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Bechini A, Zanella B, Bonito B, Bonanni P, Boccalini S. Review of scientific evidence to support recommendations of the full-dose DTaP-IPV vaccination in pre-school age children in Italy. Expert Rev Vaccines 2022; 21:1819-1830. [PMID: 36178008 DOI: 10.1080/14760584.2022.2130770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Two vaccine formulations are available to prevent diphtheria, tetanus, pertussis, and poliomyelitis: the pediatric full-dose (DTaP-IPV) and the reduced dose formulation (dTap-IPV). Different immunization schedules are internationally recommended for the pre-school booster dose. AREAS COVERED International and Italian recommendations, scientific evidence on immunogenicity and safety of DTaP/dTap vaccines to support the full dose as a pre-school booster and Italian vaccination coverage (VC) up to adolescence. EXPERT OPINION The WHO recommends a '3+1' schedule with DTaP vaccine for primary immunization, followed by a pre-school booster with DTaP or dTap vaccine. In Italy, a '2+1' schedule, with no booster in the second year, and a pre-school booster dose are recommended with DTPa-IPV vaccines. Studies showed a non-inferior immunogenicity in dTap vaccinees in pre-school age; nevertheless, the antibody titers were usually greater in children vaccinated with DTaP, while lower frequencies of adverse events were recorded in children receiving dTap. Italian VCs for pre-school and adolescent boosters have not been satisfactory, which further reduced during the COVID-19 period. In Italy, the pre-school booster offers the last chance to receive a full dose of DTaP vaccine, thus, representing the most suitable intervention to provide lasting protection in children.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Beatrice Zanella
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
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Zuo W, Li J, Jiang W, Zhang M, Ma Y, Gu Q, Wang X, Cai L, Shi L, Sun M. Dose-Sparing Intradermal DTaP-sIPV Immunization With a Hollow Microneedle Leads to Superior Immune Responses. Front Microbiol 2021; 12:757375. [PMID: 34759909 PMCID: PMC8573275 DOI: 10.3389/fmicb.2021.757375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Dose-sparing intradermal (ID) vaccination may induce the same immune responses as intramuscular (IM) vaccination, which can increase vaccine supplies and save costs. In this study, rats were immunized with fractional-dose of Sabin-derived IPV combined with diphtheria-tetanus-acellular pertussis vaccine (DTaP-sIPV) intradermally with hollow microneedle devices called MicronJet600 and the vaccine immunogenicity and efficacy were evaluated and compared with those of full-dose intramuscular immunization. We tested levels of antibodies and the subclass distribution achieved via different immunization routes. Furthermore, gene transcription in the lung and spleen, cytokine levels and protection against Bordetella pertussis (B. pertussis) infection were also examined. The humoral immune effect of DTaP-sIPV delivered with MicronJet600 revealed that this approach had a significant dose-sparing effect and induced more effective protection against B. pertussis infection by causing Th1/Th17 responses. In conclusion, ID immunization of DTaP-sIPV with the MicronJet600 is a better choice than IM immunization, and it has the potential to be a new DTaP-sIPV vaccination strategy.
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Affiliation(s)
- Weilun Zuo
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Jingyan Li
- Laboratory of Vaccine Development, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Wenwen Jiang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Mengyao Zhang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Yan Ma
- Laboratory of Vaccine Development, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Qin Gu
- Laboratory of Vaccine Development, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Xiaoyu Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Lukui Cai
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Li Shi
- Laboratory of Immunogenetics, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
| | - Mingbo Sun
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
- Laboratory of Vaccine Development, Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China
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Lee SM, Kim SJ, Chen J, Song R, Kim JH, Devadiga R, Kim YK. Post-marketing surveillance to assess the safety and tolerability of a combined diphtheria, tetanus, acellular pertussis and inactivated poliovirus vaccine (DTaP-IPV) in Korean children. Hum Vaccin Immunother 2019; 15:1145-1153. [PMID: 30668217 PMCID: PMC6605835 DOI: 10.1080/21645515.2019.1572406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Infanrix-IPV (GSK, Belgium) is a diphtheria, tetanus, acellular pertussis, and inactivated poliovirus combination vaccine (DTaP-IPV) licensed in many countries including Korea. In accordance with Korean regulations, we conducted a post-marketing surveillance (PMS) to evaluate the safety of DTaP-IPV administered to Korean children in routine immunization schedules. Children aged <7 years receiving at least one dose of DTaP-IPV either as part of a primary (3-dose) vaccination series or as a subsequent booster were enrolled. Adverse events (AEs), adverse drug reactions (ADRs) and serious AEs (SAEs) were recorded after each dose during the 30-day post-vaccination follow-up period. Among a total of 639 children, 289 subjects (45.2%) experienced AEs, mostly (79.2%) assessed as being unlikely to be related to the vaccination. ADRs were reported in 13.0% of subjects. Fever was the most commonly reported expected AE (11.9% of subjects) and also the most commonly reported expected ADR (8.5% of subjects). No obvious association between AE incidence and vaccine dose sequence was apparent. An unexpected AE was seen in 32.9% of children, and unexpected ADRs were far less common (1.9%). Thirty-four SAEs were recorded in 26 subjects (4.1%), in two of whom a causal association with the vaccine could not be excluded, although both resolved quickly. Data from this PMS indicate that DTaP-IPV has an acceptable safety profile when given to Korean children in accordance with local prescribing recommendations in routine childhood immunization. ClinicalTrials.gov identifier: NCT01568060
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Affiliation(s)
- Soon Min Lee
- a Department of Pediatrics, Gangnam Severance Hospital , Yonsei University College of Medicine , Gangnam-gu , Seoul , Republic of Korea
| | - Sung Jin Kim
- b GSK, LS Yong-san Tower, Hangang-daero , Yongsan-gu , Seoul , Republic of Korea
| | | | - Rok Song
- b GSK, LS Yong-san Tower, Hangang-daero , Yongsan-gu , Seoul , Republic of Korea
| | - Joon-Hyung Kim
- b GSK, LS Yong-san Tower, Hangang-daero , Yongsan-gu , Seoul , Republic of Korea
| | | | - Yun-Kyung Kim
- e Department of Pediatrics , Korea University College of Medicine , Seoul , Republic of Korea
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The use of multiplex PCR for the detection of atypical pathogens in Egyptian children with CAP: a high rate of Bordetella pertussis in early infancy. J Egypt Public Health Assoc 2019; 94:5. [PMID: 30713347 PMCID: PMC6338716 DOI: 10.1186/s42506-018-0003-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/20/2018] [Indexed: 01/30/2023]
Abstract
Background Atypical pathogen infections played an important role in community-acquired pneumonia (CAP) in children. Pathogen-specific clinical symptoms are often lacking, and it is difficult to detect atypical pathogens by culture methods. The use of multiplex polymerase chain reaction (PCR) methods enables testing for many pathogens simultaneously in a single analysis. Aim To determine the role of atypical pathogens in children hospitalized with CAP. Patients and methods This cross-sectional study was conducted throughout a 2-year period from August 2015 to September 2017. It included 400 Egyptian children hospitalized with clinical diagnosis of CAP at a tertiary hospital in Cairo, Egypt. Sputum samples were collected from lower respiratory tract of all enrolled patients by mucus trap catheter for identification of Bordetella pertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophilia by using multiplex real-time PCR. Results Among the 400 CAP patients enrolled in this study, atypical pathogens were detected in 12/400 (3%) patients. Bordetella pertussis was detected in 2% of cases, and it was responsible for CAP in 8/104 (7.69%) infants in the age stratum ≤ 4 months; compared with pertussis-negative cases, pertussis-positive cases were younger and incompletely vaccinated (P values were 0.001 and 0.007, respectively). Mycoplasma pneumoniae was detected in 1% of cases, all were among the age stratum > 4 months ≤ 59 months in 4/272 (1.47%) children. Conclusion In early infancy, Bordetella pertussis causes a significant proportion of hospitalized CAP cases; all were ≤ 4 months old and incompletely vaccinated. This finding could suggest the role of maternal immunization in developing countries.
