Pertussis Booster Vaccination Research Articles

Community awareness and predictors of uptake of pertussis booster vaccine in South Australian adults

ObjectivePertussis is a highly virulent vaccine preventable disease that remains a global challenge. This study aimed to assess community knowledge of pertussis infection as well as awareness and uptake of adult pertussis booster vaccine. MethodsA cross-sectional survey was conducted of randomly selected households in South Australia by Computer Assisted Telephone Interviews in 2011. Survey data were weighted to the age, gender and geographical area profile of the population. ResultsFrom 3124 randomly sampled contactable households, 1967 interviews were conducted (participation rate 63%) with individuals aged 18–93 years, including 608 parents of children aged <18 years. The majority of respondents (97%) had heard of pertussis (whooping cough) and 18% reported that a household member had previously contracted whooping cough infection. Most respondents considered whooping cough to be highly contagious (73%) and severe for infants (89%). Over half (51%) of those surveyed were aware that family members commonly transmit pertussis to infants. Despite high knowledge, pertussis vaccine uptake was low, with only 10% of respondents reporting pertussis vaccination in the previous five years. Whilst 61% of respondents were aware of the availability of an adult pertussis booster vaccine, only 8% (n=154) reported their Family Physician had discussed it with them. If provided free, 77% agreed that they would be more likely to accept a booster pertussis vaccination. Independent predictors of recent pertussis vaccination included higher education, larger household size, perception of greater disease severity for infants and discussion with a Family Physician about pertussis vaccination. ConclusionsWhilst knowledge regarding transmission and severity of Bordetella pertussis was high, uptake of pertussis vaccination for adults is remarkably low amongst the South Australian community. Improved awareness regarding the availability of a booster pertussis vaccine through Family Physicians and/or provision of funded pertussis vaccination for adults has the potential to improve pertussis vaccine coverage.

Infant Pertussis: Who's the Source?

Despite widespread vaccination, pertussis remains endemic in the United States. Unimmunized infants, typically those under 2 months of age, are at greatest risk for severe disease and death. Previous studies have shown that household contacts, usually mothers, are the most common source of infant infection. In 2005, the CDC recommended a Tdap (tetanus, diphtheria, and acellular pertussis) vaccine booster for …

A Systems Approach to Improving Tdap Immunization Within 5 Community-Based Family Practice Settings: Working Differently (and Better) by Transforming the Structure and Process of Care.

We examined how family medicine clinic physicians and staff worked in collaborative teams to implement an automated clinical reminder to improve tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administration and documentation. A clinical reminder was developed at 5 University of Michigan family medicine clinics to identify patients 11 to 64 years old who were in need of the Tdap booster vaccine. Quality improvement cycles were used to improve clinic care processes. Immunization rates from 2008 to 2011 were compared with rates at 4 primary care control clinics. Vaccination rates among eligible patients increased from 15.5% to 47.3% within the family medicine clinics and from 14.1% to 30.2% within the control clinics. After adjustment for covariates, family medicine patients had a higher probability of vaccination than control patients during each measurement period (0.17 vs 0.15 at baseline, 0.53 vs 0.22 during year 1, and 0.50 vs 0.30 during year 2). Automated clinical reminders, when designed and implemented via a consensus-based framework that addresses the process of care, can dramatically improve provision of preventive health care.

Prevention of pertussis through adult vaccination

Pertussis is a vaccine preventable respiratory infection. Young infants are at high risk of developing severe complications from infection. Despite high rates of pediatric vaccine uptake, there continues to be increases in pertussis cases, likely due to waning immunity from childhood vaccine and increased transmission through adults. Currently, pertussis booster vaccine (Tdap) is recommended for unimmunized adults and for women in the third trimester of each pregnancy; yet adult Tdap coverage remains low. Administering Tdap vaccine at non-traditional vaccination clinics and at sites where adults are accessing care for their children are effective in improving adult Tdap uptake. While most are willing to receive vaccine when recommended by their provider, lack of provider recommendation is a major obstacle to immunization. Future studies to understand barriers to provider vaccine recommendations need to be undertaken to develop interventions to improve adult Tdap vaccine uptake and reduce pertussis infection in the susceptible population.

