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Vaccines have given health care providers control over a substantial portion of the morbidity and mortality in the developing world. Global efforts have immunized two-thirds of the world's children with DTP and polio vaccines; 72% have received BCG and 59% measles vaccine; but only 29% of pregnant women have received two doses of tetanus toxoid. In addition, vaccines against yellow fever, Japanese encephalitis, hepatitis B, rubella, and mumps and meningococcal polysaccharide vaccine are being used in specific regions of the world. New vaccine candidates will enhance the vaccine armamentarium over the next decade to include the causes of pneumonia, diarrhea, and meningitis: Haemophilus influenzae type b, pneumococcal and meningococcal protein conjugate vaccines, typhoid and rotavirus vaccine. Genetically engineered vaccine vehicles, genetic reassortants, and genetic deletions are being investigated as new vaccine candidates.
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PMID:Vaccine-preventable disease and immunization in the developing world. 219 Jan 45

The incidence of pertussis in the United States decreased rapidly during the 20th century, with the most impressive decreases resulting from the widespread use of DTP vaccine since the late 1940's. As a result of immunization laws, vaccine coverage levels against pertussis at school entry have been greater than 95% since 1980. National surveillance for pertussis done by the Centers for Disease Control (CDC) consists of two parts: a weekly telephone reporting system and a written case report system providing more detailed demographic, clinical, and laboratory information. In addition, data on secondary spread of pertussis among household contacts of reported cases were available on a small proportion of reported cases during 1979-1983. During the period 1980-1986, a total of 17,396 cases of pertussis was reported to CDC by weekly telephone reports. The annual incidence of reported pertussis rose during this period from 0.5 cases per 100,000 population to 1.7/100,000. Infants less than 12 months of age had the highest average annual incidence, estimated at 32 cases per 100,000. Children 1-4 years of age accounted for 25% of all cases but had an average annual incidence only 1/7th that of infants. The incidence rates for all age groups increased consistently between 1982 and 1986. The most impressive relative increases occurred among older adolescents and persons 20 years of age and older. In 1986, 10% of reported cases were in this age group compared to only 5% in 1982. Rates of hospitalization and complications such as pneumonia, seizures, and encephalopathy associated with pertussis were highest in children less than 6 months of age and declined progressively with increasing age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Current epidemiology of pertussis in the United States. 285 18

A study recently published in the Lancet compared the incidence of pertussis between 1940 and 1996 in countries where vaccination with DTP vaccine reached a steady 90-100% of the population for many years against those in which coverage fell sharply following propaganda-driven vaccine scares. It was found that the incidence of a disease can be up to 100 times higher in a country where vaccination against the disease is disrupted by anti-vaccine movements than in countries where coverage of the population with the vaccine always remains high. It can take 10-20 years to reverse the potentially major damage caused by anti-vaccination movements. There may have been hundreds of thousands of cases of pertussis among children deprived of vaccine, while tens of thousands of cases of disease-related clinical complications such as pneumonia, encephalopathy, and seizures may have resulted.
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PMID:Immunization news. 1217 11

Pertussis, also known as whooping cough, is a highly contagious disease, which is most dangerous to infants less than one year old. About half of the babies reported nationally to the Centers for Disease Control and Prevention (CDC) as having the disease are hospitalized. As many as 16/100 babies reported with pertussis get pneumonia, and about 2/100 have convulsions. For those babies reported to have pertussis, about 1/500 has brain problems, some of which can become permanent, and about 1/250 will die because of complications from the disease. Serious illness is less likely in older children and adults. Pertussis vaccine is generally administered in combination with diphtheria and tetanus vaccines, known as DTP vaccine. A primary series of DTP keeps 70-90/100 children from getting pertussis, usually through the elementary school years at least. About half of the children who receive DTP vaccine will not experience any discomfort at all. Some will have minor problems such as soreness, swelling and redness where the shot was given; fever; fussiness; drowsiness; and loss of appetite lasting 1-2 days. Once per 100 to 1000 shots, moderate problems can occur: crying non-stop for 3 hours or more, fever of 105 degrees (F) or higher. For 1 shot in 1750, a child may experience a seizure (convulsions, fits, spasms, twitching, jerking, or staring spells) usually caused by fever, or collapse or fainting (becoming blue, pale, limp, and non-responsive). Very rarely, DTP causes long seizures, decreased consciousness, or coma that usually does not last. Permanent brain damage can very infrequently follow such acute brain problems. There are no tests that can tell in advance if a child will be adversely affected by the DTP vaccine. Definitely the benefits from the DTP vaccine far outweigh the risks for almost all children.
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PMID:Facts about pertussis and DTP vaccine. 1234 38