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Arfaatabar M, Aminharati F, Azimi G, Ashtari A, Pourbakhsh SA, Masoorian E, Pourmand MR. High frequency of Mycoplasma pneumoniae among patients with atypical pneumonia in Tehran, Iran. Germs 2018; 8:126-133. [PMID: 30250831 DOI: 10.18683/germs.2018.1139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 01/01/2023]
Abstract
Introduction Mycoplasma pneumoniae is a major cause of atypical community-acquired pneumonia (CAP) with a prevalence range of 15-20% and up to 40% in adults and children, respectively. In Iran, the recorded frequency ranges between 1-6.15%. We aimed to investigate the frequency of M. pneumoniae among patients with atypical pneumonia acquired from the community. Methods Over a period of 5 months between January and June 2017, 520 patients with suspected CAP, who had been to the hospital outpatient clinics of Tehran University, were enrolled in this study. Throat swab specimens were obtained from 110 outpatients who presented with symptoms of atypical pneumonia. M. pneumoniae was identified via culture and biochemical tests, such as fermentation of glucose and arginine, hemolysis, and hemadsorption. For confirmation, PCR was performed to amplify the gene fragment coding for p1 adhesin. Results The major and minor clinical signs of the patients were dyspnea (67.3%) and nausea (15.5%), respectively. Out of 110 specimens, 25 (22.7%) and 29 (26.4%) isolates were identified to be M. pneumoniae via culture and molecular assay, respectively. Comparing the results of the two methods, the PCR showed better sensitivity and rapidity for the detection of M. pneumoniae. There was a high congruence between culture and the PCR assay; kappa level was 'almost perfect' (κ=0.90). Conclusion This is the first report of high frequency of M. pneumoniae in our region. This finding can serve as baseline information for further investigation and confirmation of the potential epidemics of M. pneumoniae pneumonia in our community.
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Affiliation(s)
- Maryam Arfaatabar
- PhD, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Enqelab Square, Tehran, Iran
| | - Farzaneh Aminharati
- PhD, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Enqelab Square, Tehran, Iran
| | - Ghasem Azimi
- MD, PhD, Department of Internal Medicine, Shahed University of Medical Sciences, in front of the shrine of Imam Khomeini, Freeway Tehran-Qom, Tehran, Iran
| | - Abbas Ashtari
- DVM, Reference Mycoplasma Laboratory, Razi Vaccine and Serum Research Institute, Shahid Beheshti Street, Hesarak, Karaj, Iran
| | - Seyed Ali Pourbakhsh
- PhD, Reference Mycoplasma Laboratory, Razi Vaccine and Serum Research Institute, Shahid Beheshti Street, Hesarak, Karaj, Iran
| | - Ensieh Masoorian
- MSc, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Enqelab Square, Tehran, Iran
| | - Mohammad Reza Pourmand
- PhD, Department of Pathobiology, School of Public Health, and Biotechnology Research Center, Tehran University of Medical Sciences, Enqelab Square, Tehran, Iran
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Role of Serum Mycoplasma pneumoniae IgA, IgM, and IgG in the Diagnosis of Mycoplasma pneumoniae-Related Pneumonia in School-Age Children and Adolescents. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00471-16. [PMID: 27760779 DOI: 10.1128/cvi.00471-16] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/07/2016] [Indexed: 01/10/2023]
Abstract
Mycoplasma pneumoniae is an important causative pathogen of community-acquired pneumonia in children. Rapid and reliable laboratory diagnosis of M. pneumoniae infection is important so that appropriate antibiotic treatment can be initiated to reduce the misuse of drugs and resistance rates. Anti-M. pneumoniae immunoglobulin M (IgM) is an indicator of recent primary infection but can persist for several months after initial infection. It has been suggested that anti-M. pneumoniae immunoglobulin A (IgA) can be a reliable indicator for recent M. pneumoniae infection in adults. We investigated the clinical diagnostic value of M. pneumoniae IgA in school-age children and adolescents with M. pneumoniae-related pneumonia. Eighty children with pneumonia and seropositive for M. pneumoniae IgM or with a 4-fold increase of anti-M. pneumoniae immunoglobulin G (IgG) were enrolled from May 2015 to March 2016. The titers of M. pneumoniae IgA, IgM, and IgG, the clinical features, and laboratory examinations of blood, C-reactive protein, and liver enzymes were analyzed. The initial positivity rates for M. pneumoniae IgM and IgA upon admission to the hospital were 63.6 and 33.8%, respectively. One week after admission, the cumulative positivity rates for M. pneumoniae IgM and IgA increased to 97.5 and 56.3%, respectively. Detection of M. pneumoniae IgM was more sensitive than detection of M. pneumoniae IgA for the diagnosis of M. pneumoniae-related pneumonia in school-age children and adolescents; however, paired sera are necessary for a more accurate diagnosis.
