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The incredible life of Balto
\"Most people know the story of Balto, the world famous dog who led his dogsled team through a blizzard to deliver a lifesaving serum to the stricken people of Nome, Alaska, in 1925. Balto shot to instant stardom--a company named dog food after him, a famous sculptor erected a statue of him that stands in Central Park to this day, and the dog even starred in his own Hollywood movie. But what happened to Balto after the hoopla died down? With a lively, informative text and humorous, vibrant illustrations, Meghan McCarthy captures the extraordinary life of Balto beyond his days as a celebrity.\"--Amazon.com.
Book
Changing Pertussis Epidemiology: Everything Old is New Again
Before vaccination, pertussis was a universal disease of early childhood. Although apparent control of the disease in the United States and other countries was achieved through vaccination, pertussis is resurgent. Though acellular vaccines have been in use for 20 years, new data are emerging on their effectiveness and durability of protection and the contribution of these characteristics to the resurgence of pertussis.
Journal Article
Estimating the Effectiveness of Tetanus-Diphtheria-Acellular Pertussis Vaccine (Tdap) for Preventing Pertussis: Evidence of Rapidly Waning Immunity and Difference in Effectiveness by Tdap Brand
Background. We estimated the vaccine effectiveness (VE) of tetanus-diphtheria-acellular pertussis vaccine (Tdap) for preventing pertussis among adolescents during a statewide outbreak of pertussis in Wisconsin during 2012. Methods. We used the population-based Wisconsin Immunization Registry (WIR) to construct a cohort of Wisconsin residents born during 1998-2000 and collect Tdap vaccination histories. Reports of laboratory-confirmed pertussis with onset during 2012 were matched to WIR clients. Incidence rate ratios (IRRs) of pertussis and Tdap VE estimates [(1 - IRR)*100%], by year of Tdap vaccine receipt and brand (Boostrix/Adacel), were estimated using Poisson regression. Results. Tdap VE decreased with increasing time since receipt, with VEs of 75.3% (95% confidence interval [CI], 55.2%-86.5%) for receipt during 2012,68.2% (95% CI, 60.9%-74.1%) for receipt during 2011, 34.5% (95% CI, 19.9%-46.4%) for receipt during 2010, and 11.9% (95% CI, -11.1% to 30.1%) for receipt during 2009/2008; point estimates were higher among Boostrix recipients than among Adacel recipients. Among Tdap recipients, increasing time since receipt was associated with increased risk, and receipt of Boostrix (vs Adacel) was associated with decreased risk of pertussis (adjusted IRR, 0.62 [95% CI, .52-74]). Conclusions. Our results demonstrate waning immunity following vaccination with either Tdap brand. Boostrix was more effective than Adacel in preventing pertussis in our cohort, but these findings may not be generalizable to adolescent cohorts that received different diphtheria-tetanus-acellular pertussis vaccines (DTaP) during childhood and should be further examined in studies that include childhood DTaP history.
Journal Article
Assessment of on-time vaccination coverage in population subgroups: A record linkage cohort study
Reported infant vaccination coverage at age 12 months in Australia is >90%. On-time coverage of the 2–4–6 month schedule and coverage in specific populations is rarely reported. We conducted a population-based cohort study of 1.9 million Australian births, 1996–2012, combining individual birth and perinatal records with immunisation records through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards. On-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose; 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0% for the 2–4–6 month dose; 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants); up to 23.5 percentage points lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7–10.3 percentage points lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent between increasing socio-economic disadvantage and decreasing on-time coverage. On-time coverage of the 2–4–6 month schedule is only 50–60% across specific population subgroups representing a significant avoidable public health risk. Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness.
Journal Article
Immune Responses to Pertussis Vaccines and Disease
In this article we discuss the following: (1) acellular vaccines are immunogenic, but responses vary by vaccine; (2) pertussis antibody levels rapidly wane but promptly increase after vaccination; (3) whole-cell vaccines vary in immunogenicity and efficacy; (4) whole-cell vaccines and naturally occurring pertussis generate predominantly Thelper 1 (Th1) responses, whereas acellular vaccines generate mixed Th1/Th2 responses; (5) active transplacental transport of pertussis antibody is documented; (6) neonatal immunization with diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccine has been associated with some suppression of pertussis antibody, but suppression has been seen less often with acellular vaccines; (7) memory B cells persist in both acellular vaccine- and whole cell vaccine-primed children; and (8) in acellular vaccine-primed children, T-cell responses remain elevated and do not increase with vaccine boosters, whereas in whole-cell vacdne-primed children, these responses can be increased by vaccine boosting and natural exposure. Despite these findings, challenges remain in understanding the immune response to pertussis vaccines.
