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Reicherz F, Li S, Watts AA, Goldfarb DM, Lavoie PM, Abu-Raya B. Bordetella pertussis infection following relaxation of COVID-19 non-pharmaceutical interventions in 2021-2023 in Vancouver metropolitan area, British Columbia, Canada. Vaccine 2024; 42:126004. [PMID: 38797627 DOI: 10.1016/j.vaccine.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND We recently reported a near disappearance of B. pertussis and a decline in anti-B. pertussis antibodies during the peak implementation of Coronavirus disease 2019 (COVID-19) non-pharmaceutical interventions (NPI) in 2021 in British Columbia (BC), Canada. During 2021-2023, incidence of reported B. pertussis cases remained low in BC at < 1/100,000 population. This study determined how serological evidence of B. pertussis changed after the gradual relaxation of NPI between 2021-2023. METHODS Randomly selected blood samples from school staff 25-51 years old (n = 65) were collected yearly between 2021-2023 in the Vancouver metropolitan area, BC, Canada, and tested for anti-pertussis toxin (PT) IgG levels. Serological evidence of B. pertussis infection (thereafter "seroconversion") was defined as a quantifiable anti-PT IgG levels in subjects with anti-PT IgG levels below lower limit of quantification in the preceding year or a > 4-fold increase in anti-PT IgG levels between two subsequent years. Samples were also tested for anti-diphtheria toxoid (DT) IgG, and similar seroconversion criteria were applied to exclude seroconversion due to vaccination with tetanus-diphtheria-acellular-pertussis (Tdap). RESULTS Three subjects met seroconversion criteria for anti-PT IgG between 2021 and 2022 and 9 between 2022 and 2023, yielding a seroconversion rate of 4.6 /100 person-years and 14.9/100 person-years, P = 0.127, respectively. None of the subjects met the criteria for vaccination with Tdap. The geometric mean concentration of anti-PT IgG showed a statistically significant decrease in 2022 compared with 2021, 4.8 IU/mL IU/ml (95 % confidence interval [CI], 3.8-5.9) vs. 6.4 IU/ml (95 % CI, 4.9-8.2; p = 0.001), followed by a statistically significant increase in 2023 compared with 2022 6.5 IU/ml (95 % CI, 4.9-8.5) vs. 4.8 IU/ml (95 % CI, 3.8-5.9; p = 0.0006), respectively. DISCUSSION Serological evidence of B. pertussis increased between 2022 and 2023 despite low reported cases, which suggests that B. pertussis circulation resumed after relaxing of COVID-19 NPI.
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Affiliation(s)
- Frederic Reicherz
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Department of Pediatrics, Children's Hospital Datteln, University of Witten/Herdecke, Germany
| | - Sirui Li
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Allison A Watts
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - David M Goldfarb
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Canada; Departments of Pediatrics, Dalhousie University, Nova Scotia, Canada; Microbiology and Immunology, Dalhousie University, Nova Scotia, Canada.
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Abu-Raya B, Esser MJ, Nakabembe E, Reiné J, Amaral K, Diks AM, Imede E, Way SS, Harandi AM, Gorringe A, Le Doare K, Halperin SA, Berkowska MA, Sadarangani M. Antibody and B-cell Immune Responses Against Bordetella Pertussis Following Infection and Immunization. J Mol Biol 2023; 435:168344. [PMID: 37926426 DOI: 10.1016/j.jmb.2023.168344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Neither immunization nor recovery from natural infection provides life-long protection against Bordetella pertussis. Replacement of a whole-cell pertussis (wP) vaccine with an acellular pertussis (aP) vaccine, mutations in B. pertussis strains, and better diagnostic techniques, contribute to resurgence of number of cases especially in young infants. Development of new immunization strategies relies on a comprehensive understanding of immune system responses to infection and immunization and how triggering these immune components would ensure protective immunity. In this review, we assess how B cells, and their secretory products, antibodies, respond to B. pertussis infection, current and novel vaccines and highlight similarities and differences in these responses. We first focus on antibody-mediated immunity. We discuss antibody (sub)classes, elaborate on antibody avidity, ability to neutralize pertussis toxin, and summarize different effector functions, i.e. ability to activate complement, promote phagocytosis and activate NK cells. We then discuss challenges and opportunities in studying B-cell immunity. We highlight shared and unique aspects of B-cell and plasma cell responses to infection and immunization, and discuss how responses to novel immunization strategies better resemble those triggered by a natural infection (i.e., by triggering responses in mucosa and production of IgA). With this comprehensive review, we aim to shed some new light on the role of B cells and antibodies in the pertussis immunity to guide new vaccine development.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Mirjam J Esser
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eve Nakabembe
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Upper Mulago Hill Road, Kampala, P.O. Box 7072, Uganda
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Kyle Amaral
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Annieck M Diks
- Department of Immunology, Leiden University Medical Center, Albinusdreef 2, Leiden ZA 2333, the Netherlands
| | - Esther Imede
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sing Sing Way
- Department of Pediatrics, Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Ali M Harandi
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Microbiology and Immunology, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Gorringe
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Makerere University-Johns Hopkins University Research Collaboration, MU-JHU, Upper Mulago Hill, Kampala, P.O. Box 23491, Uganda
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Magdalena A Berkowska
- Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Embacher S, Maertens K, Herzog SA. Half-life Estimation of Pertussis-Specific Maternal Antibodies in (Pre)Term Infants After In-Pregnancy Tetanus, Diphtheria, Acellular Pertussis Vaccination. J Infect Dis 2023; 228:1640-1648. [PMID: 37285482 PMCID: PMC10681861 DOI: 10.1093/infdis/jiad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND To reduce the risk of pertussis-related morbidity and mortality in early life, an increasing number of countries recommend maternal pertussis vaccination. However, there is limited knowledge about half-lives of vaccine-induced pertussis-specific maternal antibodies, especially in preterm infants, and factors potentially influencing them. METHODS We compared 2 different approaches to provide estimates of the half-lives of pertussis-specific maternal antibodies in infants and explored potential effects on the half-life in 2 studies. In the first approach, we estimated the half-lives per child and used these estimates as responses in linear models. In the second approach, we used linear mixed effect models on a log2 transformed scale of the longitudinal data to use the inverse of the time parameter as an estimate for the half-lives. RESULTS Both approaches provided similar results. The identified covariates partly explain differences in half-life estimates. The strongest evidence we observed was a difference between term and preterm infants, with the preterm infants showing a longer half-life. Among others, a longer interval between vaccination and delivery increases the half-life. CONCLUSIONS Several variables influence the decay speed of maternal antibodies. Both approaches have advantages and disadvantages, while the choice is secondary when assessing the half-life of pertussis-specific antibodies. CLINICAL TRIALS REGISTRATION NCT02408926 and NCT02511327.