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Southern J, Waight PA, Andrews N, Miller E. Extensive swelling of the limb and systemic symptoms after a fourth dose of acellular pertussis containing vaccines in England in children aged 3–6 years. Vaccine 2017; 35:619-625. [DOI: 10.1016/j.vaccine.2016.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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Marchello C, Dale AP, Thai TN, Han DS, Ebell MH. Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis. Ann Fam Med 2016; 14:552-566. [PMID: 28376442 PMCID: PMC5389400 DOI: 10.1370/afm.1993] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/02/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Community-acquired pneumonia (CAP), acute cough, bronchitis, and lower respiratory tract infections (LRTI) are often caused by infections with viruses or Streptococcus pneumoniae. The prevalence of atypical pathogens Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Bordetella pertussis among patients with these illnesses in the ambulatory setting has not been previously summarized. We set out to derive prevalence information from the existing literature. METHODS We performed a systematic review of MEDLINE for prospective, consecutive-series studies reporting the prevalence of M pneumoniae, C pneumoniae, L pneumophila and/or B pertussis in outpatients with cough, acute bronchitis, LRTI, or CAP. Articles were independently reviewed by 2 authors for inclusion and abstraction of data; discrepancies were resolved by consensus discussion. A meta-analysis was performed on each pathogen to calculate the pooled prevalence estimates using a random effects model of raw proportions. RESULTS Fifty studies met our inclusion criteria. While calculated heterogeneity was high, most studies reported prevalence for each pathogen within a fairly narrow range. In patients with CAP, the overall prevalences of M pneumoniae and C pneumoniae were 10.1% (95% CI, 7.1%-13.1%) and 3.5% (95% CI, 2.2%-4.9%), respectively. Consistent with previous reports, M pneumoniae prevalence peaked in roughly 6-year intervals. Overall prevalence of L pneumophila was 2.7% (95% CI, 2.0%-3.4%), but the organism was rare in children, with only 1 case in 1,765. In patients with prolonged cough in primary care, the prevalence of B pertussis was 12.4% (95% CI, 4.9%-19.8%), although it was higher in studies that included only children (17.6%; 95% CI, 3.4%-31.8%). CONCLUSIONS Atypical bacterial pathogens are relatively common causes of lower respiratory diseases, including cough, bronchitis, and CAP. Where surveillance data were available, we found higher prevalences in studies where all patients are tested for these pathogens. It is likely that these conditions are underreported, underdiagnosed, and undertreated in current clinical practice.
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Affiliation(s)
- Christian Marchello
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Ariella Perry Dale
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Thuy Nhu Thai
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Duk Soo Han
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
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Antitoxins for diphtheria and tetanus decline more slowly after vaccination with DTwP than with DTaP: a study in a Chinese population. Vaccine 2014; 32:2570-3. [PMID: 24681275 DOI: 10.1016/j.vaccine.2014.03.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/07/2014] [Accepted: 03/13/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES DTP vaccines are used for the prevention of pertussis, diphtheria and tetanus. In 2007, in Gaobeidian city, China, the DTwP vaccine was replaced with DTaP. This study described the diphtheria and tetanus sero-epidemiology in subjects vaccinated solely with DTwP or DTaP. METHODS Blood samples were obtained between October 2012 and June 2013 from 587 healthy subjects aged 2-17 years. Serum IgG antibodies against diphtheria and tetanus were determined using ELISA. Interrupted time series analyses examined the changes in antitoxin levels over time and analyzed the alterations in diphtheria and tetanus antitoxin levels after the vaccine switch. RESULTS Mean concentrations of diphtheria antitoxin and tetanus antitoxin were 0.074 IU/ml (95% CI 0.065-0.084) and 0.063 IU/ml (95% CI 0.053-0.076). The protection rates (antitoxins >0.01 IU/ml) for diphtheria and tetanus were 88.25% and 82.11%. Mean antitoxin levels for both diphtheria and tetanus decreased with increasing age, but this decrease was much slower for DTwP than DTaP. CONCLUSIONS Although the observed protection rates for diphtheria and tetanus were sufficient to prevent an outbreak at present, the means levels of diphtheria and tetanus antitoxins decreased with increasing age; therefore, booster vaccinations at 7 and 12 years of age would be strengthened in Gaobeidian city, China.
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Booster vaccination: the role of reduced antigen content vaccines as a preschool booster. BIOMED RESEARCH INTERNATIONAL 2014; 2014:541319. [PMID: 24678509 PMCID: PMC3941168 DOI: 10.1155/2014/541319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/25/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022]
Abstract
The need for boosters for tetanus, diphtheria, pertussis, and polio, starting from preschool age, is related to the waning immune protection conferred by vaccination, the elimination/reduction of natural boosters due to large-scale immunization programs, and the possibility of reintroduction of wild agents from endemic areas. Taking into account the relevance of safety/tolerability in the compliance with vaccination among the population, it have been assessed whether today enough scientific evidences are available to support the use of dTap-IPV booster in preschool age. The review of the literature was conducted using the PubMed search engine. A total of 41 works has been selected; besides, the documentation produced by the World Health Organization, the European Centre for Disease Control, and the Italian Ministry of Health has been consulted. Many recent papers confirm the opportunity to use a low antigenic dose vaccine starting from 4 to 6 years of age. There is also evidence that 10 years after immunization the rate of seroprotected subjects against diphtheria does not differ significantly between those vaccinated with paediatric dose (DTaP) or reduced dose (dTaP or dTap) product. The dTpa vaccine is highly immunogenic for diphtheria toxoids regardless of prior vaccination history (2 + 1 and 3 + 1 schedules).
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Oskooee MB, Karimi A, Shiva F, Fallah F, Tabatabaei SR, Shirvani F, Shamshiri AR, Adabian S, Rahbar M. Detection of Mycoplasma pneumoniae and Chlamydia trachomatis in Iranian children with acute lower respiratory infections by polymerase chain reaction. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60460-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cell extract-containing medium for culture of intracellular fastidious bacteria. J Clin Microbiol 2013; 51:2599-607. [PMID: 23740722 DOI: 10.1128/jcm.00719-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The culture of fastidious microorganisms is a critical step in infectious disease studies. As a proof-of-concept experiment, we evaluated an empirical medium containing eukaryotic cell extracts for its ability to support the growth of Coxiella burnetii. Here, we demonstrate the exponential growth of several bacterial strains, including the C. burnetii Nine Mile phase I and phase II strains, and C. burnetii isolates from humans and animals. Low-oxygen-tension conditions and the presence of small hydrophilic molecules and short peptides were critical for facilitating growth. Moreover, bacterial antigenicity was conserved, revealing the potential for this culture medium to be used in diagnostic tests and in the elaboration of vaccines against C. burnetii. We were also able to grow the majority of previously tested intracellular and fastidious bacterial species, including Tropheryma whipplei, Mycobacterium bovis, Leptospira spp., Borrelia spp., and most putative bioterrorism agents. However, we were unable to culture Rickettsia africae and Legionella spp. in this medium. The versatility of this medium should encourage its use as a replacement for the cell-based culture systems currently used for growing several facultative and putative intracellular bacterial species.
