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Kutty JM, RajanBabu B, Thiruvoth S. Immune status against diphtheria in healthy adults. J Family Med Prim Care 2019; 8:3253-3257. [PMID: 31742151 PMCID: PMC6857361 DOI: 10.4103/jfmpc.jfmpc_589_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 11/14/2022] Open
Abstract
Outbreaks of diphtheria continue to occur in Kerala with an age shift to older population. Antibody seroprevalence studies are essential to understand the immune status of the community and to develop an effective immunization strategy. AIM To assess the necessity of diphtheria vaccination among adults. SETTINGS AND DESIGN Cross-sectional study, among 152 healthy adults (>18 years). METHODS AND MATERIALS Diphtheria IgG antibody detection was performed by using ELISA technique. RESULTS Out of 152 study population, 14 (9.2%) individuals had very low antibody levels, requiring basic immunization, 123 (80.9%) needed booster vaccination, 12 (7.9%) would need a booster dose in 5 years and 3 (2%) would need a booster dose in 7 years to maintain adequate antibody levels. Out of the total, 131 (86.2%) individuals had completed childhood immunization and 21 (13.8%) had incomplete or no immunization during childhood. In the population who had completed childhood immunization, 4 (3%) had very low antibody levels requiring basic immunization and 113 (86%) had antibody levels needing booster vaccine soon, with the remaining 14 (10.6%) individuals requiring a booster vaccine after 5 years and 7 years. In the partially immunized/unimmunized population, 10 (47.6%) had antibody levels requiring basic immunization and another 10 (47.6%) had antibody levels low enough to warrant a booster vaccine. CONCLUSIONS Majority of the subjects who had completed childhood immunization showed an inadequate immunity against diphtheria during adulthood. This indicates waning immunity against diphtheria. Hence, modifying the present diphtheria vaccination strategy to include booster doses during adulthood is essential. CONTEXT Even in developed countries where nearly 100% universal immunization is achieved, diphtheria outbreaks are known to occur. Several seroprevalence studies have been conducted in those regions to determine whether those populations have adequate levels of antibodies against diphtheria. In India, sporadic outbreaks occur, and an increasing number of diphtheria cases are being reported over the last few years. Large outbreaks in Kerala 2016 were about 533 cases. Recent outbreaks in 2019, in Trivandrum, about 175 cases were suspected and 19 cases were confirmed in laboratory. However, Indian studies to determine whether the adult population has adequate protective antibody levels are lacking. Knowing the immune status of the population and devising an appropriate strategies to prevent outbreaks of diphtheria are the integral parts of primary care. These concerns are the basis and evaluation of the seroprevalence of IgG antibody levels against diphtheria antitoxin among healthy adults in our region in this study.
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Affiliation(s)
- Jesheera M. Kutty
- Department of Family Medicine and Microbiology, ASTER MIMS, Calicut, Kerala, India
| | - Bijayraj RajanBabu
- Department of Family Medicine and Microbiology, ASTER MIMS, Calicut, Kerala, India
| | - Sohanlal Thiruvoth
- Department of Family Medicine and Microbiology, ASTER MIMS, Calicut, Kerala, India
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Silva GP, Santos RS, Pereira-Manfro WF, Ferreira B, Barreto DM, Frota ACC, Hofer CB, Milagres LG. A cross-reacting material CRM 197 conjugate vaccine induces diphtheria toxin neutralizing antibody response in children and adolescents infected or not with HIV. Vaccine 2017; 35:3803-3807. [PMID: 28599793 DOI: 10.1016/j.vaccine.2017.05.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
Anti-diphtheria antibody levels decrease with aging, and frequent booster vaccinations are required to maintain herd immunity. We analyzed the diphtheria toxin neutralizing antibody (DT-Nab) response induced by a conjugate vaccine (meningococcal C polysaccharide-CRM197) in HIV-vertically infected (HI) children and adolescents and healthy controls (HC) with matched age. We report the association of DT-Nab with the bactericidal antibodies to serogroup C meningococcus (MenC). Before vaccination, 21 HI patients (50%) had no protection against diphtheria (≤0.01IU/ml of antibody) and only 8 (19%) showed complete protection (≥0.1IU/ml). About half of the HC (56%) had complete protection before immunization and 6 subjects (12%) had no protection against diphtheria. After one and two vaccine injections, 96% of HC and 64% of HI vaccinees, respectively, showed full protection against diphtheria. These data indicate that CRM197 was able to induce primary and/or booster response in both groups of individuals.
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Affiliation(s)
- Giselle P Silva
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil
| | - Rafaela S Santos
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil
| | - Wânia F Pereira-Manfro
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil
| | - Bianca Ferreira
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, Brazil
| | - Daniella M Barreto
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, Brazil
| | | | - Cristina B Hofer
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, Brazil; Preventive Medicine Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucimar G Milagres
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil.