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Affiliation(s)
- Stefan Embacher
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Sereina A Herzog
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
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Antoniou T, McCormack D, Fell DB, Kwong JC, Gomes T. Impact of national recommendations for routine pertussis vaccination during pregnancy on infant pertussis in Ontario, Canada: a population-based time-series study. BMC Pregnancy Childbirth 2023; 23:627. [PMID: 37653488 PMCID: PMC10469528 DOI: 10.1186/s12884-023-05938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization (NACI) recommended antenatal tetanus-diphtheria-acellular pertussis (Tdap) immunization in every pregnancy regardless of previous Tdap immunization history. We examined the impact of the NACI recommendation on rates of infant pertussis in Ontario, Canada. METHODS We conducted a population-based time-series study of all live births in Ontario between August 1, 2011 and February 28, 2020. We used interventional autoregressive integrated moving average models to examine the impact of the NACI recommendation on monthly rates of pertussis among infants ≤ 3 months of age. RESULTS We observed 675 incident cases of pertussis among 1,368,024 infants 3 months of age or less between August 2011 and February 2020. The average monthly percent change in infant pertussis during the period up to and including publication of the NACI guidance and the period following publication were 0.0% (95% CI: -0.4-0.3%) and - 0.8% (95% CI -2.3% to -0.1%), respectively. Following interventional ARIMA modelling, publication of the NACI guidance was not associated with a statistically significant decrease in the monthly pertussis incidence trend (-0.67 cases per 100,000 infants; p = 0.73). CONCLUSION Publication of national recommendations for antenatal Tdap immunization in every pregnancy did not significantly reduce infant pertussis rates. This may reflect the persistently low rate of antenatal vaccination following publication of the recommendations. Expanding the scope of practice of allied health care providers to include antenatal Tdap immunization and patient education regarding antenatal pertussis immunization should be considered to further optimize uptake of vaccination.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
| | | | - Deshayne B Fell
- ICES, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Zhang H, Wang X, Xia H, Liu Z. Metagenomics next-generation sequencing assists in the diagnosis of infant pertussis encephalopathy: A case report. Medicine (Baltimore) 2023; 102:e33080. [PMID: 36827038 PMCID: PMC11309732 DOI: 10.1097/md.0000000000033080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
RATIONALE Pertussis is an acute respiratory infection that often occurs in the pediatric population, especially in infants under 3 months old. Bordetella pertussis is the causative agent of pertussis, which can lead to pneumonia, encephalopathy, and pulmonary hypertension, causing death in severe cases. Therefore, an accurate and comprehensive diagnosis of the pathogen is essential for effective treatment. PATIENT CONCERNS We report a case of 2-month-old male infant admitted to the pediatric intensive care unit of West China Second University due to hoarse cough for 7 days, accompanied by a crowing-like echo, fever and listlessness, occasional nonprojectile vomiting with anorexia, shortness of breath, accelerated heart rate, cyanosis of the lips, and convulsions. B pertussis was identified by metagenomic next-generation sequencing in blood and cerebrospinal fluid and polymerase chain reaction assay using blood. DIAGNOSES The infant was diagnosed with pertussis. INTERVENTIONS Intravenous infusion of erythromycin (50 mg/kg/d) for anti-infection and dexamethasone for alleviating intracranial inflammatory reaction were given. OUTCOMES The patient was eventually recovered and discharged. LESSONS This case report emphasized the importance of metagenomic next-generation sequencing using cerebrospinal fluid and blood for early diagnosis of pertussis-associated encephalopathy.
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Affiliation(s)
- Haiyang Zhang
- Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiao Wang
- Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
| | - Zhongqiang Liu
- Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Vaccination in Pregnancy against Pertussis: A Consensus Statement on Behalf of the Global Pertussis Initiative. Vaccines (Basel) 2022; 10:vaccines10121990. [PMID: 36560400 PMCID: PMC9786323 DOI: 10.3390/vaccines10121990] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Infants are at high risk for severe morbidity and mortality from pertussis disease during early infancy. Vaccination against pertussis in pregnancy has emerged as the ideal strategy to protect infants during these early, vulnerable, first months of life. On 30 November and 1 December 2021, the Global Pertussis Initiative held a meeting that aimed to discuss and review the most up-to-date scientific literature supporting vaccination against pertussis in pregnancy and outstanding scientific questions. Herein, we review the current and historically published literature and summarize the findings as consensus statements on vaccination against pertussis in pregnancy on behalf of the Global Pertussis Initiative.
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Dubé E, Trottier ME, Vivion M, Ouakki M, Brousseau N, Guay M, Laghdir Z, Boucoiran I, Tapiéro B, Quach C. Do intentions lead to action? Results of a longitudinal study assessing determinants of Tdap vaccine uptake during pregnancy in Quebec, Canada. BMC Pregnancy Childbirth 2022; 22:477. [PMID: 35698053 PMCID: PMC9189261 DOI: 10.1186/s12884-022-04809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, vaccination against pertussis (Tdap) during pregnancy has been recommended since 2018, with suboptimal uptake. We aimed to assess the determinants of intention and uptake of Tdap vaccine among pregnant women in Quebec. METHODS Participants (< 21 weeks of pregnancy) were recruited in four Quebec regions. Two online surveys were administered during pregnancy (< 21 weeks and > 35 weeks). One measured vaccination intention and the other assessed the actual decision. Questionnaires were informed by the Theory of Planned Behaviour (TPB). We used logistic multivariate analysis to identify determinants of Tdap vaccination uptake during pregnancy using responses to both questionnaires. RESULTS A total of 741 women answered the first survey and 568 (76.7%), the second survey. In the first survey most participants intended to receive the Tdap vaccine during their pregnancy (76.3%) and in the second survey, 82.4% reported having been vaccinated against Tdap during their pregnancy. In multivariate analysis, the main determinants of vaccine uptake were: a recommendation from a healthcare provider (OR = 7.6), vaccine intention (OR = 6.12), social norms (or thinking that most pregnant women will be vaccinated (OR = 3.81), recruitment site (OR = 3.61 for General Family Medicine unit) perceived behavioral control (or low perceived barriers to access vaccination services, (OR = 2.32) and anticipated feeling of guilt if not vaccinated (OR = 2.13). Safety concerns were the main reason for not intending or not receiving the vaccine during pregnancy. CONCLUSION We observed high vaccine acceptance and uptake of pertussis vaccine in pregnancy. The core components of the TPB (intention, social norms and perceived behavioral control) were all predictors of vaccine uptake, but our multivariate analysis also showed that other determinants were influential: being sufficiently informed about Tdap vaccination, not having vaccine safety concerns, and anticipated regret if unvaccinated. To ensure high vaccine acceptance and uptake in pregnancy, strong recommendations by trusted healthcare providers and ease of access to vaccination services remain instrumental.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada.
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec -Université Laval, Quebec City, Qc, Canada.