Immunogenicity and reactogenicity of a decennial booster dose of a combined reduced-antigen-content diphtheria–tetanus–acellular pertussis and inactivated poliovirus booster vaccine (dTpa–IPV) in healthy adults

BackgroundPertussis in adults and adolescents could be reduced by replacing traditional tetanus and diphtheria (Td) boosters with reduced-antigen-content diphtheria–tetanus–acellular pertussis (dTpa) vaccines. This study evaluated the administration of dTpa–IPV (dTpa–inactivated poliovirus) in adults ten years after they received a booster dose of either dTpa–IPV, dTpa+IPV or Td–IPV in trial NCT01277705. MethodsOpen multicentre, phase IV study (www.clinicaltrials.gov NCT01323959) in which healthy adults, who had received a previous dose of dTpa–IPV, dTpa+IPV or Td–IPV ten years earlier, received a single decennial booster dose of dTpa–IPV (Boostrix™-polio, GlaxoSmithKline Vaccines). Blood samples were collected before and one month after booster vaccination. Antibody concentrations against all vaccine antigens were measured and reactogenicity and safety were assessed. ResultsA total of 211 subjects (mean age 50.3 years) received vaccination of whom 201 were included in the according-to-protocol cohort for immunogenicity. Before the decennial dTpa–IPV booster, ≥71.0% subjects were seroprotected/seropositive against all vaccine antigens. One month after the booster dose, all subjects were seroprotected against tetanus and poliovirus types 2 and 3; ≥95.7% subjects were seroprotected against diphtheria and ≥98.3% against poliovirus type 1. Anti-pertussis booster responses for the various antigens were observed in ≥76.5% (pertussis toxoid; PT), ≥85.1% (filamentous haemagglutinin; FHA) and ≥63.2% (pertactin; PRN) of subjects. During the 4-day follow-up, the overall incidence of local AEs was 71.6%, 75.0% and 72.2% in dTpa–IPV, dTpa+IPV and Td–IPV groups, respectively. Pain was the most frequent solicited local adverse event (AE; ≥62.7% subjects) and fatigue the most frequent solicited general AE (≥18.5%). No serious AEs were reported during the study. ConclusionA booster dose of dTpa–IPV was immunogenic and well tolerated in adults who had received a booster dose of either dTpa–IPV, dTpa+IPV or Td–IPV, ten years previously and supports the repeated administration of dTpa–IPV.

Pertussis Booster Vaccination in Pregnancy: Women Who had it Compared to Those Who Waited

BackgroundGuidelines for protecting young infants from pertussis now recommend maternal pertussis booster vaccination (dTpa) during pregnancy (3rd trimester) over postpartum maternal vaccination. MethodsWe undertook a cross-sectional survey of 723 postpartum women on the postnatal ward of a private hospital in Sydney, Australia. We excluded 47% of women who were ‘up to date’ with their pertussis booster prior to pregnancy. We surveyed the remaining 53% of women who were eligible for the pertussis booster vaccine during their pregnancy (no dTpa<5years). ResultsIn our study, pertussis booster vaccine uptake during pregnancy was only 8.7%. We confirmed that vaccination mostly occurred at the family doctor's practice (25/33; 75.8%), at an average of 34 weeks gestation (±5wks). Women vaccinated during pregnancy were more likely to report that they received a pregnancy-specific pertussis vaccine recommendation (<0.001), and had no vaccine safety concerns (0.004) or transport difficulties in accessing an immunization provider (0.032). They also had twice the odds of receiving an influenza vaccine during pregnancy (0.002). Additionally, 70% of vaccinated women reported that their partner had also been recently vaccinated against pertussis. Amongst unvaccinated women we found that 80% intended to be vaccinated, yet 33% would only do so if the vaccine was free (publically funded). Additionally, 40% of unvaccinated women would have agreed to pertussis vaccination during pregnancy had their doctor recommended it. ConclusionProviders should highlight pertussis vaccine safety and recommend vaccination during late pregnancy.

Leukocytoclastic vasculitis following DPT vaccination

We report the case of an 18-month-old male child who developed Henoch-Schonlein purpura 7 days after receiving Diphtheria, Pertussis and Tetanus booster vaccine. To our knowledge, this is the first case report of Henoch-Schonlein purpura temporally associated with the DPT vaccine even though there are many other vaccines associated with Henoch-Schonlein purpura.

