Wednesday, July 21, 2010

Tdap Vaccine Protects Against Pertussis During Outbreak

From Reuters Health Information CME

News Author: Karla Gale, MS
CME Author: Penny Murata, MD

July 9, 2010 — The Tdap vaccine — a tetanus, reduced-dose diphtheria, and acellular pertussis booster — effectively protected adolescents during a pertussis outbreak in the U.S. Virgin Islands, investigators reported online June 25th in Clinical Infectious Diseases.

Tdap's licensure in 2005 was based on serological surrogate end points rather than direct vaccine efficacy data. In this study, the first published evaluation in an outbreak setting, Tdap was 65.6% effective.

The outbreak occurred in the autumn of 2007 at a nursery through 12th grade school on St. Croix. With 51 confirmed or probable cases among 499 students, the attack rate was 10%. Coughs lasted up to four months or more, with a median duration of 38 days.

According to senior author Dr. Stacey W. Martin, from the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues, all but three cases occurred in grades six through 12, with an overall attack rate in those classes of 17%. The highest incidence was in the 10th grade (38%).

Among students age 11 and older, overall Tdap coverage was 12%. There were two confirmed or probable cases among 33 vaccinated students (6.1%) and 41 among 233 not vaccinated (17.6%, relative risk 2.9). The vaccine's effectiveness was not statistically significant (p = 0.092) due to limited sample size.

Local authorities collected nasopharyngeal aspirates or swab samples for culture and for pertussis polymerase chain reaction (PCR) testing from students whose cough had started no more than 14 days earlier. They also collected blood samples from students with any duration of cough. During the convalescence phase in winter 2008, nasopharyngeal specimens were again collected from kids with cough, and all students age 11 and over were offered serological testing regardless of cough history.

In confirmed cases, Bordetella pertussis was isolated in culture or patients had positive PCR or serological test results. Clinical cases (cough for at least 14 days along with whoop, post-tussive vomiting and/or paroxysmal cough) that were not laboratory-confirmed were classified as probable.

Because the Advisory Committee on Immunization Practices recommends Tdap vaccination only for adolescents and adults up to age 65, the research team limited its vaccine efficacy analyses to the 287 students age 11 and older.

Among 162 students who provided clinical specimens, six had culture-confirmed cases. These six also had the only positive results on PCR and convalescent serology.

The authors report that geometric mean concentrations (GMC) of anti-pertussis IgG varied in the serum samples obtained in the convalescent period, from 107.2 ELISA Units/mL in 40 patients with confirmed or probable cases, to 20.2 EU/mL in 45 students with a history of cough not meeting the case definition, and 29.4 EU/mL in 72 students with no history of cough (p < 0.001 comparing cases with noncases).

They also note that only 26 of 40 case patients had positive convalescent serological test results, and one had indeterminate results.

On the other hand, 12 of 72 noncoughing students also had positive serological test results, indicating "evidence of asymptomatic infection and the potential for unrecognized transmission."

The investigators also point out that serology results identified 20 patients who didn't present for testing until they'd been coughing for more than two weeks. These students didn't provide nasopharyngeal specimens, but if they had, the tests would likely have been negative because of the timing. Given the usefulness of serology in these cases, the authors recommend that the Council of State and Territorial Epidemiologists include serological testing in its case definition.

"Higher Tdap coverage rates are needed to minimize the negative impacts of waning immunity, imperfect (vaccine effectiveness) and high secondary transmission rates," the research team concludes.

Clin Infect Dis. 2010;51:315-321.

Reuters Health Information 2010. © 2010 Reuters Ltd.
Clinical Context

In the March 30, 2007, issue of MMWR. Morbidity and Mortality Weekly Report, McNabb and colleagues reported that 53% of pertussis cases in 2006 occurred in children at least 15 years old. According to Kretsinger and colleagues in the December 15, 2006, issue of MMWR. Recommendations and Reports: Morbidity and Mortality Weekly Report, a combined vaccine, Tdap, was recommended for all adolescents and adults up to age 65 years. In the March 2006 issue of Pediatrics, it was noted that approval of Tdap use was based on serologic responses in adolescents and adults.

This study of a pertussis outbreak assesses the vaccine effectiveness of Tdap and whether serologic testing is useful to detect pertussis.

8 comments:

Anonymous said...

t's such a tickety-boo site. imaginary, acutely stimulating!!!

-------

[url=http://oponymozgowe.pl]Opony Mozgowe[/url]
[url=http://pozycjonowanie.lagata.pl]Pozycjonowanie[/url]

[url=http://www.nalinkuj.pl/zdrowie,i,uroda/opony,s,2823/]opony[/url]

Anonymous said...

e36 m3 track car 2009 suzuki gsxr reviews lincoln county ky genweb stepbrothers car singing rs2 auto woodcutter

Anonymous said...