| | - Marie-Eve Trottier
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada
| | - Maryline Vivion
- Direction de la valorisation scientifique et qualité, Institut national de la santé publique du Québec, Québec City, Qc, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec -Université Laval, Quebec City, Qc, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut national de la santé publique du Québec, Eve Dubé, 2400 D'Estimauville, Québec, QC, G1E 7G9, Canada
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Qc, Canada
| | - Zineb Laghdir
- CHU Sainte-Justine Research Center, Montreal, Qc, Canada
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montreal, Qc, Canada
- Department of Obstetrics & Gynecology and School of Public Health, Université de Montréal, Montréal, Qc, Canada
| | - Bruce Tapiéro
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Qc, Canada
| | - Caroline Quach
- CHU Sainte-Justine Research Center, Montreal, Qc, Canada
- Departments of Microbiology, Infectious Diseases and Immunology and of Pediatrics, Université de Montréal, Montreal, Qc, Canada
- Infection Prevention and Control, Department of Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, Qc, Canada
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Reicherz F, Golding L, Lavoie PM, Abu-Raya B. Decay of anti-Bordetella pertussis antibodies in women of childbearing age following COVID-19 non-pharmaceutical measures. Vaccine 2022; 40:3746-3751. [PMID: 35599039 PMCID: PMC9091163 DOI: 10.1016/j.vaccine.2022.04.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background Immunization against Bordetella pertussis during pregnancy reduces morbidity from severe pertussis in young infants via trans-placental transfer of anti-B. pertussis Immunoglobulin G (IgG). Studies have reported a near disappearance of respiratory pathogens including B. pertussis following implementation of mitigation strategies to control Coronavirus disease 2019 (COVID-19). We explored how immunity against B. pertussis changed in women of childbearing-age through the COVID-19 pandemic. Methods Paired blood samples from females of childbearing-age collected at the beginning (May-June 2020) and nearly one year into the COVID-19 pandemic (February-May 2021) in British Columbia (BC), Canada were tested for anti-B. pertussis IgG levels. To ascertain whether early-pandemic IgG levels in 2020 reflected levels in pregnant women early in gestation, 1st trimester sera collected from age-matched healthy pregnant women in 2018 and 2019 were tested for anti-B. pertussis IgG. Levels were compared by t tests. P-value of 0.05 was assigned and statistical significance was set as p < 0.016 using Bonferroni correction. Results Annual provincial B. pertussis incidences per 100,000 in BC in 2020 (3/100,000) and 2021 (<1/100,000) approximated the lowest levels since 1990. In 2021 vs. 2020, anti-pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) IgG levels declined in women of childbearing-age: 6.8 IU/ml (95 %CI, 4.2–10.9) vs. 8.4 IU/ml (5.1–13.9; p = 0.004); 18.8 IU/ml (10.9–32.2) vs. 23.6 IU/ml (13.2–42.1; p < 0.001); and 37.1 IU/ml (18.1–75.9) vs. 47.2 IU/ml (24.8–89.9; p = 0.092), respectively. Although all values were slightly higher, anti-PT, FHA and PRN IgG levels in women of childbearing age did not significantly differ in 2020 compared with early-gestation pregnant women in 2018–2019, 8.4 IU/ml (95% CI, 5.1–13.9) vs. 5.4 IU/ml (95% CI, 3.8–7.7; p = 0.166), 23.6 IU/ml (95% CI, 13.2–42.1) vs. 20.1 IU/ml (95% CI, 13.4–30.2; p = 0.656), and 47.2 IU/ml (24.8–89.9) vs. 17.3 IU/ml (95% CI, 10.5–28.7; p = 0.021), respectively. Discussion B. pertussis infections should be closely monitored during the relaxing of mitigation measures for COVID-19.
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Quinn HE, Comeau JL, Marshall HS, Elliott EJ, Crawford NW, Blyth CC, Kynaston JA, Snelling TL, Richmond PC, Francis JR, Macartney KK, McIntyre PB, Wood NJ. Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children. Pediatr Infect Dis J 2022; 41:180-185. [PMID: 34711785 DOI: 10.1097/inf.0000000000003367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization. METHODS Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group. RESULTS Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1-96.7). Across all years (2012-2019), of 55 cases 4-11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities. CONCLUSIONS Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.
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Affiliation(s)
- Helen E Quinn
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeannette L Comeau
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Helen S Marshall
- Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Australian Paediatric Surveillance Unit (APSU), Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nigel W Crawford
- Murdoch Children's Research Institute and The University of Melbourne, Parkville, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | | | - Tom L Snelling
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Joshua R Francis
- Global & Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kristine K Macartney
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Peter B McIntyre
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Womens and Childrens Health. University of Otago, Dunedin, New Zealand
| | - Nicholas J Wood
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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10
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Pertussis burden and acellular pertussis vaccine effectiveness in high risk children. Vaccine 2022; 40:1376-1382. [DOI: 10.1016/j.vaccine.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022]
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11
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Li Y, Brousseau N, Guay M, Dubé È, Laghdir Z, Boucoiran I, Tapiéro B, Quach C. Coverage for pertussis vaccination during pregnancy with 4 models of vaccine delivery: a quasiexperimental, multicentre observational study. CMAJ Open 2022; 10:E56-E63. [PMID: 35105682 PMCID: PMC8812719 DOI: 10.9778/cmajo.20210011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vaccination of pregnant people with a vaccine containing acellular pertussis (tetanus-diphtheria-acellular pertussis [Tdap]) has been recommended in Canada since 2018, and the evaluation of delivery models for efficient maternal Tdap administration is a priority for the Quebec Ministry of Health. We implemented 3 vaccine delivery models, in addition to the existing standard of practice model, and compared the vaccine coverage achieved by the 4 models in Quebec. METHODS In this quasiexperimental, multicentre observational study, we recruited pregnant people at less than 21 weeks' gestation in 4 Quebec regions from April to October 2019. We compared 4 vaccine delivery models: local community service centres (centre local de services communautaires [CLSCs], baseline), family medicine groups (FMGs), obstetrics clinic and the oral glucose challenge test (OGCT). In addition to the CLSCs, 3 FMGs, 1 obstetric clinic and a hospital-based OGCT screening program participated. We determined vaccination status from a self-reported questionnaire, the Quebec Immunization Registry or medical charts. We compared model-specific (for participants recruited to a model and subsequently vaccinated within that model) and overall vaccine coverage (considering all vaccine delivery pathways) and used logistic regression to adjust for sociodemographic variables. RESULTS Overall, 946 of 1000 recruited pregnant people were eligible for analyses. Vaccination via the FMGs achieved the highest model-specific vaccine coverage (67.8%, 95% confidence interval [CI] 60.5%-74.4%), but coverage was not significantly different from the CLSCs (63.8%, 95% CI 57.6%-69.6%). For overall vaccine coverage, the FMG (86.5%, 95% CI 80.6%-90.9%) and obstetrics models (85.9%, 95% CI 80.9%-89.7%) achieved significantly higher vaccine coverage than the CLSCs (66.3%, 95% CI 60.1%-71.9%). The OGCT model did not improve overall vaccine coverage (61.8%, 95% CI 56.1%-67.2%). INTERPRETATION Compared with CLSCs, overall vaccine coverage was higher when Tdap was offered in FMGs or an obstetrics clinic providing prenatal care. Health professionals involved in pregnancy follow-up recommending and offering the vaccine may be a key factor in optimizing vaccine coverage.
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Affiliation(s)
- Yinan Li
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Nicholas Brousseau
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Maryse Guay
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Ève Dubé
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Zineb Laghdir
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Isabelle Boucoiran
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Bruce Tapiéro
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Caroline Quach
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que.
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12
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Anh Tuan T, Xoay TD, Thuy PTB, Ouellette Y. Cerebral spinal fluid positive pertussis encephalopathy in infants: Case reports. SAGE Open Med Case Rep 2021; 9:2050313X211052446. [PMID: 34676077 PMCID: PMC8524677 DOI: 10.1177/2050313x211052446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Pertussis has re-emerged in both developed and developing countries and is an ongoing
public health problem, even in countries with high rates of vaccination. Pertussis
encephalopathy is a known complication of the disease, but the pathophysiology of this
complication and the role of the pertussis bacteria have not been elucidated. We report
three confirmed cases of pertussis infant younger than 3 months of age with neurological
complications including lethargy, encephalopathy, and seizures. In each case, the
cerebrospinal fluid was positive for Bordetella pertussis as determined
by polymerase chain reaction. One patient did not survive and two were discharged with a
normal neurological exam on follow-up. The cases emphasize the importance of analyzing
cerebrospinal fluid in cases of pertussis-associated encephalopathy including polymerase
chain reaction.
