Whooping Cough Immunization Research Articles

Optimising the timing of whooping cough immunisation in mums (OpTIMUM) through investigating pertussis vaccination in pregnancy: an open-label, equivalence, randomised controlled trial

Pertussis vaccination in pregnancy is recommended in many countries to provide protection to young infants. The best timing for this vaccination is uncertain. In the UK, vaccination is recommended between 16 weeks and 32 weeks of gestation. In this trial we aimed to investigate the equivalence of three time periods for pertussis vaccination in pregnancy. In this open-label, equivalence, randomised controlled trial to investigate equivalence of different time windows for pertussis vaccination in pregnancy, participants were randomly assigned (1:1:1 ratio) to receive a pertussis-containing vaccine (Boostrix-inactivated poliovirus vaccine) in one of three gestational age groups, comprising group 1 (≤23 weeks + 6 days), group 2 (24-27 weeks + 6 days), and group 3 (28-31 weeks + 6 days) using a computer-generated randomisation list. The primary outcome was concentration of pertussis-specific antibodies in the infant born at term at birth. Maternal blood sampling was done before and 2 weeks after vaccination and at delivery, together with a cord sample, and an infant sample was collected at least 4 weeks after primary vaccination. Reactogenicity was assessed for 7 days after vaccination. This trial was registered with ClinicalTrials.gov (NCT03908164). Between May 7, 2019, and Feb 13, 2020, of 1010 women assessed for eligibility, 364 women were recruited and 351 received the intervention (120 in group 1, 119 in group 2, and 112 in group 3). Equivalence of time periods was demonstrated for anti-pertussis toxin and anti-pertactin IgG concentrations. The cord blood geometric mean concentrations of anti-filamentous haemagglutinin IgG were higher with increasing gestational age at vaccination, such that for infants in group 1 (≤23 weeks + 6 days), equivalence to group 3 (28-31 weeks + 6 days) was not shown. Reported rates of fever were similar between study groups. Pertussis vaccination at three different time intervals in pregnancy resulted in equivalent concentrations of IgG antibodies in infants against two of the three pertussis antigens assessed. Overall, these findings support recommendations to vaccinate any time between 16 weeks and 32 weeks of gestation. The Thrasher Research Fund and the National Immunisation Schedule Evaluation Consortium through the National Institute for Health and Care Research policy research programme.

Optimising the Timing of whooping cough Immunisation in MUMs: a randomised controlled trial investigating the timing of pertussis vaccination in pregnancy (OpTIMUM): a protocol paper

Background: Pertussis is a highly infectious respiratory illness caused by the bacteria Bordetella pertussis. A resurgence of pertussis, even in countries with good vaccine coverage, has led to an increase in infant deaths. In response to this, many countries have introduced pertussis vaccination in pregnancy. This strategy is effective at preventing infant disease, but there remains uncertainty about what gestational timing is best to ensure maximal protection of the infant. These uncertainties are the rationale for this randomised controlled trial and a sub-study investigating pertussis-specific antibody in breastmilk. Protocol: We will recruit 354 pregnant women and will randomise them to receive their pertussis vaccination in one of three gestational age windows: ≤23+6, 24-27+6 and 28-31+6 weeks of gestation. Vaccination will be with Boostrix-IPV® and participants will be asked to complete a symptom diary for seven days following vaccination. Blood sampling will be performed prior to vaccination, two weeks following vaccination and at the time of delivery. A cord blood sample will be collected at delivery and a blood sample collected from the infant 4-10 weeks after completion of the primary immunisations. Individuals participating in the breastmilk sub-study will provide a sample of colostrum within 48 hours of delivery and samples of breastmilk at two weeks and around five-six months. Blood samples will be analysed using enzyme linked immunosorbent assay (ELISA) techniques for pertussis toxin, filamentous haemagglutinin and pertactin. A subset of serum samples will also be analysed using a functional assay. Colostrum and breastmilk samples will be analysed using functional assays. Discussion: Although pertussis vaccination has been shown to be safe and effective in pregnancy there remains debate about the optimal timing for the administration during pregnancy. This study will investigate antibody responses in serum and breastmilk when vaccination is performed in three different time periods. Clinicaltrials.gov registration: NCT03908164 (09/04/2019)

Optimising the Timing of Whooping Cough Immunisation in MUMs

Optimising the Timing of Whooping Cough Immunisation in MUMs

Alternative diphtheria, tetanus and whooping cough immunization schedule to evoke a Th2 tetanus and a Th1 pertussis immune response