Journal Article
MicroRNAs and Small Interfering RNAs Can Inhibit mRNA Expression by Similar Mechanisms
MicroRNAs (miRNAs) are endogenously encoded small noncoding RNAs, derived by processing of short RNA hairpins, that can inhibit the translation of mRNAs bearing partially complementary target sequences. In contrast, small interfering RNAs (siRNAs), which are derived by processing of long double-stranded RNAs and are often of exogenous origin, degrade mRNAs bearing fully complementary sequences. Here, we demonstrate that an endogenously encoded human miRNA is able to cleave an mRNA bearing fully complementary target sites, whereas an exogenously supplied siRNA can inhibit the expression of an mRNA bearing partially complementary sequences without inducing detectable RNA cleavage. These data suggest that miRNAs and siRNAs can use similar mechanisms to repress mRNA expression and that the choice of mechanism may be largely or entirely determined by the degree of complementary of the RNA target.
Journal Article
Seroprevalence of anti-diphtheria toxoid antibody and implications for vaccination policy in Vietnam’s South-central coast: a cross-sectional study
Background
Diphtheria is a re-emerging infectious disease and public health concern worldwide and in Vietnam with increasing cases in recent years. This study aimed to assess the anti-diphtheria toxoid antibodies status in Khanh Hoa Province and identify factors contributing to the vaccination policy in the south-central coast of Vietnam.
Methods
This was a cross-sectional study to evaluate the seroprevalence of anti-diphtheria toxoid antibodies among 1,195 participants, aged 5 – 40 years in Khanh Hoa Province, Vietnam. Immunoglobulin G antibody levels against diphtheria were detected using a commercial anti-diphtheria toxoid enzyme-linked immunosorbent assay (SERION ELISA classic Diphtheria Immunoglobulin G) and were categorized following the World Health Organization guidelines.
Results
The mean anti-diphtheria toxoid antibody levels were 0.07 IU/ml (95% Confidence Interval: 0.07–0.08). Anti-diphtheria toxoid antibody levels were found to be associated with age and history of diphtheria vaccination. The 5–15 years age group had the highest levels (0.09 IU/ml), while the older age group had the lowest antibody level (
p
< 0.001). Individuals who received three doses (adjusted Odds ratio: 2.34, 95%CI: 1.35 – 4.07) or 4
+
doses (adjusted Odds ratio: 2.45, 95%CI: 1.29 – 4.64) had a higher antibody level compared to those who received only one dose regardless of age.
Conclusion
It is crucial to promote routine vaccination coverage to over 95% for children under one year of age with three primary doses of the diphtheria-containing vaccine, including additional doses at 18 months and 7 years of age. Booster doses should be promoted and administered to adolescents and adults every 10 years.