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Affiliation(s)
- Ta Anh Tuan
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tran Dang Xoay
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Phung Thi Bich Thuy
- Department of Biomolecular Research in Infectious Disease, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Yves Ouellette
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
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13
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Abu-Raya B, Maertens K, Munoz FM, Zimmermann P, Curtis N, Halperin SA, Rots N, Barug D, Holder B, Rice TF, Kampmann B, Leuridan E, Sadarangani M. Factors affecting antibody responses to immunizations in infants born to women immunized against pertussis in pregnancy and unimmunized women: Individual-Participant Data Meta-analysis. Vaccine 2021; 39:6545-6552. [PMID: 34598822 DOI: 10.1016/j.vaccine.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exploring factors that affect immune responses to immunizations in infants born to women immunized with tetanus-diphtheria-acellular-pertussis (Tdap) in pregnancy compared with unimmunized women is important in designing immunization programs. METHODS Individual-participant data meta-analysis of 8 studies reporting post-immunization immunoglobulin G (IgG) levels to vaccine antigens in infants born to either women immunized with Tdap in pregnancy or unimmunized women, using mixed-effects models. RESULTS In infants of Tdap-immunized women, two-fold higher levels of anti-pertussis toxin (PT) and anti-diphtheria-toxoid (DT) IgG pre-primary immunization were associated with 9% and 10% lower post-primary immunization levels, (geometric mean ratio [GMR], PT: 0.91; 95% CI, 0.88-0.95,n = 494, DT: 0.9; 0.87-0.93,n = 519). Timing of immunization in pregnancy did not affect post-primary immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-primary immunization anti-B. pertussis and anti-DT levels. In infants of Tdap-immunized women, two-fold higher levels of anti-PT and anti-filamentous haemagglutinin (FHA) IgG pre-primary immunization were associated with lower post-booster immunization levels, (GMR, PT: 0.91; 0.85-0.97,n = 224, FHA: 0.92; 0.85-0.99,n = 232). Timing of immunization in pregnancy did not affect post-booster immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-booster immunization anti-PT, anti-pertactin (PRN), anti-TT and anti-DT IgG levels. In infants of unimmunized women, two-fold higher IgG levels of some vaccine antigens pre-primary immunization were associated with 8-17% lower post-primary immunization levels (GMR, PT 0.92, 95% CI:0.88-0.97, n = 373; FHA:0.88, 95% CI:0.85-0.92,n = 378; PRN:0.84, 95% CI:0.81-0.88, n = 367; TT:0.88, 95% CI:0.83-0.93, n = 241; DT: 0.83, 95% CI:0.79-0.87,n = 278). Two-fold higher levels of anti-FHA IgG pre-primary immunization were associated with 8% lower post-booster immunization levels (GMR, 0.92; 95% CI: 0.86-0.99,n = 138). DISCUSSION Increased IgG levels pre-primary immunization is associated with reduced post-primary and post-booster immunization levels for some antigens in infants of women immunized or unimmunized in pregnancy, but their clinical significance is uncertain.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium.
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, Australia; Department of Pediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, Australia
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Nynke Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Daan Barug
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Beth Holder
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom; Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Thomas F Rice
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia; The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Abstract
Pregnant women are at increased risk for severe morbidity and mortality following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading some countries to recommend vaccination of pregnant women against coronavirus disease 2019 (COVID-19). These recommendations are based on studies conducted early in the pandemic, and thus, the pregnant women in these studies most likely did not have pre-existing immunity to SARS-CoV-2 at the time of infection. The susceptibility of pregnant women and their infants to SARS-CoV-2 and the severity of infection may be attenuated as the pandemic progresses and an increasing number of women will have pre-existing immunity (following natural infection or vaccination prior to pregnancy) during pregnancy. The reactogenicity, immunogenicity and efficacy of COVID-19 vaccines administered in pregnancy may also be affected by the pre-existing immunity of pregnant women. Maternal vaccine trials should be evaluated in the context of their timing in the pandemic and interpreted based on the pre-existing immunity of pregnant women.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Tandy CB, Odoi A. Geographic disparities and socio-demographic predictors of pertussis risk in Florida. PeerJ 2021; 9:e11902. [PMID: 34540361 PMCID: PMC8415280 DOI: 10.7717/peerj.11902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications and death, particularly in infants. Between 2008 and 2011, children less than 3 months old accounted for 83% of the pertussis deaths in the United States. Understanding the geographic disparities in the distribution of pertussis risk and identifying high risk geographic areas is necessary for guiding resource allocation and public health control strategies. Therefore, this study investigated geographic disparities and temporal changes in pertussis risk in Florida from 2010 to 2018. It also investigated socioeconomic and demographic predictors of the identified disparities. METHODS Pertussis data covering the time period 2010-2018 were obtained from Florida HealthCHARTS web interface. Spatial patterns and temporal changes in geographic distribution of pertussis risk were assessed using county-level choropleth maps for the time periods 2010-2012, 2013-2015, 2016-2018 and 2010-2018. Tango's flexible spatial scan statistics were used to identify high-risk spatial clusters which were displayed in maps. Ordinary least squares (OLS) regression was used to identify significant predictors of county-level risk. Residuals of the OLS model were assessed for model assumptions including spatial autocorrelation. RESULTS County-level pertussis risk varied from 0 to 116.31 cases per 100,000 people during the study period. A total of 11 significant (p < 0.05) spatial clusters were identified with risk ratios ranging from 1.5 to 5.8. Geographic distribution remained relatively consistent over time with areas of high risk persisting in the western panhandle, northeastern coast, and along the western coast. Although county level pertussis risks generally increased from 2010-2012 to 2013-2015, risk tended to be lower during the 2016-2018 time period. Significant predictors of county-level pertussis risk were rurality, percentage of females, and median income. Counties with high pertussis risk tended to be rural (p = 0.021), those with high median incomes (p = 0.039), and those with high percentages of females (p < 0.001). CONCLUSION There is evidence that geographic disparities exist and have persisted over time in Florida. This study highlights the application and importance of Geographic Information Systems (GIS) technology and spatial statistical/epidemiological tools in identifying areas of highest disease risk so as to guide resource allocation to reduce health disparities and improve health for all.
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Affiliation(s)
- Corinne B. Tandy
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, Tennessee, United States
| | - Agricola Odoi
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, Tennessee, United States
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16
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Dalcin D, Halperin SA. Immunisation durant la grossesse avec le vaccin DCaT. CMAJ 2021; 193:E1371-E1372. [PMID: 34462300 PMCID: PMC8432317 DOI: 10.1503/cmaj.202420-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Daniel Dalcin
- Faculté de médecine (Dalcin), Université Dalhousie; Département de pédiatrie et de microbiologie et d'immunologie (Halperin); Centre canadien de vaccinologie, Université Dalhousie; Centre de santé IKW et Régie de la santé de la Nouvelle-Écosse, Halifax, N.-É.