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Spuesens EBM, Fraaij PLA, Visser EG, Hoogenboezem T, Hop WCJ, van Adrichem LNA, Weber F, Moll HA, Broekman B, Berger MY, van Rijsoort-Vos T, van Belkum A, Schutten M, Pas SD, Osterhaus ADME, Hartwig NG, Vink C, van Rossum AMC. Carriage of Mycoplasma pneumoniae in the upper respiratory tract of symptomatic and asymptomatic children: an observational study. PLoS Med 2013; 10:e1001444. [PMID: 23690754 PMCID: PMC3653782 DOI: 10.1371/journal.pmed.1001444] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 04/04/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is thought to be a common cause of respiratory tract infections (RTIs) in children. The diagnosis of M. pneumoniae RTIs currently relies on serological methods and/or the detection of bacterial DNA in the upper respiratory tract (URT). It is conceivable, however, that these diagnostic methods also yield positive results if M. pneumoniae is carried asymptomatically in the URT. Positive results from these tests may therefore not always be indicative of a symptomatic infection. The existence of asymptomatic carriage of M. pneumoniae has not been established. We hypothesized that asymptomatic carriage in children exists and investigated whether colonization and symptomatic infection could be differentiated by current diagnostic methods. METHODS AND FINDINGS This study was conducted at the Erasmus MC-Sophia Children's Hospital and the after-hours General Practitioners Cooperative in Rotterdam, The Netherlands. Asymptomatic children (n = 405) and children with RTI symptoms (n = 321) aged 3 mo to 16 y were enrolled in a cross-sectional study from July 1, 2008, to November 30, 2011. Clinical data, pharyngeal and nasopharyngeal specimens, and serum samples were collected. The primary objective was to differentiate between colonization and symptomatic infection with M. pneumoniae by current diagnostic methods, especially real-time PCR. M. pneumoniae DNA was detected in 21.2% (95% CI 17.2%-25.2%) of the asymptomatic children and in 16.2% (95% CI 12.2%-20.2%) of the symptomatic children (p = 0.11). Neither serology nor quantitative PCR nor culture differentiated asymptomatic carriage from infection. A total of 202 children were tested for the presence of other bacterial and viral pathogens. Two or more pathogens were found in 56% (63/112) of the asymptomatic children and in 55.5% (50/90) of the symptomatic children. Finally, longitudinal sampling showed persistence of M. pneumoniae in the URT for up to 4 mo. Fifteen of the 21 asymptomatic children with M. pneumoniae and 19 of the 22 symptomatic children with M. pneumoniae in this longitudinal follow-up tested negative after 1 mo. CONCLUSIONS Although our study has limitations, such as a single study site and limited sample size, our data indicate that the presence of M. pneumoniae in the URT is common in asymptomatic children. The current diagnostic tests for M. pneumoniae are unable to differentiate between asymptomatic carriage and symptomatic infection.
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Affiliation(s)
- Emiel B M Spuesens
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
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Combination vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Wang K, Gill P, Perera R, Thomson A, Mant D, Harnden A. Clinical symptoms and signs for the diagnosis of Mycoplasma pneumoniae in children and adolescents with community-acquired pneumonia. Cochrane Database Syst Rev 2012; 10:CD009175. [PMID: 23076954 PMCID: PMC7117561 DOI: 10.1002/14651858.cd009175.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is a significant cause of community-acquired pneumonia in children and adolescents. Treatment with macrolide antibiotics is recommended. However, M. pneumoniae is difficult to diagnose based on clinical symptoms and signs. Diagnostic uncertainty can lead to inappropriate antibiotic prescribing, which may worsen clinical prognosis and increase antibiotic resistance. OBJECTIVES The objectives of this review are (i) to assess the diagnostic accuracy of symptoms and signs in the clinical recognition of M. pneumoniae in children and adolescents with community-acquired pneumonia; and (ii) to assess the influence of potential sources of heterogeneity on the diagnostic accuracy of symptoms and signs in the clinical recognition of M. pneumoniae. SEARCH METHODS We searched MEDLINE (January 1950 to 26 June 2012) and EMBASE (January 1980 to 26 June 2012). We identified additional references by handsearching the reference lists of included articles and snowballing. We searched the reference lists of relevant systematic reviews identified by searching the Medion database, Database of Reviews of Effects 2012, Issue 6 (25 June 2012) and the Cochrane Register of Diagnostic Test Accuracy studies (2 July 2012). Experts in the field reviewed our list of included studies for any obvious omissions. SELECTION CRITERIA We included peer-reviewed published studies which prospectively and consecutively recruited children with community-acquired pneumonia from any healthcare setting, confirmed the presence of M. pneumoniae using serology with or without other laboratory methods and reported data on clinical symptoms and signs in sufficient detail to construct 2 x 2 tables. DATA COLLECTION AND ANALYSIS One review author scanned titles to exclude obviously irrelevant articles. Two review authors independently scanned the remaining titles and abstracts, reviewed full-text versions of potentially relevant articles, assessed the quality of included articles and extracted data on study characteristics and the following clinical features: cough, wheeze, coryza, crepitations, fever, rhonchi, shortness of breath, chest pain, diarrhea, myalgia and headache.We calculated study-specific values for sensitivity, specificity and positive and negative likelihood ratios with 95% confidence intervals (CIs). We estimated the post-test probability of M. pneumoniae based on the absence or presence of symptoms and signs.We calculated pooled sensitivities, specificities, positive and negative likelihood ratios with 95% CIs for symptoms and signs where data were reported by at least four included studies by fitting a bivariate normal model for the logit transforms of sensitivity and specificity. We explored potential sources of heterogeneity by fitting bivariate models with covariates using multi-level mixed-effects logistic regression. We performed sensitivity analyses excluding data from studies for which we were concerned about the representativeness of the study population and/or the acceptability of the reference standard. MAIN RESULTS Our search identified 8299 articles (excluding duplicates). We examined the titles and abstracts of 1125 articles and the full-text versions of 97 articles. We included seven studies in our review, which reported data from 1491 children; all were conducted in hospital settings. Overall, study quality was moderate. In two studies the presence of chest pain more than doubled the probability of M. pneumoniae. Wheeze was 12% more likely to be absent in children with M. pneumoniae (pooled positive likelihood ratio (LR+) 0.76, 95% CI 0.60 to 0.97; pooled negative likelihood ratio (LR-) 1.12, 95% CI 1.02 to 1.23). Our sensitivity analysis showed that the presence of crepitations was associated with M. pneumoniae, but this finding was of borderline statistical significance (pooled LR+ 1.10, 95% CI 0.99 to 1.23; pooled LR- 0.66, 95% CI 0.46 to 0.96). AUTHORS' CONCLUSIONS M. pneumoniae cannot be reliably diagnosed in children and adolescents with community-acquired pneumonia based on clinical symptoms and signs. Although the absence of wheeze is a statistically significant diagnostic indicator, it does not have sufficient diagnostic value to guide empirical macrolide treatment. Data from two studies suggest that the presence of chest pain more than doubles the probability of M. pneumoniae. However, further research is needed to substantiate this finding. More high quality large-scale studies in primary care settings are needed to help develop prediction rules based on epidemiological data as well as clinical and baseline patient characteristics.