What predicts postpartum pertussis booster vaccination? A controlled intervention trial

Background‘Cocooning’ aims to protect susceptible infants from pertussis via caregiver vaccination. Control trials evaluating educational interventions to promote cocooning are lacking. We evaluated the role of message-framing vs. standard health information in promoting pertussis vaccination. MethodsWe recruited postpartum women from a maternity hospital in Sydney, Australia (November 2010–July 2012). Participants self-completed a pertussis knowledge and attitudes questionnaire. We then assigned pertussis-susceptible (no pertussis vaccine ≤10 years) participants to receive a gain-framed, loss-framed pamphlet or control (Government Pertussis factsheet) using weekly sequential block allocation. Next, participants were offered a pertussis vaccine (dTpa) and completed a post-questionnaire on discharge. ResultsA baseline questionnaire was completed for 96.4% (1433/1486) of postpartum women approached. Missing data was excluded (n=29). Next, participants (1404) were screened for vaccine status: 324 (23%) reported prior pertussis booster vaccine receipt, leaving 1080 participants requiring vaccination. Among susceptible mothers, 70% (754/1080) were vaccinated post-intervention. Rates were similar between ‘gain’, ‘loss’ or ‘control’ pamphlets (69.1% vs. 71.8% vs. 68.8%; p=0.62). Intention to be vaccinated (OR 2.46, p<0.001; 95% CI: 1.69–3.58), perceived vaccine benefits (OR: 1.61, p<0.001; 95% CI: 1.25–2.15) and having received a vaccine recommendation (OR 1.68; p=0.025; 95% CI: 1.07–2.65) were independent predictors of vaccine uptake. At discharge, overall pertussis vaccine coverage had increased from 23% to 77% among women screened (1078/1404). ConclusionA cocooning strategy for pertussis vaccination can be highly effective when partially implemented within maternity hospitals, with information accompanied by a funded vaccine. Mothers were highly receptive to vaccination in the postnatal ward: facts about pertussis were as effective as message-framing in promoting a high uptake of 70%. Perceived vaccine benefits, intentions and vaccine recommendation were important predictors of uptake. Our intervention trial increased the existing pertussis vaccine coverage of 23–77%.

68.: Acute meningomyelitis following diphtheria, tetanus, pertussis booster vaccination in a young adult

We report a case of severe post-vaccinal menigomyelitis in a 30-year-old man with symptom onset a week after of administration diphtheria, tetanus, pertussis booster vaccination (Boostrix; GlaxoSmithKline, Brentford, Middlesex, UK). The case highlights the characteristic features of post-vaccinal myelitis and raises some interesting issues. There were no other precipitating factors and extensive infection and other etiological screening was unremarkable. The patient responded well to corticosteroids and rehabilitation. There was a lymphocytic pleocytosis on cerebrospinal fluid analysis and a raised opening pressure along with increased body temperature and normal initial MRI of the spine, despite having signs suggestive of a upper thoracic myelopathy for 1 week. This led to extensive investigations for an infective cause. Spinal MRI changes can lag behind clinical signs and symptoms of myelopathy and a repeat scan a week later showed three distinct areas of cord signal abnormalities involving the cervical and thoracic cord. Fever can be a part of an inflammatory response but does not necessarily reflect an infective etiology. Vaccinations are important but in rare cases serious neurological sequelae can occur.

PO-0186 Influence Of Il-10 Gene Polymorphisms On Immune Responses After Acellular Pertussis Booster Vaccination In Adolescents: Abstract PO-0186 Table 1