In a previous study, using BALB/c mice, we found that while diphtheria (D), tetanus (T) and whooping cough (Pw, whole-cell Bordetella pertussis) immunization induces a Th1/Th2 tetanus response and memory T cells able to proliferate in response to in vitro stimulation with B. pertussis, DTPa immunization induces a Th2 tetanus immune response and no memory T cells that recognize B. pertussis as stimulus. Considering that a pro-inflammatory cytokine production is not necessary for protection against tetanus and therefore should be avoided, an alternative DTP immunization schedule with minimal Pw exposure was assessed in order to obtain a Th2 tetanus response and a Th1 pertussis response. BALB/c mice were primed with DT vaccine at day 0, with Pw vaccine at day 14 and boosted with DTPa vaccine at days 21 and 28. A control group was inoculated with saline. Antibodies against B. pertussis surface antigens, tetanus and diphtheria toxoids were produced by mice. Spleen cells stimulated in vitro with B. pertussis produced IL-6 and IFNγ. Only IL-5 was produced by cells in response to tetanus toxoid stimulation. These results are in line with the low IgG1/IgG2a ratio for pertussis antibodies compared with those corresponding to tetanus and diphtheria. The immunization protocol presented herein succeeded in producing tetanus and pertussis immune responses of Th2 and Th1 type, respectively. In contrast to previous results obtained with DTPw immunization, no IL-12 production was observed. Our findings provide direct evidence that an immunization protocol with an interval of 14 days between DT and Pw primings, followed by DTPa boosters, can induce appropriate immune responses against DTP vaccine antigens.

Estudio de un brote epidémico de tos ferina en Castellón

Based on the report of several cases at one school, a study of an epidemic outbreak was started for the purpose of characterizing this outbreak from the person, place and time standpoint, calculating the effectiveness of the immunization and the concordance of the cases with the positive result of the serological study. A "case" is defined as being that individual who has a cough fasting for two weeks. A study is made of the spread of the disease by means of the epidemic curve and the effectiveness of the pertussis vaccine. The concordance of the cases and the positive serology is evaluated by way of the Kappa index. From among the students at several schools and those with whom they were living at the time, a total of 130 individuals were surveyed, 94 of whom fit the "case" definition. The average age of the cases was 10.5 years of age, 42.6% being males and 84% school age children, 71.3% showing signs of recent infection (positive IgM), the average length of time since the last whooping cough immunization being 8.25 years. The effectiveness of the whooping cough booster is 66%. The concordance between the cases and the positive results of the serology reveals a Kappa = 0.45. No B. Pertussis was isolated in the 25 throat swab samples. Classrooms and the family environment are a factor in spreading this disease. The including of a booster at 18 months improves the effectiveness of the whooping cough immunization. The isolation of B. Pertussis is not very frequent, and the serology may be an alternative when this disease is clinically suspected.

Internal variation in the uptake of whooping cough immunisation within a health authority

Data were obtained on the vaccination history of 6,898 children immunised with D3, the final dose of diphtheria vaccine. These children were born between 1984 and 1990 and were also resident within a single Health Authority during part or all of this time. Analysis of this data revealed consistent variation by treatment centre in the uptake of whooping cough vaccine in those children receiving the diphtheria vaccine. Certain treatment centres consistently achieved greater success in giving the whooping cough vaccine to those children who had received the diphtheria vaccine.

Decision making for routine measles/MMR and whooping cough immunisation

Decision making for routine measles/MMR and whooping cough immunisation

Decision making for routine measles/MMR and whooping cough immunisation

Decision making for routine measles/MMR and whooping cough immunisation

Decision making for routine measles/MMR and whooping cough immunisation

Decision making for routine measles/MMR and whooping cough immunisation

Decision making for routine measles/MMR and whooping cough immunisation: Author's reply

Decision making for routine measles/MMR and whooping cough immunisation: Author's reply

Decision making for routine measles/MMR and whooping cough immunisation.

Decision making for routine measles/MMR and whooping cough immunisation.