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Affiliation(s)
- Kay Wang
- Department of Primary Care Health Sciences,University of Oxford, Oxford, UK.
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Hadi N, Kashef S, Moazzen M, Shamoon Pour M, Rezaei N. Survey of Mycoplasma pneumoniae in Iranian children with acute lower respiratory tract infections. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70152-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Loens K, Goossens H, Ieven M. Acute respiratory infection due to Mycoplasma pneumoniae: current status of diagnostic methods. Eur J Clin Microbiol Infect Dis 2010; 29:1055-69. [PMID: 20526788 PMCID: PMC7088226 DOI: 10.1007/s10096-010-0975-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 05/18/2010] [Indexed: 11/30/2022]
Abstract
Because of the absence of well-standardized both in-house and FDA-approved commercially available diagnostic tests, the reliable diagnosis of respiratory infection due to Mycoplasma pneumoniae remains difficult. In addition, no formal external quality assessment schemes which would allow to conclude about the performance of M. pneumoniae diagnostic tests exist. In this review, the current state of knowledge of M. pneumoniae-associated respiratory infections in the context of epidemiological studies published during the past 5 years is discussed, with particular emphasis on the diagnostic strategies used and their impact on results. The role of M. pneumoniae as a cause of respiratory tract infections (RTIs) differs from study to study due to geographical and epidemiological differences, as well as to the application of different diagnostic techniques and criteria used.
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Affiliation(s)
- K Loens
- Department of Microbiology, Vaccine and Infectious Disease Institute (VIDI), University of Antwerp, Antwerp, Belgium.
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18
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Johns TL, Hutter GE. New Combination Vaccines: DTaP-IPV (Kinrix) and DTaP-IPV/Hib (Pentacel). Ann Pharmacother 2010; 44:515-23. [DOI: 10.1345/aph.1m468] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the clinical utility of diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine ([DTaP-IPV]; Kinrix) and diphtheria and tetanus toxoids and acellular pertussis adsorbed, Inactivated poliovirus and Haemophilus b conjugate (tetanus toxoid conjugate) vaccine ([DTaP-IPV/Hib]; Pentacel) in the schedule for pediatric immunizations. Data Sources: PubMed was searched (1966–April 2009) using the key words Kinrix and Pentacel. Subject headings included vaccines, combined; diphtheria-tetanus-pertussis vaccine; diphtheria-tetanus-acellular pertussis vaccines; poliovirus vaccine, inactivated; and Haemophilus influenzae type b polysaccharide vaccinetetanus toxin conjugate. The search was limited to English-language publications involving humans. Product labeling was obtained from GlaxoSmithKline and Sanofi Pasteur. The Centers for Disease Control and Prevention (CDC) Web site was searched for relevant recommendations published June 2008–October 2009. Study Selection And Data Extraction: Phase 2 and 3 clinical trials evaluating immunogenicity and safety of DTaP-IPV and DTaP-IPV/Hib were reviewed. Published trials were supplemented with abstracts, review articles, manufacturer product labeling, and CDC recommendations. Data Synthesis: DTaP-IPV is immunogenic compared to its component vaccines, with no effect of concomitantly administered measles, mumps, and rubella vaccine. Although injection site pain has occurred more with the combination vaccine, its use would reduce by 1 the number of injections given when a child is 4–6 years old. DTaP-IPV/Hib is immunogenic and safe compared to separate vaccines. Immunogenicity to 7-valent pneumococcal conjugate vaccine and hepatitis B (HepB) vaccine is not affected by concomitant administration. DTaP-IPV/Hib decreases injections by up to 7 when given at 2, 4, 6, and 15–18 months of age. It fits into the schedule more easily than DTaP-HepB-IPV (Pediarix), the other DTaP-containing combination vaccine indicated for the primary infant series. Conclusions: DTaP-IPV and DTaP-IPV/Hib combination vaccines are immunogenic and safe when given to infants and children. They reduce the number of required injections. Combination vaccines are encouraged to promote timely vaccination and complete immunization schedules.
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Affiliation(s)
- Tracy L Johns
- Family Medicine Residency, University of South Florida, Morton Plant Mease Health Care;, Department of Family Medicine, College of Medicine, University of South Florida, Clearwater, FL
| | - George E Hutter
- Family Medicine Residency, University of South Florida, Morton Plant Mease Health Care;, Department of Family Medicine, College of Medicine, University of South Florida; Administrator, Clinical Research, Morton Plant Mease Health Care, BayCare Health System
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Weston WM, Klein NP. Kinrix: a new combination DTaP-IPV vaccine for children aged 4-6 years. Expert Rev Vaccines 2008; 7:1309-20. [PMID: 18980534 DOI: 10.1586/14760584.7.9.1309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Combination vaccines allow the administration of multiple vaccine antigens without the need for multiple injections. Recently, a combined diphtheria toxoid, tetanus toxoid, acellular pertussis and inactivated poliomyelitis vaccine (DTaP-IPV), Kinrix, has been licensed in the USA for use as the fifth DTaP dose and fourth IPV dose in children 4-6 years of age. Clinical trials have shown Kinrix to be immunogenic in 4-6-year-old children, with a safety profile comparable with that of separate DTaP and IPV vaccination. The use of Kinrix reduces by one the number of injections required to provide this age group with all recommended immunizations. Strategies such as the use of combined vaccines can help to maintain high levels of coverage against diphtheria, tetanus, pertussis and poliomyelitis diseases.
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Affiliation(s)
- Wayde M Weston
- GlaxoSmithKline Biologicals, 2301 Renaissance Boulevard, RN0220, King of Prussia, PA 19406, USA.