Background and aim Despite the mass vaccinations, pertussis has recently caused large epidemics in many industrialised countries. Vaccine-induced immune responses may be impaired due to polymorphisms in genes encoding regulatory cytokines such as IL-10. The aim of this study was to evaluate the role of IL-10 promoter polymorphisms on vaccine responses after acellular pertussis booster vaccinations. Methods Seventy-five adolescents received diphtheria-tetanus-acellular pertussis (dTap) vaccination in 1997. They were followed at 3, 5 and 10 years after. At year 10, a second booster was administrated. Antibodies (n = 52) and cell mediated immunity (CMI) (n = 38) against pertussis antigens were measured. IL-10 polymorphisms (rs1800890 and rs1800896) were detected using Sequenom iPlex Gold system. Results After the second booster, rs1800896 was found to affect the geometric mean value (GMV) of proliferation (counts per minute, cpm) and stimulation index (SI) against pertussis antigens; pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (PRN) (Table). Another SNP (rs1800890) affected the CMI against PT and FHA after the booster vaccination. Also, the IgG antibody concentration against PT and PRN differed significantly between the genotypes after the original vaccination, at 3-year follow-up and before the second booster. Conclusion These preliminary results suggest that IL-10 might play an important role in modulating both antibody and cell mediated immune responses after pertussis vaccination.

Tdap: the need to educate and immunize.

The resurgence of pertussis is puzzling, especially given the requirement that children complete recommended immunizations prior to school entry. Are adult carriers unknowingly infecting children? What do adult caregivers know about pertussis and the tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine? How can the incidence of pertussis in children younger than 2 years, a group most at risk for complications of the disease, be reduced? This article examines the incidence of pertussis and strategies to reduce pertussis incidence in the United States. If the need for Tdap vaccine is identified and favorably received by adults, immunization programs can be arranged at worksites to better protect infants who are most at risk for pertussis.

Seroprevalence of IgG antibodies to pertussis toxin in children and adolescents in Estonia

Background and aimsDespite high immunisation coverage and frequent booster doses, the national notification rates of pertussis in Estonia have been increasing. The peak of 97/100,000 was reached in 2010 which is the highest incidence rate since 1962 (210/100,000).We aimed to measure the prevalence of pertussis toxin (PT) IgG type antibodies in subjects of <18 years and to estimate the pertussis infection activity in a recently non-immunised cohort. MethodsIn a cross-sectional serosurvey, all consecutive leftover sera were collected in the Tartu University Hospital during April–August 2012. Anti-PT IgG concentration was measured by commercial ELISA and analysed in yearly cohorts. The antibody concentrations ≥62.5IU/mL was considered suggestive to pertussis in the last year among 9- to 14-year-olds. ResultsThe GMC of the anti-PT-IgG was 7.4IU/mL (95% CI 6.9–8.0). In the total of 1053 serum samples, the highest proportion of sera with high antibody titres ≥125IU/mL and ≥62.5IU/mL were at the ages when pertussis vaccine boosters were given: 7 years 10.9% (95% CI 4.1–22.3) and 2 years 36.9% (95% CI 25.3–49.8), respectively. Approximately half of all sera had undetectable anti-PT IgG levels. The estimated incidence of Bordetella pertussis infection among 9- to 14-year-olds in the year before serum sampling was 6.3% (95% CI 3.3–10.8), which is at least 60 times higher than the officially reported incidence of pertussis disease in respective years. ConclusionsThe serologic method is not suitable for diagnosing pertussis in instances when the last pertussis immunisation was less than one year ago. The relatively high proportion of subjects with undetectable anti-PT IgG levels and the relatively low rate of officially reported pertussis cases suggest that low antibody levels do not necessarily indicate the absence of protection. The estimated incidence rate of pertussis is much higher than officially reported figures, which suggests that asymptomatic/mild B. pertussis infection remains unrecognised and unreported.

Recognizing the vaccination strategy of pertussis according to the family aggregation feature of transmission

To understand the age distribution of pertussis patients admitted in the children hospital and to analyze the source of infection as well as its transmission patterns. Patients visiting to the Children Hospital and epidemiologically related cases during Feb. 2012 to Aug. 2013 were tested to confirm the diagnosis. Excel 2007 software was used to analyze the age distribution and clinical symptoms of clinic cases, the source of infection or subsequent cases. 165 out of 254 clinically suspicious pertussis cases and 38 out of the 54 epidemiologically related cases were confirmed of having pertussis infection. There were 138 (83.6%) cases under 1 year of age in the confirmed clinical cases and 36 (94.7%) cases older than 20 years of age among the confirmed epidemiologically related pertussis cases. All the confirmed epidemiologically related cases were misdiagnosed or missed for diagnosis. As the source of pertussis infection in confirmed clinical cases, parents played an imported role among 25 of the 32 cases. Transmission from infants and/or little children to adults were also observed in this study. Infants accounted for the most among the pertussis patients that visiting the clinics. Adults, being misdiagnosed or missed diagnosed, were the main sources of infection to infants. Epidemics of pertussis occurred under family aggregation. Further study was in need to develop the proper strategy for pertussis booster vaccination.