David Gwynne Evans, 6 September 1909 - 13 June 1984

David Gwynne Evans was born in Atherton, near Manchester, on 6 September 1909 of Welsh parents; his father, a schoolmaster, was from Pembrokeshire and his mother from Bangor, North Wales. He was the third of four children in a distinguished family. His older brother, Meredith Gwynne, became Professor of Physical Chemistry in Leeds and later in Manchester and was a Fellow of the Royal Society. His sister, Lynette Gwynne, took a degree in modern languages at Manchester University and taught in girls’ high schools. His younger brother, Alwyn Gwynne, after holding a lectureship in Manchester University was appointed to the Chair of Physical Chemistry in Cardiff University. David left Leigh Grammar School in 1928 at the age of 18 years and worked for two years in a junior capacity for the British Cotton Growers’ Association at the Manchester Cotton Exchange. However, when Alwyn went up to Manchester University in 1931, David decided to go with him and both graduated B.Sc. in physics and chemistry three years later and M .S c. after a further year. At this time Professor Maitland in the Department of Bacteriology wanted a chemist to help in the public health laboratory which was run by his department. Professor Lapworth recommended David for the post and thus David entered the field of bacteriology and immunology, to which he was to contribute so much. He was appointed Demonstrator and soon afterwards Assistant Lecturer in the University Department. During these early years he worked with Professor Maitland on the toxins of Haemophilus pertussis (now Bordetella pertussis ) and related organisms, work that provided a sound basis for his subsequent interest in whooping cough immunization and later for his abiding interest in vaccination against other diseases and in the standardization of vaccines and antisera.

Whooping cough

THE Department of Health have identified the need for a major health education campaign aimed at increasing the rate of immunisation against whooping cough, and therebydecreasingits incidence, particularly in view of a predicted upturn in Autumn 1985. The Health Education Council is developing this campaign to be run later this year, the first stage of which was to commission preliminary research to examine attitudes, knowledge and behav iour in this area. The results would be used to help identify the appropriate form and content of the materials to be used, but quite apart from this particular use, this research, has a wider interest value — and perhaps further applications. This article describes the research and some of the main findings with this in mind. (MORI — Market and Opinion Research International — were commissioned to undertake the research, and the HEC has received their report 'Attitudes towards Whooping Cough Immunisation' by Brian Gosschalk and Lynn Cherkas, — now lodged in the HEC library).

CONTRAINDICATIONS TO WHOOPING-COUGH IMMUNISATION—MYTHS OR REALITIES?

Since 1974 when a report on the neurological complications of whooping cough immunization received massive professional and public attention, there has been a loss of confidence in the vaccine's safety resulting in a drop of immunization rates and a sharp rise in whooping cough morbidity in Great Britain. Nicoll attributes this loss of confidence to ambiguities in official guidelines on contraindications to immunization which have led to professional uncertainty and fear of responsibility for possible vaccine injury, and to the persistence among health professionals and the public of myths about immunization. The author urges an aggressive official approach to affirm the efficacy of immunization by issuing clear, factual guidelines, including an acknowledgement and repudiation of the myths.

Whooping Cough Immunization in France and Britain: Discussion Paper1

Whooping Cough Immunization in France and Britain: Discussion Paper¹

Prolonged hospital stay for whooping cough: The need for prevention

Three hundred and thirty-two children with whooping cough were admitted to a children's hospital during 1977–80. Sixty-five (20%) stayed for over 14 days, and 14 (4%) required intensive care. Infants under 6 months old were most likely to be severely ill and to stay longer. In the prolonged-stay group coughing fits lasting more than 2 min with more than 10 paroxysms in 24 h were common. A whoop was not less common in young infants. Prolonged stay was frequently linked with cough or chest infection, often complicated by apnoea, cyanosis and feeding difficulties. Isolation of Bordetella pertussis in 11% was unrelated to length of illness before admission or length of stay. Whooping-cough notifications on Merseyside are common, immunization rates are very low and study of hospital admission confirms that a serious illness called whooping cough requires prevention. There is need for evaluation of pernasal swab cultures and routine paired serology in confirming that clinical cases of whooping cough are suffering from a disease preventable by immunization. Further controlled trials of prophylactic antibiotic given to asymptomatic family contacts for 14 days, as an alternative or adjunct to whooping cough immunization, are urgently required.

Interpretation of the contraindications to whooping cough vaccination.

The official recommendations on the contraindications to whooping cough immunisation are currently couched in general terms. The results of a simple inquiry made to directors of public health laboratories, general paediatriciains, paediatric neurologists, medical officers, general practitioners, and health visitors to see how they would interpret the contraindications in certain specific cases suggest that there is considerable uncertainty on how the contraindications should be interpreted. This is probably one factor responsible for the fall in the rate of whooping cough immunisation in the United Kingdom.

The whooping-cough immunisation controversy.

The whooping-cough immunisation controversy.

Whooping-cough immunization: Fact and fiction

This paper is based on a contribution to a Symposium on Community Child Health for the Yorkshire Branch of the Society of Community Medicine at Leeds General Infirmary on 15 February 1980.

Whooping-cough immunisation

Whooping-cough immunisation