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20
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Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev 2008; 32:956-73. [PMID: 18754792 DOI: 10.1111/j.1574-6976.2008.00129.x] [Citation(s) in RCA: 306] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Since its initial description in the 1940s and eventual elucidation as a highly evolved pathogenic bacterium, Mycoplasma pneumoniae has come to be recognized as a worldwide cause of primary atypical pneumonia. Beyond its ability to cause severe lower respiratory illness and milder upper respiratory symptoms it has become apparent that a wide array of extrapulmonary infectious and postinfectious events may accompany the infections in humans caused by this organism. Autoimmune disorders and chronic diseases such as asthma and arthritis are increasingly being associated with this mycoplasma, which frequently persists in individuals for prolonged periods. The reductive evolutionary process that has led to the minimal genome of M. pneumoniae suggests that it exists as a highly specialized parasitic bacterium capable of residing in an intracellular state within the respiratory tissues, occasionally emerging to produce symptoms. This review includes discussion of some of the newer aspects of our knowledge on this pathogen, characteristics of clinical infections, how it causes disease, the recent emergence of macrolide resistance, and the status of laboratory diagnostic methods.
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21
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Combination vaccines. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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22
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Ieven M. Currently used nucleic acid amplification tests for the detection of viruses and atypicals in acute respiratory infections. J Clin Virol 2007; 40:259-76. [PMID: 17977063 PMCID: PMC7108459 DOI: 10.1016/j.jcv.2007.08.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 08/20/2007] [Indexed: 12/03/2022]
Abstract
For the detection of respiratory viruses conventional culture techniques are still considered as the gold standard. However, results are mostly available too late to have an impact on patient management. The latest developments include appropriate DNA- and RNA-based amplification techniques (both NASBA and PCR) for the detection of an extended number of agents responsible for LRTI. Real time amplification, the latest technical progress, produces, within a considerable shorter time, results with a lower risk of false positives. As results can be obtained within the same day, patient management with appropriate therapy or reduction of unnecessary antibiotic therapy in LRTI will be possible. A number of technical aspects of these amplification assays, and their advantages are discussed. The availability and use of these new diagnostic tools in virology has contributed to a better understanding of the role of respiratory viruses in LRTI. The increasing importance of the viral agents, Mycoplasma pneumoniae and Chlamydophila pneumoniae in ARI is illustrated. A great proportion of ARI are caused by viruses, but their relative importance depends on the spectrum of agents covered by the diagnostic techniques and on the populations studied, the geographical location and the season. The discovery of new viruses is ongoing; examples are the hMPV and the increasing number of coronaviruses. Indications for the use of these rapid techniques in different clinical situations are discussed. Depending on the possibilities, the laboratory could optimize its diagnostic strategy by applying a combination of immunofluorescence for the detection of RSV an IFL, and a combination of real-time amplification tests for other respiratory viruses and the atypical agents. When implementing a strategy, a compromise between sensitivity, clinical utility, turn around time and cost will have to be found.
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Affiliation(s)
- Margareta Ieven
- Laboratory for Microbiology, Vaccine & Infectious Disease Institute (VIDI), University Hospital Antwerp, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
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Dumke R, Schurwanz N, Lenz M, Schuppler M, Lück C, Jacobs E. Sensitive detection of Mycoplasma pneumoniae in human respiratory tract samples by optimized real-time PCR approach. J Clin Microbiol 2007; 45:2726-30. [PMID: 17537933 PMCID: PMC1951254 DOI: 10.1128/jcm.00321-07] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To enhance the sensitivity of the available real-time PCR systems for the detection of Mycoplasma pneumoniae, we established a method to amplify copies of the repetitive element repMp1. In a study of respiratory tract samples, we found that, compared to the use of the conserved part of the P1 adhesin gene as a monocopy target, the use of the repMp1-PCR showed an increase in the detected genome equivalents by a factor of 22.
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Affiliation(s)
- Roger Dumke
- Technical University Dresden, Medical Faculty Carl Gustav Carus, Institute of Medical Microbiology and Hygiene, Fetscherstrasse 74, D-01307 Dresden, Germany.
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Forsyth KD, Wirsing von Konig CH, Tan T, Caro J, Plotkin S. Prevention of pertussis: Recommendations derived from the second Global Pertussis Initiative roundtable meeting. Vaccine 2007; 25:2634-42. [PMID: 17280745 DOI: 10.1016/j.vaccine.2006.12.017] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 11/16/2006] [Accepted: 12/10/2006] [Indexed: 10/23/2022]
Abstract
The Global Pertussis Initiative (GPI) was established in 2001 to assess the global extent of the ongoing problem of pertussis and to evaluate and prioritize pertussis control strategies. Exchange of data, knowledge, and experience, facilitated by discussion and debate, resulted in the formulation, in 2002, of the following recommendation: all countries should consider expanding existing vaccination strategies to include adding pertussis booster doses to pre-school children (4-6 years old), to adolescents, and to those specific adults that have the highest risk of transmitting Bordetella pertussis infection to vulnerable infants. The GPI met again in 2005, where it reinforced its previous recommendation for universal adolescent immunization. Additionally, the GPI recommended implementation of the cocoon strategy (immunization of family members and close contacts of the newborn) in countries where it is economically feasible, and encouraged efforts toward global standardization of pertussis disease clinical definitions and diagnostics. Universal adult vaccination is a logical goal for the ultimate elimination of pertussis disease, but feasibility issues remain obstacles to implementation.
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Affiliation(s)
- Kevin D Forsyth
- Department of Pediatrics, Flinders Medical Centre and Flinders University, Adelaide, South Australia.
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25
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Flekna G, Schneeweiss W, Smulders FJM, Wagner M, Hein I. Real-time PCR method with statistical analysis to compare the potential of DNA isolation methods to remove PCR inhibitors from samples for diagnostic PCR. Mol Cell Probes 2007; 21:282-7. [PMID: 17383153 DOI: 10.1016/j.mcp.2007.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
A real-time PCR method for fast comparison of different DNA isolation methods to remove PCR inhibitors from samples is presented. A fixed amount of target-200 copies of a 79-bp region of the COCH gene of the zebrafish (Danio rerio)-was added to each PCR reaction together with isolated DNA from different types of samples including chicken feces. Four commercial DNA isolation kits and a chelex-based technique were compared using this method. The copy numbers calculated and the endpoint fluorescence were statistically compared to the values of 22 control samples containing the control target and water instead of isolated DNA, processed together in the same PCR run. The level of the endpoint fluorescence was more often negatively influenced by inhibitors than the copy number calculated, suggesting a more pronounced effect on the plateau phase of the reaction by limiting one or more compounds in the PCR reaction.
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Affiliation(s)
- Gabriele Flekna
- Department of Veterinary Public Health and Food Science, University of Veterinary Medicine, Veterinärplatz 1, A-1210 Vienna, Austria.