| | - Scott A Halperin
- Faculté de médecine (Dalcin), Université Dalhousie; Département de pédiatrie et de microbiologie et d'immunologie (Halperin); Centre canadien de vaccinologie, Université Dalhousie; Centre de santé IKW et Régie de la santé de la Nouvelle-Écosse, Halifax, N.-É
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17
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Abu-Raya B, Maertens K, Munoz FM, Zimmermann P, Curtis N, Halperin SA, Rots N, Barug D, Holder B, Kampmann B, Leuridan E, Sadarangani M. The Effect of Tetanus-Diphtheria-Acellular-Pertussis Immunization During Pregnancy on Infant Antibody Responses: Individual-Participant Data Meta-Analysis. Front Immunol 2021; 12:689394. [PMID: 34305922 PMCID: PMC8299947 DOI: 10.3389/fimmu.2021.689394] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy is increasingly recommended. We determined the effect of Tdap immunization in pregnancy on infants' vaccine responses. Methods Individual-participant data meta-analysis of ten studies (n=1884) investigating infants' antibody response to routine immunizations following Tdap immunization in pregnancy was performed. Geometric mean ratios (GMRs) of antigen-specific immunoglobulin G (IgG) levels were calculated using mixed-effects models. Seroprotection rates were compared using chi-squared tests. Results Infants of Tdap-immunized women had significantly lower IgG against pertussis toxin (GMR 0.65; 95%CI 0.57-0.74), filamentous haemagglutinin (FHA) (0.68; 0.53-0.87), pertactin (0.65; 0.58-0.72) and fimbria 2/3 (FIM2/3) (0.41; 0.32-0.52) after primary immunization, compared with infants of unimmunized women. These lower levels persisted after booster immunization for FHA (0.72; 0.61-0.84) and FIM2/3 (0.53; 0.29-0.96). After primary immunization, infants of Tdap-immunized women had lower seroprotection rates against diphtheria (90% [843/973] vs 98% [566/579]; p<0.001) and invasive pneumococcal disease (IPD) caused by 5 Streptococcus pneumoniae (SPN) serotypes (SPN5, SPN6B, SPN9V, SPN19A, SPN23F), and higher seroprotection rates against Haemophilus influenzae type b (short-term and long-term seroprotection rates, 86%[471/547] vs 76%[188/247] and 62%[337/547] vs 49%(121/247), respectively, all p=0.001). After booster immunization, seroprotection rates against diphtheria and tetanus were 99% (286/288) and (618/619) in infants of Tdap-immunized women, respectively. Conclusions Infants of Tdap-immunized women in pregnancy had lower IgG levels against pertussis, diphtheria and some SPN serotypes after their immunization compared with infants of unimmunized women. Enhanced surveillance of pertussis, diphtheria and IPD in infants is needed to determine the clinical significance of these findings. Systematic Review Registration CRD42017079171.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Pediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Nynke Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Daan Barug
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Beth Holder
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom.,Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia.,The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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18
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Dalcin D, Halperin SA. Tdap vaccination in pregnancy. CMAJ 2021; 193:E911. [PMID: 34860689 PMCID: PMC8248450 DOI: 10.1503/cmaj.202420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel Dalcin
- Faculty of Medicine (Dalcin), Dalhousie University; Departments of Pediatrics, and of Microbiology & Immunology (Halperin); Canadian Centre for Vaccinology, Dalhousie University; IKW Health and Nova Scotia Health, Halifax, NS
| | - Scott A Halperin
- Faculty of Medicine (Dalcin), Dalhousie University; Departments of Pediatrics, and of Microbiology & Immunology (Halperin); Canadian Centre for Vaccinology, Dalhousie University; IKW Health and Nova Scotia Health, Halifax, NS
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19
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Merdrignac L, Aït El Belghiti F, Pandolfi E, Jané M, Murphy J, Fabiánová K, García Cenoz M, Flem E, Guillot S, Tozzi AE, Carmona G, Habington A, Zavadilová J, Navasués A, Bøås H, Lévy-Brühl D, Ferretti B, Lanaspa M, O'Sullivan N, Křížová P, Fernandino L, Bekkevold T, Hanslik T, Muñoz-Almagro C, Bacci S, Spiteri G, Valenciano M, Moren A. Incidence and severity of pertussis hospitalisations in infants aged less than 1 year in 37 hospitals of six EU/EEA countries, results of PERTINENT sentinel pilot surveillance system, December 2015 to December 2018. ACTA ACUST UNITED AC 2021; 26. [PMID: 33509338 PMCID: PMC7848786 DOI: 10.2807/1560-7917.es.2021.26.4.1900762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction PERTINENT is a pilot active surveillance system of infants hospitalised with pertussis in six European Union/European Economic Area countries (37 hospitals, seven sites). Aim This observational study aimed to estimate annual pertussis incidence per site from 2016 to 2018 and respective trends between 2017 and 2018. Pertussis cases were described, including their severity. Methods We developed a generic protocol and laboratory guidelines to harmonise practices across sites. Cases were hospitalised infants testing positive for Bordetella pertussis by PCR or culture. Sites collected demographic, clinical, laboratory data, vaccination status, and risk/protective factors. We estimated sites’ annual incidences by dividing case numbers by the catchment populations. Results From December 2015 to December 2018, we identified 469 cases (247 males; 53%). The median age, birthweight and gestational age were 2.5 months (range: 0–11.6; interquartile range (IQR): 2.5), 3,280 g (range: 700–4,925; IQR: 720) and 39 weeks (range: 25–42; IQR: 2), respectively. Thirty cases (6%) had atypical presentation either with cough or cyanosis only or with absence of pertussis-like symptoms. Of 330 cases with information, 83 (25%) were admitted to intensive care units including five deceased infants too young to be vaccinated. Incidence rate ratios between 2018 and 2017 were 1.43 in Czech Republic (p = 0.468), 0.25 in Catalonia (p = 0.002), 0.71 in France (p = 0.034), 0.14 in Ireland (p = 0.002), 0.63 in Italy (p = 0.053), 0.21 in Navarra (p = 0.148) and zero in Norway. Conclusions Incidence appeared to decrease between 2017 and 2018 in all but one site. Enhanced surveillance of hospitalised pertussis in Europe is essential to monitor pertussis epidemiology and disease burden.
