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Query: UMLS:C0043167 (pertussis)
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Reports of abscesses after the use of diphtheria and tetanus toxoids and pertussis vaccine (DTP vaccine) from two different lots (No. 1 and 2) of a single manufacturer (manufacturer A) prompted an investigation into the rates of abscess formation following the use of DTP vaccine from several different manufacturers. A total of 74 abscesses for lot 1, 16 for lot 2, and three for other DTP products was uncovered. The overall rate after lots 1 and 2 was 1.1 per 1,000 doses administered compared with 0.01 per 1,000 doses for DTP vaccine from other manufacturers (P less than .0001). Faulty technique, site and route of inoculation, microbiologic contamination, and hypersensitivity were ruled out as likely explanations for the increase in abscesses among recipients of DTP vaccine from manufacturer A. Use of a single needle to withdraw vaccine from the vial and to inoculate the vaccinees, combined with high aluminum adjuvant content in the implicated vaccine, may have led to an increased rate of abscess formation.
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PMID:Abscesses complicating DTP vaccination. 728 59

There is currently no animal model which reliably predicts the immunogenicity of Haemophilus influenzae type b (Hib) polysaccharide-protein conjugate vaccines in human infants. We evaluated various Hib vaccines in guinea pigs using techniques similar to the United States potency test for adsorbed diphtheria and tetanus toxoids with a view to developing a method for evaluating the potency of a combined adsorbed tetanus, diphtheria, pertussis and Hib conjugate vaccine. Groups of 6-8 guinea pigs received 1.5 single human doses of vaccine at 0 and at 6 or 8 weeks and were bled at 6 weeks and 2 weeks after the booster injection. Total antibodies to polyribosylribitolphosphate (PRP), the Hib capsular polysaccharide, were measured in individual animals and in serum pools by radioimmunoassay. The relative antibody responses of guinea pigs to Hib conjugate vaccines qualitatively resembled those of human infants. Unconjugated polysaccharide was not immunogenic; PRP-D produced a low antibody response, HbOC, PRP-T (Merieux) and Hib-T (MPMBL) produced a low response to the first dose and a strong anamnestic response to the booster (geometric mean anti PRP > 1 micrograms ml-1). PRP-OMP uniquely produced a strong response after the first dose which was further boosted by the second dose. Experimental Hib-T vaccine lots with low levels of conjugation were poorly immunogenic in guinea pigs. Combinations of DTP and Hib-T vaccines showed equivalent or greater immunogenicity than Hib-T alone. We propose that the guinea pig model may be useful to verify the immunogenicity of PRP conjugate vaccines and for pre-clinical evaluations of DTP-Hib combination vaccines containing PRP conjugates.
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PMID:Development of a guinea pig model to assess immunogenicity of Haemophilus influenzae type b capsular polysaccharide conjugate vaccines. 748 72

Administration of whole-cell diphtheria and tetanus toxoids and pertussis vaccine adsorbed (DTP vaccine) caused marked depression in the expression of mRNA for isozymes of cytochrome P-450 in the livers of endotoxin-responsive and nonresponsive mice. The levels of expression of mRNA for a polycyclic aromatic hydrocarbon-inducible (CYP1A2) and an ethanol-inducible (CYP2E1) form of P-450 were reduced by 70% to 80% 8 to 12 hr after vaccination or Bordetella pertussis endotoxin administration. These effects are preceded by marked increases (threefold to sixfold) in mRNA expression for interleukin-6, interleukin-1 and tumor necrosis factor in both strains of mice, with maximal increases 1 to 2 hr after injection. This is the first demonstration that levels of cytokine mRNA are altered in the liver in response to DTP vaccine administration. The finding of increased cytokine mRNA in the livers of mice injected with vaccine supports a role for cytokines as mediators of the decreased levels of cytochrome P-450. In addition, inducible nitric oxide synthase mRNA expression is also increased after vaccine administration, with a peak at 4 hr. The temporal relationship of the increased cytokine mRNA expression, increased nitric oxide synthase and decreased expression of P-450 mRNAs suggests a mechanism by which cytokines mediate the induction of nitric oxide synthase, which increases nitric oxide and decreases the activities of some cytochromes P-450.
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PMID:Modulation of hepatic mRNA levels after administration of lipopolysaccharide and diphtheria and tetanus toxoids and pertussis vaccine adsorbed (DTP vaccine) to mice. 752 68