Pertussis-specific memory B-cell and humoral IgG responses in adolescents after a fifth consecutive dose of acellular pertussis vaccine.

In order to impede the increase in pertussis incidence in the adolescent group, a school-leaving booster dose administered at the age of 14 to 16 years will be introduced in Sweden in 2016. Preceding this introduction, an open-label, randomized, multicenter, clinical trial without a control group and with blinded analysis was performed, investigating both safety and immunogenicity. Reported here are the memory B-cell and serological responses detected in a smaller cohort (n = 34) of the 230 subjects recruited to the study. All subjects had received primary vaccination consisting of three doses of diphtheria-tetanus-5-component pertussis (DTaP5) vaccine, at 3, 5, and 12 months of age, and a tetanus-low-dose diphtheria-5-component pertussis (Tdap5) vaccine booster at 5.5 years. In this study, the subjects were randomly assigned and received either a Tdap1 or Tdap5 booster. Of the 230 participants, 34 subjects had samples available for evaluation of IgG-producing memory B-cell responses. Both vaccine groups had significant increases in pertussis toxin-specific serum IgG levels, but only the 1-component group showed significant increases in pertussis toxin-specific memory B cells. The 5-component group had significant increases in filamentous hemagglutinin- and pertactin-specific memory B-cell and serum IgG levels; these were not seen in the 1-component group, as expected. In conclusion, this study shows that a 5th consecutive dose of an acellular pertussis vaccine induces B-cell responses in vaccinated adolescents. (This study has been registered at EudraCT under registration no. 2008-008195-13 and at ClinicalTrials.gov under registration no. NCT00870350.).

Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study

Objective To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the...

Seroepidemiology of Bordetella pertussis Infection in Fresh College Students in Iran: A Multicenter Study

Background: Pertussis is a highly communicable, vaccine-preventable respiratory disease; which may circulate even in populations with high vaccination coverage. Although frequent, but it is often underestimated as a cause of prolonged cough illness in both children and adults. Without boosting, the protection of the childhood vaccination would be minimal after 10 years. The need for adult booster vaccination depends on the national epidemiology. Objectives: The aim of this study was to evaluate the seroepidemiological incidence of Pertussis in fresh college students in four majors. Patients and Methods: In a cross sectional multicenter study, blood samples were obtained from 1617 junior students of four universities. None had received Pertussis booster vaccine in the preceding 10 years. Serum immunoglobulin G (IgG) antibody for Pertussis toxin antigen was measured. Some social and demographic determinants including age, sex and number of family members were recorded. Results: The mean age of participants was 19.64 ± 2.1 years; positive anti Pertussis toxin IgG levels (by cut point of 94 U/mL) was detected in 31.6%. Positivity rate was associated with sex but not with age or residential area. Conclusions: Pertussis continues to challenge medical and public health professionals. Recent reports of increases in the prevalence and incidence may be because of the limited time of protection of childhood vaccination. Our study can serve as one of the scarce population-based reports from developing countries. A universal cut point should be determined for diagnosis of seropositivity, and a booster of a cellular vaccine is recommended in adolescence.