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Affiliation(s)
| | | | - Elisabetta Pandolfi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Mireia Jané
- Epidemiological surveillance and response, Public Health Agency of Catalonia, Barcelona, Spain
| | - Jane Murphy
- Research, Temple Street Children's University Hospital, Dublin, Ireland
| | | | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Elmira Flem
- Infectious Disease Epidemiology and Modeling, Norwegian Institute of Public Health, Oslo, Norway
| | - Sophie Guillot
- Biodiversité et Epidémiologie des bactéries et pathogènes, Institut Pasteur, Paris, France
| | - Alberto E Tozzi
- Chief Innovation Unit and Clinical Trials, Bambino Gesù Children Hospital, Rome, Italy
| | - Gloria Carmona
- Epidemiological surveillance and response, Public Health Agency of Catalonia, Barcelona, Spain
| | - Adele Habington
- Microbiology, Our Lady's Children's hospital Crumlin, Dublin, Ireland
| | | | - Ana Navasués
- Clinical Microbiology Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Håkon Bøås
- Infectious Disease Epidemiology and Modeling, Norwegian Institute of Public Health, Oslo, Norway
| | - Daniel Lévy-Brühl
- Direction des maladies infectieuses, Santé Publique France, Paris, France
| | - Beatrice Ferretti
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Miguel Lanaspa
- Instituto de Recerca Pediatrica Hospital Sant Joan de Deu, Barcelona, Spain
| | - Niam O'Sullivan
- Microbiology, Our Lady's Children's hospital Crumlin, Dublin, Ireland
| | - Pavla Křížová
- National Institute of Public Health, Prague, Czech Republic
| | - Leticia Fernandino
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Terese Bekkevold
- Infectious Disease Epidemiology and Modeling, Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Hanslik
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Carmen Muñoz-Almagro
- CIBER of Epidemiology and Public Health CIBERESP, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Instituto de Recerca Pediatrica Hospital Sant Joan de Deu, Barcelona, Spain
| | - Sabrina Bacci
- European Centre for Diseases Prevention and Control, Stockholm, Sweden
| | | | | | - Alain Moren
- Epidemiology Department, Epiconcept, Paris, France
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- The members of the network are listed at the end of the article
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20
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Esteghamati A, Sayyahfar S, Alimohamadi Y, Salahi S, Faramarzi M. Is it time to administer acellular pertussis vaccine to childbearing age/pregnant women in all areas using whole-cell pertussis vaccination schedule? Ther Adv Vaccines Immunother 2021; 9:25151355211015842. [PMID: 34104864 PMCID: PMC8161843 DOI: 10.1177/25151355211015842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Whole-cell pertussis (wP) vaccine administration is still advocated for children under 7 years of age in Iran. However, there is no recommendation for the administration of a dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to childbearing age/pregnant women in the Iranian vaccination program and it has increased the risk of infection through waning immunity during women’s childbearing age life. The study aimed to assess the levels of anti-Bordetella pertussis antibodies in childbearing age women of different ages in Iran. Methods: A cross-sectional study was conducted on a total number of 360 childbearing age women divided into six age groups, with 5-year intervals from 15 to 45 years old, in 2018–2019. Then, the levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) antibodies against B. pertussis were evaluated using enzyme-linked immunosorbent assay (ELISA). The IBM SPSS Statistics software (version 16.0) (SPSS Inc., Chicago, IL, USA) was used for data analysis. Results: The mean age of the participants was 30.01 ± 8.35 years (range 14–45 years). All the cases were IgM negative, but two IgA-positive individuals (in the age groups of 14–19 and 30–34 years) were reported. Overall, 239 (66.4%) cases were IgG positive. The mean age of IgG-positive cases was 30.37 ± 8.37 years. The IgG-positive cases were mostly in the age groups of 30–34 and 35–39 years [43 (71.1%)]. The odds of IgG positivity were 1.97. The highest odds of IgG positivity were seen in 30–34 and 35–39 years groups (2.52) and the lowest odds were seen in the 20–24 and 25–29 years groups (1.60). Using the Jonckheere–Terpstra test, the increasing trend of IgG changes in different age groups was not statistically significant (Tπ=5.78, p = 0.09). Conclusion: The infants of women of childbearing age might be prone to pertussis in countries using the wP vaccination schedule. It is suggested to administer a dose of Tdap to women before or during pregnancy to increase the immunity of their infants against this disease during early infancy.
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Affiliation(s)
- Abdoulreza Esteghamati
- Research Center of Pediatric Infectious diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Sayyahfar
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Iran University of Medical Sciences, Ali Asghar Children Hospital, Vahid Dastgerdi Street, Shariati Street, Tehran 1919816766, Iran
| | - Yousef Alimohamadi
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Salahi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Faramarzi
- Research Center of Pediatric Infectious diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
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21
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Maertens K, Orije MRP, Herzog SA, Mahieu LM, Hens N, Van Damme P, Leuridan E. Pertussis immunization during pregnancy: assessment of the role of maternal antibodies on immune responses in term and preterm born infants. Clin Infect Dis 2021; 74:189-198. [PMID: 33971009 DOI: 10.1093/cid/ciab424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Limited data exist on the impact of maternal Tetanus, Diphtheria, acellular Pertussis (aP) (Tdap) vaccination for preterm born infants. We report its effect at birth and on antibody-mediated immune responses to a DTaP-IPV-HB-PRP~T vaccine in preterm compared to term infants. METHODS Women delivering at term or prematurely were either vaccinated with a Tdap vaccine (Boostrix®, GSK) during pregnancy or not vaccinated in the last 5 years. Cord and maternal blood were collected at delivery. Infants were vaccinated with DTaP-IPV-HB-PRP~T vaccine (Hexyon®, Sanofi Pasteur) and bled before and one month after primary (8-12-16 weeks) and before and one month after booster vaccination (13 or 15 months for preterm and term respectively). Immunoglobulin G antibodies against all antigens included in DTaP-IPV-HB-PRP~T vaccine were measured (NCT02511327). RESULTS Cord blood Geometric Mean Concentrations (GMCs) in preterm infants from Tdap-vaccinated women were significantly higher than in term and preterm infants from unvaccinated women. A longer time interval between maternal vaccination and delivery resulted in higher cord blood GMCs in preterm infants. Equal GMCs in term and preterm infants from Tdap-vaccinated women were observed after primary vaccination. After boosting, significantly lower GMCs were seen for PT, FHA and TT in preterm compared to term infants from Tdap-vaccinated women, yet still comparable to GMCs in both term and preterm infants from unvaccinated women. CONCLUSION Preterm infants profit from maternal Tdap vaccination. Prematurity did not influence primary immune responses in the presence of maternal antibodies, but was associated with a lower booster immune response.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Marjolein R P Orije
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Sereina A Herzog
- Centre for Health Economic Research and Modeling Infectious Diseases, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - Ludo M Mahieu
- Department of Pediatrics, Division of Neonatology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economic Research and Modeling Infectious Diseases, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
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22
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Macina D, Evans KE. Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in Asia. Infect Dis Ther 2021; 10:1115-1140. [PMID: 33928533 PMCID: PMC8322225 DOI: 10.1007/s40121-021-00439-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
Cyclic epidemics of pertussis (whooping cough) have been observed globally over the past twenty years despite high infant vaccine coverage. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity in older children and adults, as well as better surveillance and diagnostics. Moreover, in adolescents and adults, pertussis symptoms are mild and similar to common cough syndromes, meaning that it is under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE, and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology, burden of illness, and mortality in school-aged children, adolescents, and adults in Asia. Studies identified for inclusion were reviewed narratively because a statistical comparison was not possible due to the mix of methodologies used. The results showed that in East Asia, including Japan, South Korea, China, and Taiwan, pertussis is circulating in older children and adults. Diphtheria-tetanus-pertussis (DTP4) coverage is high in East Asia, yet outbreaks observed in Japan and South Korea suggest that vaccine-acquired immunity had waned in adolescents and adults. Several school outbreaks in China show that pertussis is circulating in young children, with continued circulation in adolescents and adults. There was a lack of information from Southeast/South Asian countries, although pan-Asian serosurveys showed that recent pertussis infection was common in adolescents and in adults with persistent cough. To conclude, the circulation of pertussis in Asian countries with high DTP4 coverage supports the expansion of routine vaccination to include booster doses for children at school entry and adolescents. However, surveillance is weak or absent in many countries, meaning that the true burden of pertussis, particularly among older populations, is unknown.