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Borba RCN, Vidal VM, Moreira LO. The re-emergency and persistence of vaccine preventable diseases. AN ACAD BRAS CIENC 2015; 87:1311-22. [PMID: 26312431 DOI: 10.1590/0001-3765201520140663] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The introduction of vaccination worldwide dramatically reduced the incidence of pathogenic bacterial and viral diseases. Despite the highly successful vaccination strategies, the number of cases among vaccine preventable diseases has increased in the last decade and several of those diseases are still endemic in different countries. Here we discuss some epidemiological aspects and possible arguments that may explain why ancient diseases such as, measles, polio, pertussis, diphtheria and tuberculosis are still with us.
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Affiliation(s)
- Rodrigo C N Borba
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Vinícius M Vidal
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Lilian O Moreira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
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Gomes DLR, Peixoto RS, Barbosa EAB, Napoleão F, Sabbadini PS, Dos Santos KRN, Mattos-Guaraldi AL, Hirata R. SubMICs of penicillin and erythromycin enhance biofilm formation and hydrophobicity of Corynebacterium diphtheriae strains. J Med Microbiol 2013; 62:754-760. [PMID: 23449875 DOI: 10.1099/jmm.0.052373-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Subinhibitory concentrations (subMICs) of antibiotics may alter bacterial surface properties and change microbial physiology. This study aimed to investigate the effect of a subMIC (⅛ MIC) of penicillin (PEN) and erythromycin (ERY) on bacterial morphology, haemagglutinating activity, cell-surface hydrophobicity (CSH) and biofilm formation on glass and polystyrene surfaces, as well as the distribution of cell-surface acidic anionic residues of Corynebacterium diphtheriae strains (HC01 tox(-) strain; CDC-E8392 and 241 tox(+) strains). All micro-organisms tested were susceptible to PEN and ERY. Growth in the presence of PEN induced bacterial filamentation, whereas subMIC of ERY caused cell-size reduction of strains 241 and CDC-E8392. Adherence to human erythrocytes was reduced after growth in the presence of ERY, while CSH was increased by a subMIC of both antibiotics in bacterial adherence to n-hexadecane assays. Conversely, antibiotic inhibition of biofilm formation was not observed. All strains enhanced biofilm formation on glass after treatment with ERY, while only strain 241 increased glass adherence after cultivation in the presence of PEN. Biofilm production on polystyrene surfaces was improved by ⅛ MIC of ERY. After growth in the presence of both antimicrobial agents, strains 241 and CDC-E8392 exhibited anionic surface charges with focal distribution. In conclusion, subMICs of PEN and ERY modified bacterial surface properties and enhanced not only biofilm formation but also cell-surface hydrophobicity. Antibiotic-induced biofilm formation may contribute to the inconsistent success of antimicrobial therapy for C. diphtheriae infections.
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Affiliation(s)
- D L R Gomes
- Faculty of Pharmacy, Federal Institute of Education, Science and Technology of Rio de Janeiro, IFRJ, Rio de Janeiro RJ, Brazil
- Laboratory of Diphtheria and Corynebacteria of Medical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, UERJ, Rio de Janeiro RJ, Brazil
| | - R S Peixoto
- Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, UFRJ, Rio de Janeiro RJ, Brazil
- Laboratory of Diphtheria and Corynebacteria of Medical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, UERJ, Rio de Janeiro RJ, Brazil
| | - E A B Barbosa
- Faculty of Pharmacy, Federal Institute of Education, Science and Technology of Rio de Janeiro, IFRJ, Rio de Janeiro RJ, Brazil
| | - F Napoleão
- Laboratory of Diphtheria and Corynebacteria of Medical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, UERJ, Rio de Janeiro RJ, Brazil
| | - P S Sabbadini
- Laboratory of Diphtheria and Corynebacteria of Medical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, UERJ, Rio de Janeiro RJ, Brazil
| | - K R N Dos Santos
- Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, UFRJ, Rio de Janeiro RJ, Brazil
| | - A L Mattos-Guaraldi
- Laboratory of Diphtheria and Corynebacteria of Medical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, UERJ, Rio de Janeiro RJ, Brazil
| | - R Hirata
- Laboratory of Diphtheria and Corynebacteria of Medical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, UERJ, Rio de Janeiro RJ, Brazil
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Dias AADSDO, Santos LS, Sabbadini PS, Santos CS, Silva Junior FC, Napoleão F, Nagao PE, Villas-Bôas MHS, Hirata Junior R, Guaraldi ALM. Corynebacterium ulcerans diphtheria: an emerging zoonosis in Brazil and worldwide. Rev Saude Publica 2012; 45:1176-91. [PMID: 22124745 DOI: 10.1590/s0034-89102011000600021] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/27/2011] [Indexed: 11/21/2022] Open
Abstract
The article is a literature review on the emergence of human infections caused by Corynebacterium ulcerans in many countries including Brazil. Articles in Medline/PubMed and SciELO databases published between 1926 and 2011 were reviewed, as well as articles and reports of the Brazilian Ministry of Health. It is presented a fast, cost-effective and easy to perform screening test for the presumptive diagnosis of C. ulcerans and C. diphtheriae infections in most Brazilian public and private laboratories. C. ulcerans spread in many countries and recent isolation of this pathogen in Rio de Janeiro, southeastern Brazil, is a warning to clinicians, veterinarians, and microbiologists on the occurrence of zoonotic diphtheria and C. ulcerans dissemination in urban and rural areas of Brazil and/or Latin America.