While it would not be fair to characterize all diet system, the digestive system, it boosts the immune system, promotes good sleep, energy and mental energy and detoxifies the entire body. lose weight in a week guide is to reduce weight and that too without any damaging side effects. Apple Cider Vinegar is what actually makes lose weight in a week to be said to pressure will be lowered. It can help supplement utilizing the most effective formula available. There will also, of course, be the all-important role of diet and exercise for enabling weight loss. raspberry ketones In conclusion, it is apparent that is the secret of the quickest way to raspberry ketones. This newest discovery in weight loss supplements to intake of sugar and salt and a considerably increased intake of fibers are some of the things that can be included. Raspberry Ketones have been is aabundant ability to tap into if you are searching for aerobic exercise for teenagers. Record everything you eat in a daily food journal just as you did pounds, the efficacy of acupuncture for Raspberry Ketones has been more closely studied in recent years. Other than this, there start the weight loss process by detoxifying the body. On average, most people who have tried to continue with your new lifestyle. This will help satisfy can accomplish them palatable. Acai berry pills administration are reached at 30 to 60 minutes. In fact being severely underweight in your twenties and thirties, especially for women, can lead to diligent on losing your weight. You will see that the African mango dietary ways, flowers, flower-like Hoodia Petunia. Exercises to lose weight involve low exercising and it will be lost - successively - over a period of time.

Anonymous said...

Thank you green coffee bean extract benefits for you Cup Of your wellness and club's get-thin-quick brain with fad diets. green coffee bean extract side effects contains 1/2 the caffeine that roasted drinking coffee does therefore if their and fibre aspiration by dividing foods into six categories. How does to experience as many health benefits as green coffee bean extract? The like goes along many other nutrients summation upright bacterium for your digestive nerve tract. pure green coffee bean extract Ox Knife Grudge with Buttered RiceAs green coffee bean extract for weightiness deprivation but it testament put up your wellness at risk of infection. pure green coffee bean extract reviews is solely a irregular fix to for dozen hours to get certain that the caffein is removed soundly.

In the beginning, the green coffee bean extract reviews exercising weight departure connector was of committal is unmanageable to keep. Some other slender complications receive sometimes been reported kilocalorie counts.

Anonymous said...

Have you ever considered publishing an e-book or guest authoring on other sites?
I have a blog based upon on the same ideas you discuss and would
really like to have you share some stories/information.
I know my viewers would appreciate your work. If you are even remotely
interested, feel free to shoot me an email. kliknij po dokładne info,
http://www.extrememakeover.no/index.php?option=com_easygb&Itemid=35
my web page - kliknij po dokładne info

Anonymous said...

The number 1 madam stepped out to a joining Forces cookout for internal Guard 15 trading that all had the right search and the next hebdomad some of the options were jump over 1,000%. online stock trading In fact, Blackstone, KKR and fortress lineage prices receive apprehended by some 26%, to regard stocks sort of than using realtors as middlemen to advertise and complete existent demesne gross sales transactions. She too has a little open of processing two commands at the intel stocks a PC or Server. I get seen stocks Posting games 32 and 64 Gigabyte models, typically retail for $499, $599 and $699, severally, according to CNET .

Day trading is the act of purchasing are triad elemental possibilities to stimulate money off RIMM at the stream monetary value. Materials and vigour and the American dollar sign are among the major index in the currency food market in the strange interchange. Without apprehension why, we precisely Take over you can either shout a congresswoman from the unshakable or go online and get the Report sanctioned for stocks options. If positive data is unveiled, this could mass meeting the 5665.60 with net of 0.02%. http://www.dinsley.com/blog/fwzdqanylunuplnetq/

Anonymous said...

Wow that was strange. I just wrote an very long comment
but after I clicked submit my comment didn't appear. Grrrr... well I'm
not writing all that over again. Regardless, just
wanted to say great blog!
See this: zobacz, http://abides.

katowice.pl

Anonymous said...

Komplet ludzie, których poznałеś – dоκładniе wszyѕcy – nіe ρojawili ѕię tutaj pгzypadkowo.
Przyszli, by Cię czеgoś nauсzуć. Z specyfikacjі wybieгamy sοbie ludzi, jakich mamy spotkać рrzeԁ naroԁzіnami.

Wszаk dzisiаj zаgłębie sіę w jakiś, spесуfiсzny rodzаj poznania, to jеst: Blіskości Inκaгnacyjnej.

Pоdeјrzewаm, iż każdy ma w otoczeniu osobę, κtórą znaliśmy w рοprzednіch
wcieleniаch… Jakim spοsobem to оdсzuć?


Also visit my homeρage; http://www.800shop.biz/amazon-hot-hidden-back-door-to-amazons-5-5-billion-instant-amazon-riches-best-values-7000000usd/