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Bordetella pertussis is a highly contagious bacterium known to cause pertussis (whooping cough) and is transmitted via airborne droplets. Although childhood vaccination has dramatically reduced reported pertussis cases, the incidence of the disease has increased over the past 20 years, most notably in previously immunized adolescents and adults. Pertussis should be suspected in patients of all ages with cough who meet the clinical criteria for the disease. Diagnostic tests currently approved by the U.S. Food and Drug Administration for pertussis infection have low sensitivity. Regardless of test results, physicians should treat clinically suspected pertussis with antimicrobials and report cases to their state health department. A 14-day erythromycin regimen has been the treatment of choice; however, shorter-course macrolide antibiotics (e.g., azithromycin, clarithromycin) may be as effective with fewer adverse effects and better adherence to therapy. The recently recommended tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for adolescents and adults may decrease the incidence of pertussis in infants--the group at the greatest risk of pertussis complications.
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PMID:Pertussis: a disease affecting all ages. 1691 56

The present inter-University study aims to analyze the vaccine statute of the Belgian French-speaking general practionners and the reasons of their possible non-vaccination. A questionnaire with an exhaustive list of vaccines was sent by postal way to a random sample of thousand two hundred and twenty general practitioners. The results were analyzed via SPSS 13. The rate of answer is 60.83%. Two thirds of the doctors (67%) considered themselves in order of vaccination anti-influenza. A majority of doctors (59.7%) is vaccinated systematically each year. The majority of the doctors (83%) considered themselves in antitetanus order of vaccination. Two thirds (67%) think that the vaccine protects from 5 to 10 years. Nearly 73% of the doctors considered themselves in order of vaccination against hepatitis B. More than 50% of the doctors received a vaccine HBV since less than 10 years. The majority of the doctors (79.2%) made a blood control of their protection after vaccination HBV Almost half of the doctors thinks that the vaccine protect for life, 23% from 10 to 20 years and 14% from 5 to 10 years. Two thirds (67%) of the doctors did not make a vaccine against rubella. In 80% of the cases vaccination dated from more than 20 years. In nearly two thirds of the cases the doctors did not make blood control of their protection. Nearly 60% of the questioned doctors think that vaccination offers a protection to life. About half of the doctors did not consider themselves in order of vaccination against the whooping-cough. In three quarter of the cases last vaccination dated from more than 20 years. The two principal durations of protection of the vaccine are with life and between 10 and 20 years. Three quarters of the questioned doctors are considered in order of vaccination against the poliomyelitis. However in 62% of the cases the last vaccine goes up with more than 20 years. More two thirds of the doctors think than the vaccine protects with life or from 10 to 20 years. Two thirds of doctors considered themselves in order of vaccination against the diphteria. For a third of the doctors the vaccine dated from less than 5 years, in more than one quarter of the cases to more than 20 years like between 5 and 10 years. About half of the doctors said they were vaccinated against other pathologies: hepatitis A (34.5%), the yellow fever (21.1%), the thyphoid fever (12.5%), the BCG (8.9%), the pneumococcus (6.6%), meningitis and variola (5%). In the French Community, the vaccine coverage of the general practitioners against the influenza (67%), tetanus (83%) and hepatitis B (73%) is, in this study, higher or equal to the other Belgian and international studies but remains insufficient. A bad vaccine coverage is observed concerning rubella, the whooping-cough, the poliomyelitis. The answers over the durations of protection of the vaccines are rather disparate and show a bad knowledge of these durations and diagrams of vaccination. An update of this knowledge could be carried out during the continuous medical trainings.
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PMID:[Evaluation of the vaccine coverage of the general practitioners in the French Community]. 1709 94

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.
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PMID:Pertussis in adolescents. 1756 26