Intention to accept Bordetella pertussis booster vaccine during pregnancy in Mexico City

ObjectiveAdult booster vaccination against pertussis can help prevent severe infections in young infants. We examined influences on intention to accept pertussis booster vaccination among pregnant women in Mexico City. MethodsWe conducted a cross-sectional survey, recruiting convenience samples of pregnant women receiving prenatal care from three public healthcare centers between March and May 2012. Our primary outcome was intention to accept pertussis vaccination during pregnancy. We examined socio-demographic factors, vaccination history, pertussis knowledge, perceptions of vaccine information sources, and other potential influences on vaccine decision-making. ResultsA total of 402 pregnant women agreed to participate, of which 387 (96%) provided their intention to accept or decline pertussis vaccination. Among respondents, 57% intended to accept a pertussis booster vaccine if offered, but only 16% had ever heard of pertussis, and only 2% knew someone who had contracted this disease. Over 80% of respondents would accept pertussis vaccination if recommended by an obstetrician-gynecologist. The most frequently selected reasons to refuse pertussis vaccination were concerns that the vaccine might harm the unborn baby or pregnant woman. In multivariate analysis, rating doctors and nurses as good sources of vaccine information, and having ever heard of pertussis, were independently associated with intention to accept pertussis vaccination. ConclusionsPromoting patient awareness about pertussis disease and vaccine safety, and encouraging general practitioners, nurses and obstetricians to recommend pertussis booster vaccine, may increase vaccine uptake among pregnant women.

Epidemiological and clinical reasons for vaccination against pertussis and influenza in pregnant women.

Vaccinations in pregnancy are an important aspect of prenatal care for improving both maternal health and neonatal outcomes. Despite the fact that protection against some infectious diseases for pregnant women can be easily provided through immunizations, current coverage rates are low. Two vaccines are notably recommended during pregnancy: influenza and the combined tetanus, diphtheria and acellular pertussis (Tdap) vaccine. In this review the authors discuss current recommendations for vaccination against pertussis and influenza in pregnant women in terms of epidemiological, clinical, and immunological reasons, taking into account safety and effectiveness. Promoting patients' awareness about pertussis and influenza and encouraging general practitioners, nurses and obstetricians to recommend the pertussis booster and influenza vaccine will hopefully increase the number of pregnant women who choose to become vaccinated.

Different T cell memory in preadolescents after whole-cell or acellular pertussis vaccination

To better understand vaccine-induced protection and its potential failure in light of recent whooping cough resurgence, we evaluated quantity as well as quality of memory T cell responses in B. pertussis-vaccinated preadolescent children. Using a technique based on flow cytometry to detect proliferation, cytokine production and phenotype of antigen-specific cells, we evaluated residual T cell memory in a cohort of preadolescents who received a whole-cell pertussis (wP; n=11) or an acellular pertussis vaccine (aP; n=13) during infancy, and with a median of 4 years elapsed from the last pertussis booster vaccine, which was aP for all children. We demonstrated that B. pertussis-specific memory T cells are detectable in the majority of preadolescent children several years after vaccination. CD4+ and CD8+ T cell proliferation in response to pertussis toxin and/or filamentous hemagglutinin was detected in 79% and 60% of the children respectively, and interferon-γ or tumor necrosis factor-α producing CD4+ T cells were detected in 65% and 53% of the children respectively. Phenotyping of the responding cells showed that the majority of antigen-specific cells, whether defined by proliferation or cytokine production, were CD45RA−CCR7− effector memory T cells. Although the time since the last booster vaccine was significantly longer for wP-compared to aP-vaccinated children, their proliferation capacity in response to antigenic stimulation was comparable, and more children had a detectable cytokine response after wP- compared to aP-vaccination. This study supports at the immunological level recent epidemiological studies indicating that infant vaccination with wP induces longer lasting immunity than vaccination with aP-vaccines.

Pertussis, a Disease Whose Time Has Come

In the United States, major epidemics of pertussis or whooping cough have occurred in the last 5 years making this disease a major public health issue. The adolescent and adult populations are the major transmitters of disease to the community. However, these epidemics have had the greatest effect on the young infant population resulting in high rates of hospitalizations and complications and accounting for 100% of the mortality. Optimization of vaccine recommendations is a strategy that is critically important as a method to control the disease burden and decrease the transmission of disease to the young infant population. Immunization that is focused on the close contacts of these young infants (the cocoon strategy) is felt to be one of the main cornerstones to vaccine optimization with the immunization of pregnant women being critical. Transmission studies have shown that adolescent and adult close contacts, especially new mothers, are the source of disease transmission to their young infants in more than 50% of the cases. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists strongly recommend that the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis booster vaccine be given to pregnant women during each pregnancy between 27 weeks and 36 weeks of gestation to protect their infant against pertussis disease.