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Speranza FAB, Ishii SK, Hirata R, Mattos-Guaraldi AL, Milagres LG. Diphtheria toxin IgG levels in military and civilian blood donors in Rio de Janeiro, Brazil. Braz J Med Biol Res 2009; 43:120-3. [PMID: 20027481 DOI: 10.1590/s0100-879x2009007500032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 12/03/2009] [Indexed: 11/22/2022] Open
Abstract
Serologic data on diseases that are preventable by vaccines are necessary to evaluate the success of immunization programs and to identify susceptible subgroups. In the present study, we determined serum IgG levels against diphtheria toxin of military and civilian blood donors (N = 75; 69.3% males and 30.7% females) aged 18-64 years, from the Brazilian Army Biology Institute, Rio de Janeiro, using a commercial diphtheria kit (Diphtheria IgG ELISA; IBL, Germany). Most (63%) unprotected military donors were from the older age group of 41 to 64 years. In contrast, the majority (71%) of young military donors (18 to 30 years) were fully protected. About half of the military donors aged 31 to 40 years were protected against diphtheria. Among the civilians, about 50% of persons aged 18 to 30 years and 31 to 40 years had protective antibody levels against diphtheria as also did 64% of individuals aged 41 to 64 years. All civilians had a similar antibody response (geometric mean = 0.55 IU/mL) independent of age group. Military donors aged 18-30 years had higher IgG levels (geometric mean = 0.82 IU/mL) than military donors of 41-64 years (geometric mean = 0.51 IU/mL; P > 0.05). In conclusion, the existence of a considerable proportion of susceptible adults supports the position that reliable data on the immune status of the population should be maintained routinely and emphasizes the importance of adequate immunization during adulthood.
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Affiliation(s)
- F A B Speranza
- Faculdade de Ciências Médicas, Instituto de Biologia do Exército, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Martins RDM, Camacho LAB, Marcovistz R, Noronha TGD, Maia MDLS, dos Santos EM, Barbosa GG, Silva AMVD, Souza PCNFD, Lemos MCF, Homma A. Immunogenicity, reactogenicity and consistency of production of a Brazilian combined vaccine against diphtheria, tetanus, pertussis and Haemophilus influenzae type b. Mem Inst Oswaldo Cruz 2009; 103:711-8. [PMID: 19057823 DOI: 10.1590/s0074-02762008000700014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 09/29/2008] [Indexed: 11/22/2022] Open
Abstract
A randomized, double-blinded study evaluating the immunogenicity, safety and consistency of production of a combined diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccine entirely produced in Brazil by Bio-Manguinhos and Instituto Butantan (DTP/Hib-BM) was undertaken. The reference vaccine had the same DTP vaccine but the Hib component was produced using purified materials supplied by GlaxoSmithKline (DTP/Hib-GSK), which is registered and has supplied the Brazilian National Immunization Program for over more than five years. One thousand infants were recruited for the study and received vaccinations at two, four and six months of age. With respect to immunogenicity, the vaccination protocol was followed in 95.6% and 98.4% of infants in the DTP/Hib-BM and DTP/Hib-GSK groups, respectively. For the Hib component of the study, there was 100% seroprotection (> or =0.15 microg/mL) with all three lots of DTP/Hib-BM and DTP/Hib-GSK. The geometric mean titer (GMT) was 9.3 microg/mL, 10.3 microg/mL and 10.3 microg/mL for lots 1, 2 and 3 of DTP/Hib-BM, respectively, and the GMT was 11.3 g/mL for DTP/Hib-GSK. For diphtheria, tetanus and pertussis, seroprotection was 99.7%, 100% and 99.9%, respectively, for DTP/Hib-BM, three lots altogether and 99.2%, 100% and 100% for DTP/Hib-GSK. GMTs were similar across all lots and vaccines. Adverse events rates were comparable among the vaccine groups. The Brazilian DTP/Hib vaccine demonstrated an immunogenicity and reactogenicity profile similar to that of the reference vaccine.
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