Affiliation(s)
- Giovanni Gabutti
- Laboratory of Hygiene, Di.S.Te.B.A. University of Lecce, Lecce, Italy.
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Ellis RD, Mullen GED, Pierce M, Martin LB, Miura K, Fay MP, Long CA, Shaffer D, Saul A, Miller LH, Durbin AP. A Phase 1 study of the blood-stage malaria vaccine candidate AMA1-C1/Alhydrogel with CPG 7909, using two different formulations and dosing intervals. Vaccine 2009; 27:4104-9. [PMID: 19410624 DOI: 10.1016/j.vaccine.2009.04.077] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 04/20/2009] [Accepted: 04/25/2009] [Indexed: 12/31/2022]
Abstract
A Phase 1 study was conducted in 24 malaria naïve adults to assess the safety and immunogenicity of the recombinant protein vaccine apical membrane antigen 1-Combination 1 (AMA1-C1)/Alhydrogel with CPG 7909 in two different formulations (phosphate buffer and saline), and given at two different dosing schedules, 0 and 1 month or 0 and 2 months. Both formulations were well tolerated and frequency of local reactions and solicited adverse events was similar among the groups. Peak antibody levels in the groups receiving CPG 7909 in saline were not significantly different than those receiving CPG 7909 in phosphate. Peak antibody levels in the groups vaccinated at a 0,2 month interval were 2.52-fold higher than those vaccinated at a 0,1 month interval (p=0.037, 95% CI 1.03, 4.28). In vitro growth inhibition followed the antibody level: median inhibition was 51% (0,1 month interval) versus 85% (0,2 month interval) in antibody from samples taken 2 weeks post-second vaccination (p=0.056).
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Affiliation(s)
- Ruth D Ellis
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Twinbrook I, MD 20852, USA.
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Bråve A, Hallengärd D, Gudmundsdotter L, Stout R, Walters R, Wahren B, Hallermalm K. Late administration of plasmid DNA by intradermal electroporation efficiently boosts DNA-primed T and B cell responses to carcinoembryonic antigen. Vaccine 2009; 27:3692-6. [PMID: 19428161 DOI: 10.1016/j.vaccine.2009.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 03/30/2009] [Accepted: 04/03/2009] [Indexed: 12/24/2022]
Abstract
Heterologous boost immunisation is considered the most efficient way to enhance DNA-primed immune responses. We have previously shown that administration of recombinant carcinoembryonic antigen (CEA) efficiently boosts humoral responses in mice primed with CEA DNA. However, clinical grade recombinant proteins are far more intriguing to produce than plasmid DNA. Therefore, the possibility to use plasmid DNA for both priming and boosting would be beneficial. With the prospect of future use in a clinical trial, we investigated if electroporation-mediated delivery of DNA could be used to boost DNA-primed immune responses to CEA. The Biojector was used to prime BALB/c mice intradermally three times with CEA66 DNA, encoding an intracellular modified form of CEA. Twelve weeks after the last prime, the animals received either one injection of recombinant CEA or one intradermal injection of twtCEA DNA, encoding the wild type CEA fused to a tetanus T helper epitope, in combination with electroporation. Boosting with rCEA protein did not enhance T cell responses to CEA but induced CEA-specific IgG in 4 of 8 mice. In contrast, intradermal delivery of twtCEA DNA by electroporation led to a tenfold increase in IFN-gamma-producing CD8+ T cells, compared to the levels obtained after the third priming immunisation. The DNA boost also induced high CEA-specific IgG titers in all immunised animals (8/8). The data suggests that a late DNA boost, in combination with enhanced DNA delivery by electroporation, could be used to enhance the efficiency of DNA vaccination and substitute for a heterologous protein boost vaccination.