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Affiliation(s)
- Denis Macina
- Global Medical, Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
| | - Keith E Evans
- InScience Communications, Chowley Oak Business Park, Chowley Oak Lane, Tattenhall, Cheshire, UK
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23
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Abu-Raya B, Maertens K. Protection of the Newborn Through Vaccination in Pregnancy. Neoreviews 2021; 22:e25-e39. [PMID: 33386312 DOI: 10.1542/neo.22-1-e25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Newborns and infants are at risk for severe infections with some pathogens (eg, Bordetella pertussis, influenza, respiratory syncytial virus, group B Streptococcus) during early life. To decrease this window of high susceptibility to some infections during early life and protect young infants, vaccination in pregnancy against some vaccine-preventable diseases (eg, influenza, pertussis, tetanus) has been recommended in an increasing number of countries with notable success. In addition, recent advances have been made in developing vaccines for pregnant women with the aim of reducing the respiratory syncytial virus and group B Streptococcus burden in infancy. In this article, we review the vaccines currently recommended during pregnancy and their benefits to newborns and infants. We also discuss progress made in the development of other vaccines that are expected to be evaluated in pregnant women in the near future.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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24
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Liu C, Yang L, Cheng Y, Xu H, Xu F. Risk factors associated with death in infants <120 days old with severe pertussis: a case-control study. BMC Infect Dis 2020; 20:852. [PMID: 33198647 PMCID: PMC7668018 DOI: 10.1186/s12879-020-05535-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Pertussis is a serious infectious disease in young infants, and severe cases frequently cause death. Our study explored risk factors for death from severe pertussis. Method A case-control study of infants with severe pertussis admitted to the paediatric intensive care unit (PICU) in the Children’s Hospital of Chongqing Medical University, China, from January 1, 2013, to June 30, 2019, was conducted. Pertussis was confirmed by clinical features and laboratory examinations. Severe pertussis was defined as patients with pertussis resulting in PICU admission or death. To understand the risk factors for death, we compared fatal and nonfatal cases of severe pertussis in infants aged < 120 days by collecting clinical and laboratory data. Results The participants included 63 infants < 120 days of age with severe pertussis. Fifteen fatal cases were confirmed and compared with 44 nonfatal severe pertussis cases, Four patients with termination of treatment were excluded. In the univariate analysis, the risk factors associated with death included apnoea (P = 0.001), leukocytosis (white blood cell (WBC) count≥30 × 109/L (P = 0.001) or ≥ 50 × 109/L (P = 0)), highest lymphocyte count (P = 0), pulmonary hypertension (P = 0.001), and length of PICU stay (P = 0.003). The multivariate analysis revealed that apnoea (OR 23.722, 95%CI 2.796–201.26, P = 0.004), leukocytosis (OR 63.708, 95%CI 3.574–1135.674, P = 0.005) and pulmonary hypertension (OR 26.109, 95%CI 1.800–378.809, P = 0.017) were significantly associated with death. Conclusion Leukocytosis and pulmonary hypertension exhibited the greatest associations with death in infants with severe pertussis admitted to the PICU. Vaccination is still the most effective protection method against pertussis.
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Affiliation(s)
- Cong Liu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Lin Yang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.,Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yuwei Cheng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.,Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Hongmei Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Feng Xu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China. .,Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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25
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Abu-Raya B, Coyle D, Bettinger JA, Vaudry W, Halperin SA, Sadarangani M. Pertussis vaccination in pregnancy in Canada: a cost-utility analysis. CMAJ Open 2020; 8:E651-E658. [PMID: 33077536 PMCID: PMC7588263 DOI: 10.9778/cmajo.20200060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Canadian National Advisory Committee on Immunization recommends universal vaccination against pertussis in pregnancy. We assessed the cost-effectiveness of vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy in Canada. METHODS We conducted a cost-utility analysis comparing a vaccination program to no program corresponding with the 2017 Canadian guideline for economic evaluation from the Canadian Agency for Drugs and Technologies in Health. We developed 2 models - part decision tree, part Markov model - to estimate the long-term cost and quality-adjusted life-years (QALYs) for pregnant women and their infants. We obtained epidemiologic data from 2006 to 2015, and derived costs and utility values from relevant sources. Results were reported in 2019 Canadian dollars. We obtained expected values through probabilistic analysis, with methodologic and structural uncertainty assessed through scenario analyses. The analysis adopted an acquisition price of Tdap vaccine of $12.50, with scenario analysis conducted to identify the threshold price for vaccination to be cost-effective. RESULTS In the base-case scenario, for every 1000 pregnant women vaccinated, the program would lead to a gain of 0.3 QALYs, occurring solely in infants, at an increased total cost of $12 987, or $44 301 per QALY gained. Based on a threshold of $50 000 per QALY gained, vaccination would have been cost-effective in 6 of the 10 years included in the model (range of incremental costs $20 463-$100 348 per QALY gained). The threshold cost for Tdap vaccine to be cost-effective over the 10-year horizon was $14.03. INTERPRETATION Based on a threshold of $50 000 per QALY gained, vaccination against pertussis in pregnancy would be cost-effective if the acquisition cost per vaccine were $14.03 or less. Province- and territory-specific analyses should be done to inform local decision-making.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Doug Coyle
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Julie A Bettinger
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Wendy Vaudry
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Scott A Halperin
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
| | - Manish Sadarangani
- Vaccine Evaluation Center (Abu-Raya, Bettinger, Sadarangani), BC Children's Hospital Research Institute; Division of Infectious Diseases (Abu-Raya, Bettinger, Sadarangani), Department of Pediatrics, University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Stollery Children's Hospital (Vaudry), Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Canadian Center for Vaccinology (Halperin), IWK Health Centre and Dalhousie University, Halifax, NS
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26
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Kandeil W, van den Ende C, Bunge EM, Jenkins VA, Ceregido MA, Guignard A. A systematic review of the burden of pertussis disease in infants and the effectiveness of maternal immunization against pertussis. Expert Rev Vaccines 2020; 19:621-638. [PMID: 32772755 DOI: 10.1080/14760584.2020.1791092] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction Infants too young to be fully immunized are the most vulnerable to severe pertussis disease. To close this susceptibility gap, passive infant immunization through vaccination of pregnant women against pertussis was first introduced in 2011 in the United States and has been extended since then to more than 40 countries. Areas covered We conducted two systematic literature searches to describe the worldwide burden of pertussis disease in infants <6 months of age since 2005, and the effectiveness and impact of maternal pertussis vaccination in preventing infant pertussis since 2011. Expert opinion Pertussis disease incidence rates in infants aged <2-3 months were substantial in all countries with available data, exceeding 1000 cases per 100,000 population during outbreaks. Virtually all pertussis deaths occurred in this age group. Data from Africa, Eastern Mediterranean, and Asia were limited, but suggest a similar or higher disease burden than in Europe or the Americas. Estimates of effectiveness of second/third trimester pertussis vaccination in preventing pertussis disease in <2-3 months old infants were consistently high (69%-93%) across the observational studies reviewed, conducted in various settings with different designs. Maternal vaccination programs appear to be achieving their goal of reducing the burden of disease in very young infants. Plain language summary What is the context? Pertussis, also known as whooping cough, is a highly contagious disease of the respiratory tract. Infants too young to be fully vaccinated are at the highest risk of severe pertussis disease, hospitalization, and death. Vaccinating pregnant women against pertussis with a Tdap vaccine is recommended in more than 40 countries as a safe and effective strategy to protect infants for the first months of life. What is new? This review summarizes recent literature describing the burden of pertussis disease in infants worldwide prior to the introduction of maternal vaccination programs; pertussis disease incidence rates in infants aged <2-3 months were substantial in all countries with available data, exceeding 1000 cases per 100,000 population during outbreaks. Immunization of pregnant women with a Tdap vaccine can prevent about 70-90% of pertussis disease and up to 90.5% of pertussis hospitalizations in infants under 3 months of age. What is the impact? Limited available data suggest that incidence rates of pertussis disease after the introduction of Tdap maternal immunization have declined in infants. Current knowledge supports the implementation of Tdap maternal immunization programs.