Adverse Events Following Immunization (AEFI) are disadvantageous side effects of preventive vaccination. In 1993 we found 17 cases of AEFI out of 1440 children between 0 and 2 years of age who had received BCG, diphtheria-tetanus-pertussis, measles or poliomyelitis vaccine. They were classified as reactions in 14 children (0.9%) or complications in 3 children (0.2%). Twelve adverse reactions followed DTP vaccination (0.8%), two followed BCG vaccination (0.14%), another two measles vaccination (0.14%) and one followed poliomyelitis vaccination (0.07%). Both generalized and local symptoms were present and they regressed with no further complications. Two children who had received BCG were noted to have a deeply placed abscess at the injection site remaining scar as well as axillary, submandibular and cervical lymph nodes enlargement within 6 months. In a 3 months old child, after the first injection of DTP vaccine, convulsions and consciousness disorder occurred. Transfontanel ultrasonography revealed intraventricular haemorrhage. After one year of intensive neurological care child's health state was improved. In spite of using still more and more safe vaccines none of them is the ideal one--the one with no adverse events following vaccination. Vaccination technics, distribution and storage of vaccines are to be improved which may result in decrease number of AEFI.
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PMID:[Adverse events following immunization: AEFI in 17 children between 0 and 2 years of age]. 759 91

Pertussis was a major cause of morbidity and mortality among infants and children in the United States during the prevaccine era (i.e., before the mid-1940s). Since pertussis became a nationally reportable disease in 1922, the highest number of pertussis cases (approximately 260,000) was reported in 1934; the highest number of pertussis-related deaths (approximately 9000) occurred in 1923. Following the licensure of whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids (DTP) in 1949 and the widespread use of DTP among infants and children, the incidence of reported pertussis declined to a historical low of 1010 cases in 1976 (Figure 1). However, since the early 1980s, reported pertussis incidence has increased cyclically with peaks occurring in 1983, 1986, 1990, and 1993 (1-3). This report summarizes national surveillance data for pertussis from January 1992 through June 1995 from CDC's National Public Health Surveillance System (NPHSS) and Supplementary Pertussis Surveillance System (SPSS) and assesses the effectiveness of pertussis vaccination in the United States during this period using vaccination coverage data from CDC's National Health Interview Survey (NHIS).
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PMID:Pertussis--United States, January 1992-June 1995. 760 28

Inactivated and trivalent oral poliovirus vaccines contain either formalin-inactivated or live, attenuated poliovirus, respectively, of the three serotypes. Interference among the three attenuated poliovirus serotypes was minimized with a "balanced-formulation" vaccine, and serologic responses after IPV were optimized by adjusting the antigenic content of each inactivated poliovirus serotype. Seroconversion is dependent on both the relative content as well as the absolute quantity of virus in the vaccine. The "gold standard" method to assess humoral antibody responses following vaccination is the neutralization assay. Any detectable titer of neutralizing antibody against poliovirus is considered protective against clinical paralytic diseases. Recently, standard procedures were adopted for conducting neutralization assays. Efforts are being undertaken now to develop a combined diphtheria and tetanus toxoids and pertussis vaccine and IPV vaccine in the United States using a dual-chambered syringe that mixes the content of both vaccines at the time of injection; this approach is necessary to overcome the potential detrimental effect of thimerosal on IPV (the preservative in DTP). Other vaccines that combine DTP and/or Haemophilus influenzae type b and/or hepatitis B with IPV appear feasible but require further investigation. New combination vaccines should induce similar or superior levels of neutralizing antibody in serum for individual protection against paralytic disease and mucosal immunity that effectively decreases viral replication in the intestine and pharynx for population protection against transmission of poliovirus.
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PMID:Defining surrogate serologic tests with respect to predicting protective vaccine efficacy: poliovirus vaccination. 762 65