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26
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Zahariadis G, Gooley TA, Ryall P, Hutchinson C, Latchford MI, Fearon MA, Jamieson FB, Richardson S, Kuschak T, Mederski B. Risk of ruling out severe acute respiratory syndrome by ruling in another diagnosis: variable incidence of atypical bacteria coinfection based on diagnostic assays. Can Respir J 2006; 13:17-22. [PMID: 16470249 PMCID: PMC2539008 DOI: 10.1155/2006/862797] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) caused the first epidemic of the 21st century and continues to threaten the global community. OBJECTIVE To assess the incidence of coinfection in patients confirmed to have SARS-associated coronavirus (SARS-CoV) infection, and thus, to determine the risk of ruling out SARS by ruling in another diagnosis. METHODS The present report is a retrospective study evaluating the incidence and impact of laboratory-confirmed SARS-CoV and other pulmonary pathogens in 117 patients. These patients were evaluated in a Toronto, Ontario, community hospital identified as the epicentre for the second SARS outbreak. RESULTS Coinfection with other pulmonary pathogens occurred in patients with SARS. Seventy-three per cent of the patient population evaluated had laboratory-confirmed SARS-CoV infection. Serology showing acute or recent Chlamydophila pneumoniae or Mycoplasma pneumoniae infection revealed an incidence of 30% and 9%, respectively, in those with SARS. These rates are similar to previously published studies on coinfection in pneumonia. All nucleic acid diagnostic assays were negative for C pneumoniae and M pneumoniae in respiratory samples from patients with SARS having serological evidence for these atypical pathogens. CONCLUSIONS Diagnostic assays for well-recognized pulmonary pathogens have limitations, and ruling out SARS-CoV by ruling in another pulmonary pathogen carries significant risk. Despite positive serology for atypical pathogens, in a setting where clinical suspicion for SARS is high, specific tests for SARS should be performed to confirm or exclude a diagnosis.
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27
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Black S, Friedland LR, Schuind A, Howe B. Immunogenicity and safety of a combined DTaP–IPV vaccine compared with separate DTaP and IPV vaccines when administered as pre-school booster doses with a second dose of MMR vaccine to healthy children aged 4–6 years. Vaccine 2006; 24:6163-71. [PMID: 16759769 DOI: 10.1016/j.vaccine.2006.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 04/04/2006] [Indexed: 11/17/2022]
Abstract
Combination vaccines represent one solution to the problem of increased numbers of injections during single clinic visits. A combined DTaP-IPV (Infanrix-IPV) vaccine has been developed for use as a pre-school booster. Four hundred healthy children aged 4-6 years previously primed with 4 doses of DTaP vaccine (Infanrix), 3 doses of poliovirus vaccine and 1 dose of MMR vaccine were randomized to receive single doses of either the combined DTaP-IPV vaccine or separate DTaP and IPV vaccines in a Phase II trial (DTaP-IPV-047). All children also received a second dose of MMR vaccine. Immunogenicity was assessed in serum samples taken before and 1 month after booster administration. Safety was actively assessed for 42 days post-vaccination. Non-inferiority of the DTaP-IPV vaccine to separate DTaP and IPV vaccines was demonstrated for all DTaP antigen booster response rates and poliovirus geometric mean titers of antibody ratios. Post-vaccination, > or =99.4% of children in both groups had seroprotective levels of anti-diphtheria and anti-tetanus antibodies (> or =0.1IU/mL) and seroprotective anti-poliovirus antibody titers (> or =1:8). All children in both groups were seropositive for measles, mumps and rubella antibodies, with similar post-vaccination geometric mean concentrations/titers. No significant differences were observed in the incidence of solicited local or general symptoms, unsolicited symptoms and serious adverse events between the two groups. This combined DTaP-IPV appeared safe and immunogenic when given as a booster dose at 4-6 years of age. The DTaP-IPV vaccine had no negative effect on the response to co-administered MMR vaccine, making it well-suited for use as a pre-school booster.
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Affiliation(s)
- Steven Black
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, USA.
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28
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Shen H, Rogelj S, Kieft TL. Sensitive, real-time PCR detects low-levels of contamination by Legionella pneumophila in commercial reagents. Mol Cell Probes 2006; 20:147-53. [PMID: 16632318 DOI: 10.1016/j.mcp.2005.09.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Accepted: 09/28/2005] [Indexed: 11/16/2022]
Abstract
In a real-time PCR assay of Legionella pneumophila (targeting the L. pneumophila-specific mip gene and using SYBR Green dye for DNA detection in conjunction with the iCycler system) we detected as few as 1.3 copies of a mip gene in a 50-microl reaction from serially diluted L. pneumophila genomic DNA. However, cycle threshold (C(T)) were yielded and DNA product detected in our no-template negative controls and the phenomenon persisted when two separate batches of PCR reagents and water from two different biochemical companies were tested. Since L. pneumophila can be widespread in municipal water supplies, the commercial reagents, especially the reagent water (80% of the reaction volume), could be the source of contamination. To test this hypothesis, we treated Millipore Milli-Q water by filtering through a 0.2 microm-pore-size polycarbonate filter to remove bacteria prior to autoclaving. Real-time PCR using this water had no contamination. Our finding is indirect evidence that commercially available purified water can harbor low level contamination by L. pneumophila DNA that has escaped purification processes. This presents a challenge when developing a sensitive DNA-based bacterial detection method if the target organism or its DNA is a common contaminant of necessary reagents.
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Affiliation(s)
- Hua Shen
- Department of Biology, New Mexico Tech., 801 Leroy Place, Socorro, 87801, USA.
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29
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Karevold G, Kvestad E, Nafstad P, Kvaerner KJ. Respiratory infections in schoolchildren: co-morbidity and risk factors. Arch Dis Child 2006; 91:391-5. [PMID: 16464964 PMCID: PMC2082748 DOI: 10.1136/adc.2005.083881] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To assess co-morbidity and risk factors for otitis media, tonsillopharyngitis, and lower respiratory infections in school children. METHODS Logistic regression analysis of co-morbidity and risk factors for airway infections in a population based sample of 10 year old children living in Oslo, Norway. MAIN OUTCOME MEASURES otitis media, tonsillopharyngitis, and lower respiratory infections in past 12 months. RESULTS Airway infections in 10 year old children were common, and significant co-morbidity was found between the various airway infections. Home dampness was a risk factor for all infections, adjusted odds ratios ranging from 1.2 (95% CI 1.0 to 1.5) to 1.4 (95% CI 1.1 to 1.6) for otitis media and tonsillopharyngitis respectively. Atopic disease was a constitutional risk factor, particularly strong for lower airway infections (adjusted odds ratio 2.4, 95% CI 1.8 to 3.1). African or Asian ethnicities were associated with the airway infections, adjusted odds ratios ranging from 1.2 (95% CI 0.9 to 1.7) to 1.7 (95% CI 1.2 to 2.3). CONCLUSIONS Respiratory tract infections were common in 10 year old children. There was substantial co-morbidity between upper and lower airway infections. Environmental and constitutional factors were identified and positively associated with the infections. Results support the hypothesis of 1957 that the whole respiratory tract is one unit.