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Affiliation(s)
- Walid Kandeil
- GSK , Wavre, Belgium.,Takeda Pharmaceuticals International AG , Zurich, Switzerland
| | | | - Eveline M Bunge
- Health Research and Consultancy , Rotterdam, The Netherlands
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Top KA, Macartney K, Bettinger JA, Tan B, Blyth CC, Marshall HS, Vaudry W, Halperin SA, McIntyre P. Active surveillance of acute paediatric hospitalisations demonstrates the impact of vaccination programmes and informs vaccine policy in Canada and Australia. ACTA ACUST UNITED AC 2020; 25. [PMID: 32613939 PMCID: PMC7331140 DOI: 10.2807/1560-7917.es.2020.25.25.1900562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sentinel surveillance of acute hospitalisations in response to infectious disease emergencies such as the 2009 influenza A(H1N1)pdm09 pandemic is well described, but recognition of its potential to supplement routine public health surveillance and provide scalability for emergency responses has been limited. We summarise the achievements of two national paediatric hospital surveillance networks relevant to vaccine programmes and emerging infectious diseases in Canada (Canadian Immunization Monitoring Program Active; IMPACT from 1991) and Australia (Paediatric Active Enhanced Disease Surveillance; PAEDS from 2007) and discuss opportunities and challenges in applying their model to other contexts. Both networks were established to enhance capacity to measure vaccine preventable disease burden, vaccine programme impact, and safety, with their scope occasionally being increased with emerging infectious diseases’ surveillance. Their active surveillance has increased data accuracy and utility for syndromic conditions (e.g. encephalitis), pathogen-specific diseases (e.g. pertussis, rotavirus, influenza), and adverse events following immunisation (e.g. febrile seizure), enabled correlation of biological specimens with clinical context and supported responses to emerging infections (e.g. pandemic influenza, parechovirus, COVID-19). The demonstrated long-term value of continuous, rather than incident-related, operation of these networks in strengthening routine surveillance, bridging research gaps, and providing scalable public health response, supports their applicability to other countries.
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Affiliation(s)
- Karina A Top
- These authors contributed equally.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Kristine Macartney
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia.,These authors contributed equally
| | - Julie A Bettinger
- University of British Columbia and Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, Canada
| | - Ben Tan
- University of Saskatchewan, Royal University Hospital, Saskatoon, Canada
| | - Christopher C Blyth
- Telethon Kids Institute and School of Medicine, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and VIRTU Women's and Children's Health Network, Adelaide, Australia
| | - Wendy Vaudry
- University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Peter McIntyre
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia
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- The IMPACT and PAEDS investigators are acknowledged at the end of this article
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Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Abu-Raya B. Extending Timing of Immunization Against Pertussis During Pregnancy and Protection of Premature Infants from Whooping Cough Disease. Clin Infect Dis 2020; 73:e2509-e2511. [PMID: 32569371 DOI: 10.1093/cid/ciaa831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bahaa Abu-Raya
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Mijović H, Greyson D, Gemmell E, Trottier MÈ, Vivion M, Graham JE, Dubé È, Bettinger JA. Perinatal health care providers' approaches to recommending and providing pertussis vaccination in pregnancy: a qualitative study. CMAJ Open 2020; 8:E377-E382. [PMID: 32414884 PMCID: PMC7239636 DOI: 10.9778/cmajo.20190215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In 2018, the Canadian National Advisory Committee on Immunization and the Society of Obstetricians and Gynaecologists of Canada recommended a single dose of tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis (Tdap) vaccine in every pregnancy. To understand how perinatal health care providers in Canada are translating recent recommendations for universal antenatal Tdap vaccine into routine clinical practice, we examined health care providers' perceptions of what influences their ability to recommend and provide Tdap vaccine consistently to pregnant women. METHODS Between June 2018 and July 2019, we conducted semistructured telephone interviews with perinatal health care providers (nurses, midwives, family physicians and obstetricians) from 5 provinces (British Columbia, Manitoba, Ontario, Quebec and Nova Scotia) representing diverse educational experiences, practice settings and models of care. We analyzed the data using interpretive description. RESULTS We interviewed 44 perinatal health care providers (13 family physicians, 12 midwives, 10 obstetricians and 9 nurses) practising in a variety of settings. Health care providers' ability to recommend and provide antenatal Tdap vaccine was strongly influenced by structural constraints in the Canadian perinatal health care system. The participants' clinical training varied, which resulted in different knowledge and practices. Participants felt hindered by a lack of lay information resources. Consistent and convenient vaccine access was perceived to be key to promoting confidence and encouraging uptake, yet antenatal Tdap vaccine was not easily accessible for all women. INTERPRETATION Our findings suggest that Canada's fragmented health care model has a detrimental effect on health care providers' ability to recommend and ensure access to antenatal Tdap vaccine. Lessons from this study are pertinent to the implementation of successful pertussis vaccine programs and future pregnancy vaccination initiatives.
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Affiliation(s)
- Hana Mijović
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Devon Greyson
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Emily Gemmell
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Marie-Ève Trottier
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Maryline Vivion
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Janice E Graham
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Ève Dubé
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que
| | - Julie A Bettinger
- Vaccine Evaluation Center (Mijović, Greyson, Gemmell, Bettinger), BC Children's Hospital Research Institute, University of British Columbia; Department of Pediatrics (Mijović, Bettinger), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Quebec National Institute of Public Health (Trottier, Vivion, Dubé), Québec, Que.; Department of Pediatrics (Graham), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Anthropology (Dubé), Université Laval, Québec, Que.
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Switzer C, D'Heilly C, Macina D. Immunological and Clinical Benefits of Maternal Immunization Against Pertussis: A Systematic Review. Infect Dis Ther 2019; 8:499-541. [PMID: 31535327 PMCID: PMC6856250 DOI: 10.1007/s40121-019-00264-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Indexed: 11/17/2022] Open
Abstract
Infants are vulnerable to pertussis infection particularly before initiation of pertussis vaccination. Maternal pertussis vaccination during pregnancy has been introduced in a number of countries in order to confer on young infants indirect protection from the disease through transplacental transfer of maternal antibodies. We reviewed the evidence on the immunogenicity and efficacy of maternal pertussis vaccination during pregnancy. A systematic search of PubMed/MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews, ProQuest, and Science Direct was undertaken to identify studies published between January 1995 and December 2018. This review was not specific to any particular pertussis vaccine but included applicable data on available pertussis vaccines administered to pregnant women. The search identified 40 publications for inclusion in this review. Vaccination during pregnancy elicited robust maternal immune responses against all vaccine antigens and resulted in high placental transfer of pertussis antibodies to the infant that persisted well beyond delivery. Vaccination during the second or early third trimesters was considered ideal for antibody quantity and functionality. Although blunting of immune responses to some antigens in the primary immunization series was documented in neonates born to women vaccinated during pregnancy, there was no apparent adverse effect on vaccine efficacy. Multiple studies conducted in diverse settings have confirmed the effectiveness of maternal pertussis vaccination during pregnancy in preventing pertussis in infants prior to receipt of their first primary vaccine dose and beyond. These findings collectively underscore the value of maternal pertussis vaccination during pregnancy in protecting vulnerable infants too young to be vaccinated.Funding Sanofi Pasteur.Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
| | | | - Denis Macina
- Sanofi Pasteur, Vaccines Epidemiology and Modeling, Lyon, France.
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