The aim of this study was to evaluate the existence and the rate of pertussis infection in December 2002 among the symptomatic contacts in Konurhaciobasi village of Kirikkale province (placed in middle Anatolia, Turkey, with a population of 500 people), where a laboratory-confirmed pertussis case was defined by culture positivity. Sixty contacts with cough history of more than two weeks have been interviewed and their nasopharyngeal swabs have been collected together with the serum samples from 47 of them. "Probable case" definition included cough lasting longer than two weeks together with at least one of the following symptoms: paroxysms of cough, inspiratory "whooping" and post-tussive vomiting without other apparent cause. The samples were inoculated onto cephalexin Bordet-Gengou agar (C-BGA), and following the growth of suspected colonies identification tests including slide agglutination by using Bordetella pertussis phase 1 and B.parapertussis specific antisera, were performed. IgG antibodies against B.pertussis were searched with an in-house ELISA method by using purified pertussis toxin, and titers of > or = 100 ELISA units (EU)/ml were considered as acute/recent infection. Among the subjects 80% were children and 75% were female. Thirty-six subjects (76.6%) had a history of immunization with 3-4 doses of diphtheria-pertussis-tetanus (DPT) vaccine. According to questionnaires the mean household number was calculated as 5.0 +/- 0.26. Fifteen contacts (age range: 4-12 years, 11 were female) were defined as "probable cases", however all of them were found to be culture negative. All these cases had been vaccinated with DPT vaccine. Among the probable cases 12 serum samples were available, and six of them were evaluated as acute/recent pertussis infection, since their antibody titers were found as > or = 100 EU/ml. In addition, the evaluation of ELISA results of 47 individuals indicated that 27 of them had antibody titers of > or = 100 EU/ml, who could be considered as acute or recent pertussis infection. The data of this field survey indicated a possible pertussis outbreak in this village.
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PMID:[A field survey carried out on the confirmation of a pertussis case in a village of Kirikkale Province, Turkey]. 1768 3

After 2 decades of development, acellular pertussis vaccines are becoming more widely available for use. Products that contain from 1 to 5 purified antigens of Bordetella pertussis have been assessed in safety, immunogenicity and efficacy studies and are licensed in an increasing number of countries. All acellular pertussis vaccines are associated with fewer local and systemic adverse reactions than the whole-cell pertussis vaccines that have been used for the last 50 years. The acellular pertussis vaccines elicit an antibody response that is generally equivalent to that seen with the whole-cell pertussis vaccines. The acellular pertussis vaccines are effective; using a case-definition of paroxysmal cough of 21 or more days and laboratory confirmation of pertussis, protective efficacy was variable but in excess of 70% for most products. Relative efficacy of the acellular pertussis vaccines and the whole-cell pertussis vaccines was also variable, depending on the products involved and the study design. The choice of antigen content for acellular pertussis vaccines is controversial. Although there are proponents of a monocomponent pertussis toxoid vaccine, the weight of evidence suggests that multicomponent vaccines containing pertussis toxoid and filamentous haemagglutinin and pertactin are more effective than 1- or 2-component vaccines, and that the addition of fimbriae may provide additional protection against less severe disease. Acellular pertussis vaccines are all available in combination with diphtheria and tetanus toxoids; some products also contain inactivated poliovirus vaccine and Haemophilus influenzae b-conjugate vaccine or hepatitis B vaccine. Not all acellular pertussis vaccines are available in these larger combinations because of difficulties with decreased antibody response to one or more antigens in the combined product. Future directions for research into acellular pertussis vaccines include optimisation of antigen content and administration schedule, and further development of multicomponent vaccines.
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PMID:Developing better paediatric vaccines: the case of pertussis vaccine. 1803 Nov 75

Recent legislative texts have changed vaccinal policy and reinforced the role of midwives in vaccine prevention in perinatal healthcare. Quite as paediatricians and obstetricians-gynecologists, midwives can now prescribe and carry out, for the mothers, vaccines against rubella, tetanus, poliomyelitis, diphtheria, hepatitis B, influenza and whooping-cough and for the newborns vaccines against hepatitis B and tuberculosis. Concerning vaccinations, practitioners have to respect the vaccination calendar and a collaborative action is useful and necessary. These national guidelines are regularly updated when new vaccines and new recommendations come to light, for example for children (papillomavirus, tuberculosis, pneumococcus...), young adults (varicella, whooping-cough) and health professions in contact with very young children (varicella, measles, influenza and whooping-cough). The recent changes in tuberculosis prevention from routine vaccination of all newborn infants to selective vaccination lead to reinforce measures to detect the infants at higher risk, for them to be vaccinated before discharge at home. Midwives and nurses occupy a central place in family policy and become, with obstetricians-gynecologists and pediatricians, key actors for the effectiveness and the success of vaccine strategies in perinatal health.
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PMID:[Vaccine prevention in perinatal health care: parents, children and professionals]. 1841 9