Acute respiratory infection (ARI) is the most common infectious cause of childhood death in Africa. Most deaths from ARI are caused by bacteria, including Haemophilus influenzae type b (Hib). Hib is also the most common bacterial cause of meningitis, except in those areas with outbreaks of meningococcal disease. Up to 40% of infants with meningitis die, and many of the survivors have permanent deafness and brain damage. Until recently, however, early diagnosis and treatment was the only defence against these infections. The newly developed Hib conjugate vaccines have been shown to be effective against Hib meningitis and pneumonia, and are now routinely used in infants in more than 25 countries around the world. A study of the efficacy of the vaccine in The Gambia's Western Region in 1993-95 showed that it was 95% effective in preventing meningitis and bloodstream infection, and 100% effective in preventing pneumonia. Hib vaccine was introduced this year in The Gambia as a routine immunization for children, to be given in the same injection as DTP at 2, 3, and 4 months of age. A 1-year study is underway to evaluate the impact of the vaccine upon disease. Trials are now underway for new pneumococcal and meningococcal vaccines which may be ready for wider use within 5-10 years.
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PMID:Hib vaccine introduced in The Gambia. 1234 71

Hemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis among infants and young children and the second leading cause of bacterial pneumonia deaths among children under 5 y. The overall case-fatality rate for Hib meningitis is 20-29%, and nearly 30% of surviving children suffer from major disabilities, while all invasive Hib disease (including meningitis) has a case fatality rate of 16% in India. Using the estimates from the Hib study, ~215,000 new cases of Hib pneumonia occur yearly in Indian children under the age of 5 y and result in over 61,000 deaths. This level of mortality is because of poor access to health services and poor health-seeking behavior by population, lack of laboratory infrastructure, and difficulty to diagnosis Hib disease among affected children. Disease burden is difficult to calculate. Even for those affected children who do reach healthcare facilities, the lack of quality health services and increasing prevalence of antibiotic-resistance makes treatment difficult for these children. Even in countries that have poor immunization coverage, indirect benefits of the Hib vaccine have been reported due to the herd effect. The Hib vaccine thus should be effective in India where Universal Immunization Programme (UIP) coverage is poor. Following the World Health Organization (WHO) recommendation that Hib-containing Pentavalent DTP vaccine (a combination vaccine that protects against five killer diseases: diphtheria, pertussis, tetanus, hepatitis B [hepB] and Hib) should be administered to every child in the world, the Government of India asked the National Technical Advisory Group on Immunization (NTAGI) to study the need for HepB and Hib vaccines in the Indian population. The India Ministry of Health and Family Welfare introduced Pentavalent DTP vaccines in the UIP with the aim of reducing the burden of Hib-related morbidity and mortality.
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PMID:Pentavalent DTP vaccine: need to be incorporated in the vaccination program of India. 2357 Dec 25

Pneumococcal conjugate vaccine (PCV) has the potential to interact with other vaccines containing diphtheria toxin-like antigens (such as those found in the DTP vaccine) upon sequential administration. This is attributed to the similarity of the diphtheria toxoid antigen to the carrier protein used to make PCV, (known as cross reactive material [CRM]) to diphtheria toxin 197 or CRM197. The interaction could lead to enhanced immunogenicity of PCV as a result of a phenomenon called carrier priming, whereby DTP is given some weeks before the first dose of PCV. This phenomenon could be implemented in the immunisation schedule in developing countries and among vulnerable populations to enhance the immunogenicity of PCV, reduce the number of doses required, and produce a more cost-effective immunisation program in developing countries.
Pneumonia (Nathan) 2016
PMID:Carrier priming to improve pneumococcal disease control and reduce the international program's cost in children. 2870 95