Journal Article
Rates of Influenza and Tdap Vaccination in Teaching and Private Obstetrical Practices, and the Influence of Vaccine Hesitancy
ObjectivesWe evaluated differences in vaccination rates of patients of teaching and private practices, and explored the rate of vaccine hesitancy in pregnant women.MethodsThis was a cross-sectional study of a convenience sample of recently delivered women. Women completed a survey, which included a question about whether they received the influenza and/or Tdap vaccine, and a vaccine hesitancy scale for both influenza and Tdap vaccines. We also reviewed prenatal records to confirm vaccine administration and collected demographic data. Patients who received care on the teaching service (care by residents supervised by faculty) were compared with those who received care from 26 private practitioners in nine groups. The primary outcome was rate of vaccination. Fisher’s exact test was performed to compare groups.ResultsOf the 231 women approached, 208 (90.0%) agreed to participate. Of the 208 participants, 70 (33.7%) had prenatal care with a teaching practice, and 138 (66.3%) with a private practice. Patients of teaching practices had a higher influenza and Tdap vaccination rate compared with patients of private practices (Influenza: 70% versus 54.3%, p = 0.036; Tdap: 77.1% versus 58.4%, p = 0.009). Among the entire cohort, 55.3% had some degree of vaccine hesitancy. This did not differ between teaching and private practices (54.3% versus 55.8%, p = 0.883).ConclusionsIn spite of similar prevalence of vaccine hesitancy, pregnant women cared for in teaching practices had higher vaccination rates than those cared for in private practices.SignificanceWhat is Already Known on this Subject? Prior studies have assessed individual patient characteristics as predictors of influenza and tetanus, diphtheria, and pertussis (Tdap) vaccination in pregnancy, but little is published on the role of provider type.What this Study Adds? Teaching practices had higher vaccination rates in pregnancy than private practices despite similar prevalence of vaccine hesitancy between groups. Areas of future research should focus on incorporating evidence-based strategies in practices, particularly private practices, to improve vaccination rates in pregnancy.
Journal Article
Vaccinated Children and Adolescents With Pertussis Infections Experience Reduced Illness Severity and Duration, Oregon, 2010–2012
Background. Bordetella pertussis causes severe respiratory illness among infants and adolescents. High proportions of breakthrough infection have been observed. To understand the effect of vaccination in the era of acellular pertussis vaccines (DTaP and Tdap), we assessed if vaccination status is associated with disease severity and duration. Methods. The Multnomah County Health Department conducts enhanced pertussis surveillance for 1.7 million residents in the Portland, Oregon, metropolitan area. Surveillance activities include ascertaining demographics, clinical presentation, cough duration, vaccination history, and other health outcomes. Utilizing Advisory Committee on Immunization Practices (ACIP) routine vaccination recommendations, we analyzed a cohort of persons aged 6 weeks to 18 years with confirmed pertussis to assess illness severity and duration by vaccination status. Analysis was conducted using both logistic regression (disease severity) and survival analysis (cough duration). Results. During 2010–2012, 98.7% (n = 624) of patients with confirmed pertussis in our cohort had vaccination, treatment, demographic, and outcome information. Among these patients, 45% (n = 286) were ACIP up to date with vaccinations. Ever-vaccinated cases were significantly less likely to be hospitalized or develop severe illness (adjusted odds ratio [aOR], 0.2; 95% confidence interval [CI], .1–.8 and aOR, 0.4; 95% CI, .2–.9, respectively). ACIP up-to-date patients stopped coughing significantly more rapidly than unvaccinated patients (adjusted hazard ratio, 1.7; 95% CI, 1.3–2.2). Conclusions. Patients with pertussis vaccination had decreased morbidity characterized by less severe illness and significantly reduced illness duration. Therefore, vaccination is recommended among at–risk individuals, and research into the nature of the residual vaccine immunity is warranted.
Journal Article
Maternal and Neonatal Vaccination Protects Newborn Baboons From Pertussis Infection
Background. The United States is experiencing a pertussis resurgence that resulted in a 60-year high of 48 000 cases in 2012. The majority of hospitalizations and deaths occur in infants too young to be vaccinated. Neonatal and maternal vaccination have been proposed to protect newborns until the first vaccination, currently recommended at 2 months of age. These interventions result in elevated anti-Bordetella pertussis titers, but there have been no studies demonstrating that these measures confer protection. Methods. Baboons were vaccinated with acellular pertussis vaccine at 2 days of age or at 2 and 28 days of age. To model maternal vaccination, adult female baboons primed with acellular pertussis vaccine were boosted in the third trimester of pregnancy. Neonatally vaccinated infants, infants born to vaccinated mothers, and naive infants born to unvaccinated mothers were infected with B. pertussis at 5 weeks of age. Results. Naive infant baboons developed severe disease when challenged with B. pertussis at 5 weeks of age. Baboons receiving acellular pertussis vaccine and infants born to mothers vaccinated at the beginning of their third trimester were protected. Conclusions. Our results demonstrate that neonatal vaccination and maternal vaccination confer protection in the baboon model and support further study of these strategies for protection of newborns from pertussis.
Journal Article