The number of pertussis cases in Japan has decreased dramatically following the nationwide use of an acellular pertussis vaccine combined with diphtheria-tetanus toxoids (DTaP vaccines) which began in 1981. However, the effectiveness of the DTaP vaccine has not been systematically evaluated using appropriate epidemiological methods during a non-epidemic period in Japan. We evaluated the vaccine effectiveness (VE) of the Kaketsuken DTaP vaccine which contains two-component pertussis antigens in Japanese children from 1999 to 2001 using a matched case-control design and data from the Basic Resident Registration and Maternal and Child Health Handbooks. The DTaP vaccination history of 15 children with pertussis and 59 controls was obtained. The VE of 3 or 4 pertussis vaccinations compared with non-vaccination (baseline) was 96.9% for coughing attacks that lasted 7 days, 96.4% for those lasting 14 days, and 95.9% for those lasting 21 days. These findings suggest that DTaP vaccination effectively prevented pertussis during a non-epidemic period in Japan.
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PMID:Effectiveness of an acellular pertussis vaccine in Japanese children during a non-epidemic period: a matched case-control study. 1847 25

On July 10, 2004, staff members at a children's hospital in Texas noted that six infants with pertussis diagnosed by clinical symptoms and confirmed by polymerase chain reaction (PCR) testing had all been born during June 4-16 at the same area general hospital. The infants had symptoms consistent with pertussis, including cough, congestion, cyanosis, emesis, or apnea. Infection-control personnel at the general hospital (general hospital A), children's hospital (children's hospital A), and the county health department investigated and determined that an outbreak of pertussis among 11 newborns at general hospital A had occurred after direct exposure to a health-care worker (HCW) with pertussis. This report describes the outbreak investigation and highlights the importance of following recommendations to administer tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine to HCWs to prevent transmission of pertussis to patients.
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PMID:Hospital-acquired pertussis among newborns--Texas, 2004. 1852 16

On September 6, 2006, the Cook County Department of Public Health (CCDPH) was notified that a local high school student aged 17 years had pertussis. During September 2006-January 2007, 36 pertussis cases directly linked to the high school were identified. Because Bordetella pertussis immunity from childhood vaccinations wanes over time, outbreaks of pertussis can periodically occur among students and staff at middle and high schools. School settings facilitate transmission of pertussis, disrupting school and community activities and putting vulnerable populations, such as unvaccinated infants, at risk. A pertussis booster vaccine suitable for adolescents and adults became available in the United States in 2005, when two new tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines were licensed for persons aged 10-18 years and 11-64 years, respectively. In 2006, the Advisory Committee on Immunization Practices (ACIP) recommended that all adolescents and adults receive a one-time Tdap booster vaccination. This report summarizes strategies used to control the pertussis outbreak in Cook County, Illinois, including efforts to increase Tdap vaccination coverage. Despite multiple communications recommending Tdap vaccination and implementation of a cough exclusion policy during the pertussis outbreak, student vaccination rates did not increase substantially until a school-based Tdap vaccination clinic was implemented. Because persons at risk for pertussis might not seek vaccination from their usual health-care provider, even during an outbreak, local health departments might consider early implementation of a cough exclusion policy and on-site Tdap vaccination clinic as control measures.
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PMID:Use of mass Tdap vaccination to control an outbreak of pertussis in a high school--Cook County, Illinois, September 2006-January 2007. 1865 Jul 87

Tetanus still remains a significant health problem in developing countries; it is a serious disease with a high mortality rate. The purpose of this study was to characterize the oral sensorimotor function for feeding in patients with tetanus. Thirteen patients clinically diagnosed with tetanus and admitted to an intensive care unit between December of 2005 and May of 2007 underwent a screening tool for dysphagia, involving the assessment of clinical features and 2 swallowing tests. Results indicate that the oral sensorimotor function for feeding in these patients is severely compromised, with the exception for the clinical feature of palate elevation and performance in the saliva swallowing test. The factor analysis indicated that the evaluation of tongue movement change in the oromotor examination is important in predicting alterations of cough/voice in the water swallowing test, thus suggesting that oral feeding might be unsafe. When looking at developing countries, the prolonged intensive medical and nursing care required by many patients with tetanus places extra demands on an already stretched healthcare budget. Intervention by a speech pathologist could mean that time in the ICU would be reduced as well as the number of re-admissions due to complications.
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PMID:Oral sensorimotor function for feeding in patients with tetanus. 1948 99


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