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Affiliation(s)
- G Karevold
- Faculty Division of Akershus University Hospital, University of Oslo, Norway.
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Jacquet JM, Bégué P, Grimprel E, Reinert P, Sandbu S, Silfverdal SA, Faldella G, Nolan T, Lambert S, Richmond P, Marshall H, Roberton D, Schuerman L. Safety and immunogenicity of a combined DTPa–IPV vaccine administered as a booster from 4 years of age: A review. Vaccine 2006; 24:2440-8. [PMID: 16406224 DOI: 10.1016/j.vaccine.2005.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 11/28/2005] [Accepted: 12/02/2005] [Indexed: 11/22/2022]
Abstract
A combined DTPa-IPV booster vaccine was administered as a 4th or 5th dose after DTPa or DTPw priming. Over 99% vaccines developed antibody levels considered to be protective to diphtheria, tetanus and poliovirus, and >95% mounted a response to acellular pertussis antigens. Rectal temperature >39.5 degrees C was observed in at most 3.2% of vaccinees. Swelling >50 mm occurred in 24% of DTPa-primed compared to 5.5% of DTPw-primed children. Large swelling involving the entire upper arm (extending to involve the elbow joint) was reported for up to 1.2% of DTPa-primed subjects, which is consistent with literature reports for other DTPa vaccines.
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Affiliation(s)
- J M Jacquet
- GlaxoSmithKline Biologicals, Rixensart, Belgium.
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31
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Abstract
The polymerase chain reaction (PCR) has become one of the most important tools in molecular diagnostics, providing exquisite sensitivity and specificity for detection of nucleic acid targets. Real-time monitoring of PCR has simplified and accelerated PCR laboratory procedures and has increased information obtained from specimens including routine quantification and differentiation of amplification products. Clinical diagnostic applications and uses of real-time PCR are growing exponentially, real-time PCR is rapidly replacing traditional PCR, and new diagnostic uses likely will emerge. This review analyzes the scope of present and potential future clinical diagnostic applications of this powerful technique. Critical discussions focus on basic concepts, variations, data analysis, instrument platforms, signal detection formats, sample collection, assay design, and execution of real-time PCR.
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Affiliation(s)
- Bernhard Kaltenboeck
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
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Trollfors B, Knutsson N, Taranger J, Mark A, Bergfors E, Sundh V, Lagergård T. Diphtheria, tetanus and pertussis antibodies in 10-year-old children before and after a booster dose of three toxoids: implications for the timing of a booster dose. Eur J Pediatr 2006; 165:14-8. [PMID: 16249929 DOI: 10.1007/s00431-005-1763-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 06/25/2005] [Accepted: 06/27/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED In an open study, 502 10-year-old children, who had received primary vaccination against diphtheria and tetanus in infancy and had varying histories of pertussis disease and vaccination, were vaccinated with diphtheria-tetanus vaccine (DT) alone or with the addition of 20 microg or 40 microg of pertussis toxoid. Diphtheria toxin neutralising antibodies, pertussis toxin IgG and tetanus toxoid IgG antibodies were measured before and 1 month after the booster. All toxoids were highly immunogenic. In pertussis toxoid recipients, median levels of pertussis toxin IgG increased to 16.5 U/ml (DTaP20) and to 36 U/ml (DTaP40) in children with non-detectable (<1 U/ml) antibodies before vaccination and to >400 U/ml in children (both DTaP20 and DTaP40) with detectable antibodies before vaccination. A total of 60 children (12%) with non-detectable (<0.01 IU/ml) diphtheria antibodies and 36 children (7%) with non-detectable (<0.01 IU/ml) tetanus antibodies before the booster had lower median antibody concentrations post-vaccination than children with detectable antibodies before the booster (diphtheria: 5.12 vs. 20.48 IU/ml; tetanus: 4.0 vs. 10.0 IU/ml). There were no differences in diphtheria and tetanus antibodies after vaccination between children who did and did not receive pertussis toxoid. CONCLUSION 10-year-old children with non-detectable diphtheria and tetanus antibodies before the booster had lower post-vaccination antibodies than those with detectable antibodies before the booster indicating a poor immunological memory. Addition of pertussis toxoid to diphtheria-tetanus vaccine did not affect the antibody responses to diphtheria and tetanus toxoids when the three toxoids were combined as a booster. Even though immunity to diphtheria and tetanus was only estimated by surrogate markers (serum antitoxin antibodies) the results indicate that a lower age for the booster dose of diphtheria-tetanus vaccine or diphtheria-tetanus acellular pertussis vaccine should be considered.
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Affiliation(s)
- Birger Trollfors
- Department of Paediatrics, Sahlgrenska University Hospital/East, 41685, Göteborg, Sweden.
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Liu WB, Zhang JZ, Jiang BH, Ren TT, Gong MM, Meng L, Shou CC. Lipoprotein p37 from Mycoplasma hyorhinis inhibiting mammalian cell adhesion. J Biomed Sci 2005; 13:323-31. [PMID: 16328779 DOI: 10.1007/s11373-005-9045-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 10/18/2005] [Indexed: 02/07/2023] Open
Abstract
p37 protein is a membrane lipoprotein of Mycoplasma hyorhinis, and our previous work showed that there was high ratio of M. hyorhinis infection in human gastric carcinoma. To investigate the possible functions of p37 in cancer development, the nucleotide sequence of p37 gene was modified and expressed well in transfected cells. We found that p37 localized at the Golgi apparatus and could be secreted out of the cell. Human gastric cancer cells AGS, after being transfected with the p37 gene, were smaller, more spherical and easy to detach from each other. Their adhesion to matrix was also diminished and cytoskeleton in these stable p37 AGS cell was rearranged and transcription co-factor beta-actin was transferred to nucleolus with down-regulation of ICAM-1 and integrin beta1. These findings will be helpful for us to elucidate the effects of p37 on eukaryotic cells as well as to better understand the potential relationship between cancer and mycoplasma infection.
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Affiliation(s)
- Wen-Bin Liu
- Peking University School of Oncology and Beijing Institute for Cancer Research, People's Republic of China
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