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Affiliation(s)
- Andreas Bråve
- Department of Virology, Swedish Institute for Infectious Disease Control, Stockholm, Sweden
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Maintaining protection against invasive bacteria with protein–polysaccharide conjugate vaccines. Nat Rev Immunol 2009; 9:213-20. [DOI: 10.1038/nri2494] [Citation(s) in RCA: 309] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Long-term antibody persistence in children primed and boosted with a DTPw-HBV vaccine at 2, 4, 6, 18, months of age. Vaccine 2008; 26:1535-40. [DOI: 10.1016/j.vaccine.2008.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 11/19/2007] [Accepted: 01/11/2008] [Indexed: 11/17/2022]
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Vitek CR, Wharton M. Diphtheria toxoid. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
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Brice GT, Dobaño C, Sedegah M, Stefaniak M, Graber NL, Campo JJ, Carucci DJ, Doolan DL. Extended immunization intervals enhance the immunogenicity and protective efficacy of plasmid DNA vaccines. Microbes Infect 2007; 9:1439-46. [PMID: 17913540 DOI: 10.1016/j.micinf.2007.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 07/25/2007] [Accepted: 07/26/2007] [Indexed: 10/23/2022]
Abstract
Effective vaccines against infectious diseases and biological warfare agents remain an urgent public health priority. Studies have characterized the differentiation of effector and memory T cells and identified a subset of T cells capable of conferring enhanced protective immunity against pathogen challenge. We hypothesized that the kinetics of T cell differentiation influences the immunogenicity and protective efficacy of plasmid DNA vaccines, and tested this hypothesis in the Plasmodium yoelii murine model of malaria. We found that increasing the interval between immunizations significantly enhanced the frequency and magnitude of CD8+ and CD4+ T cell responses as well as protective immunity against sporozoite challenge. Moreover, the interval between immunizations was more important than the total number of immunizations. Immunization interval had a significantly greater impact on T cell responses and protective immunity than on antibody responses. With prolonged immunization intervals, T cell responses induced by homologous DNA only regimens achieved levels similar to those induced by heterologous DNA prime/ virus boost immunization at standard intervals. Our studies establish that the dosing interval significantly impacts the immunogenicity and protective efficacy of plasmid DNA vaccines.
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Affiliation(s)
- Gary T Brice
- Malaria Program, Naval Medical Research Center, Silver Spring, MD 20910-7500, USA.
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Trollfors B, Knutsson N, Taranger J, Mark A, Bergfors E, Sundh V, Lagergård T. Diphtheria, tetanus and pertussis antibodies in 10-year-old children before and after a booster dose of three toxoids: implications for the timing of a booster dose. Eur J Pediatr 2006; 165:14-8. [PMID: 16249929 DOI: 10.1007/s00431-005-1763-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 06/25/2005] [Accepted: 06/27/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED In an open study, 502 10-year-old children, who had received primary vaccination against diphtheria and tetanus in infancy and had varying histories of pertussis disease and vaccination, were vaccinated with diphtheria-tetanus vaccine (DT) alone or with the addition of 20 microg or 40 microg of pertussis toxoid. Diphtheria toxin neutralising antibodies, pertussis toxin IgG and tetanus toxoid IgG antibodies were measured before and 1 month after the booster. All toxoids were highly immunogenic. In pertussis toxoid recipients, median levels of pertussis toxin IgG increased to 16.5 U/ml (DTaP20) and to 36 U/ml (DTaP40) in children with non-detectable (<1 U/ml) antibodies before vaccination and to >400 U/ml in children (both DTaP20 and DTaP40) with detectable antibodies before vaccination. A total of 60 children (12%) with non-detectable (<0.01 IU/ml) diphtheria antibodies and 36 children (7%) with non-detectable (<0.01 IU/ml) tetanus antibodies before the booster had lower median antibody concentrations post-vaccination than children with detectable antibodies before the booster (diphtheria: 5.12 vs. 20.48 IU/ml; tetanus: 4.0 vs. 10.0 IU/ml). There were no differences in diphtheria and tetanus antibodies after vaccination between children who did and did not receive pertussis toxoid. CONCLUSION 10-year-old children with non-detectable diphtheria and tetanus antibodies before the booster had lower post-vaccination antibodies than those with detectable antibodies before the booster indicating a poor immunological memory. Addition of pertussis toxoid to diphtheria-tetanus vaccine did not affect the antibody responses to diphtheria and tetanus toxoids when the three toxoids were combined as a booster. Even though immunity to diphtheria and tetanus was only estimated by surrogate markers (serum antitoxin antibodies) the results indicate that a lower age for the booster dose of diphtheria-tetanus vaccine or diphtheria-tetanus acellular pertussis vaccine should be considered.
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Affiliation(s)
- Birger Trollfors
- Department of Paediatrics, Sahlgrenska University Hospital/East, 41685, Göteborg, Sweden.
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Pertussis: An Old Disease That is Still With Us *. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2002. [DOI: 10.1097/00019048-200206000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Our knowledge of pathogenesis, clinical presentation and prevention of pertussis has improved substantially over recent years. We now better understand the function of long-known virulence factors for Bordetella pertussis, and genome sequencing has identified a multitude of new proteins; their functions are yet to be elucidated. Furthermore, improved diagnostic tools have revealed the broad spectrum of disease, and new insights into the host's immune response have been gained. Finally, the development, evaluation, licensing and implementation of several new acellular pertussis vaccines with high acceptance have changed the epidemiology of pertussis in many countries (i.e. a shift towards an increasing burden of disease in adolescent persons and adults). These developments are likely to have great impact on the daily practice not only of paediatricians, but also of general practitioners, internists, gynaecologists and many other specialists in adolescent and adult medicine. The present review provides an update on recent progress.
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Affiliation(s)
- U Heininger
- University Children's Hospital, Basel, Switzerland.
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