An outbreak of pertussis was recognized in a highly immunized sixth-grade class of schoolchildren. Among 43 children aged 11-12 years in the class, 38 had been immunized with three doses or more of DTP containing whole-cell pertussis vaccine, two with two doses of DTP and three children were unimmunized. The last DTP vaccines had been given 6-10 years before the outbreak. A total of eight children with pertussis suffering paroxysmal coughing attacks for 3 weeks or more were identified, seven being fully immunized and one unimmunized. Among the eight cases, two were confirmed by both culture and serology and one by serology alone. The attack rate in fully immunized children was 18.4% (7/38). Secondary spread of pertussis was identified in five of the households from which the eight patients originated. A total of six cases of pertussis from these five households were identified, and two of these were culture-confirmed. These observations suggest that vaccine-induced immunity weakens considerably 6-10 years after vaccination, and that booster immunization with DTP instead of DT is therefore recommended for the control of pertussis.
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PMID:Outbreak of pertussis in highly immunized adolescents and its secondary spread to their families. 764 80

The Childhood Immunization Initiative (CII) was initiated to increase vaccination coverage among 2-year-old children. The 1996 objective is to have at least 90% coverage for four of the five critical vaccines routinely recommended for children (i.e., one dose of measles-mumps-rubella vaccine [MMR] and at least three doses each of diphtheria and tetanus toxoids and pertussis vaccine [DTP], oral poliovirus vaccine, and Haemophilus influenzae type b vaccine [Hib]), and at least 70% coverage for three doses of hepatitis B vaccine (Hep B) (1). These objectives are an interim step toward the year 2000 goal of at least 90% coverage for the recommended series of vaccinations and are being monitored on an ongoing basis. This report presents national estimates of vaccination coverage among 2-year-old children derived from provisional data from the National Health Interview Survey (NHIS) for the first quarter of 1994 and compares these with the last two quarters of 1993.
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PMID:Vaccination coverage of 2-year-old children--United States, January-March, 1994. 786 81

The effects of combining three Haemophilus influenzae type b (Hib) capsular polysaccharide vaccines, conjugated to different proteins, with DTP vaccine on the subsequent control testing were examined. The addition of the Hib vaccines had little effect on the reactogenicity or the potency of the whole-cell pertussis component. The potency of, and antibody responses to, the diphtheria component were also unaffected in all three combinations. However, combination with the Hib vaccine comprising polysaccharide conjugated to tetanus toxoid resulted in a fivefold potentiation of the tetanus potency and large increases in the antibody responses to tetanus toxin and toxoid and Hib polysaccharide. These results have implications for the control testing of combined vaccines containing a whole-cell pertussis component and Hib polysaccharide-tetanus protein conjugate vaccine.
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PMID:Interaction of Haemophilus influenzae type b conjugate vaccines with diphtheria-tetanus-pertussis vaccine in control tests. 788 24

A 1992 retrospective survey by the Kansas Department of Health and Environment (KDHE) of children entering school in Kansas indicated that 52% were completely vaccinated by 24 months of age (i.e., received four doses of diphtheria and tetanus toxoids and pertussis vaccine [DTP], three doses of poliomyelitis vaccine, and one dose of measles-mumps-rubella vaccine [MMR]). In response to this low vaccination coverage rate, the KDHE set a goal for 1995 of completely vaccinating 90% of children by age 24 months. A major new initiative--Operation Immunize (OI)--undertaken to accomplish this goal consisted of three statewide vaccination campaigns on weekends during 1993-1994. This report summarizes the results of an assessment of the short-term impact of OI on children who remained undervaccinated following the first campaign.
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PMID:Assessment of undervaccinated children following a mass vaccination campaign--Kansas, 1993. 804 53


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