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  1. 1. Duration of Protection After First Dose of Acellular Pertussis Vaccine in Infants
  3. 3. PERTUSSIS  an acute respiratory tract infection that was described by Sydenham as pertussis, meaning intense cough, it is preferable to whooping cough because most infected individuals do not “whoop.”
  4. 4. ETIOLOGY  Bordetella pertussis .  Bordetella parapertussis that contributes significantly to 5% of pertussis.  All are gram-negative coccobacilli that are recovered best on Bordet- Gengou media.
  5. 5.  In very young children, the prolonged coughing fits and vomiting can interfere with sleeping and feeding patterns.
  6. 6. EPIDEMIOLOGY  Spread by direct contact or droplet infections during cough.  Infants less than one year of age constitute 50- 70% of diagnosed cases.
  7. 7. DROPLET PRECAUTIONS  Surgical mask ( N 95 not necessary)  Gloves / Consider Gown  Frequent hand washing  Transmission risk within ~ 3 feet or less of a cough , sneeze, face to face talking .
  8. 8. PERIOD OF COMMUNICABILITY  The disease occurs 3-12 days after exposure to an infected individual  The coughing stage lasts for approximately six weeks before subsiding. In some countries, this disease is called the 100 days' cough or cough of 100 days .
  9. 9. CLINICAL MANIFESTATIONS  The incubation period of pertussis has a mean of 7 and a range of 6-20 days.  Classically, divided into: 1- Catarrhal, 2- Paroxysmal, and 3- Convalescent stages.
  10. 10. CATARRHAL STAGE  The term "catarrh" meaning"to flow."  Nasal congestion  Runny nose  Mild fever  Eye redness and excess eye watering
  11. 11. PAROXYSMAL STAGE (2-4WK) The term "paroxysm" means a sudden, violent burst. The paroxysms or "fits" of coughing may...  start as a dry, intermittent, annoying cough that increases in intensity and frequency  occur at least once an hour  cause the child to turn red, blue, or purple
  12. 12. CONTD….  cause the eyes to bulge and water excessively  cause significant distress in the child  vomiting after coughing
  13. 13. CONT…….. Young infants may have small bursts of cough or no cough before developing...  Gasping  Choking  Turning red, blue or purple  Apnea (episodes of not breathing)
  14. 14. CONVALESCENT STAGE (≥2 WK)  The coughing fits become less frequent and less intense. Young infants may develop louder coughing but typically the breathing difficulty improves.
  15. 15. DIAGNOSIS  Clinical diagnosis is during paroxysmal stage.  H/O incomplete vaccination.  H/o contact.  CBC shows leukocytosis.  Fluorescent antibody staining of nasopharyngeal secretions.  nasopharyngeal swab.  X-ray chest
  16. 16. TREATMENT  Hospitalization is especially for infants less than 6 months.  supplemental oxygen or even mechanical venitlation may be necessary for severe disease.  All individuals with confirmed pertussis should be treated with antibiotics such as erythromycin, azithromycin or clarithromycin.  Antibiotics reduce the severity of illness and also reduce the spread of the illness.
  17. 17. ANTIBIOTICS  Erythromycin [50mg/kg/day] for 14 days may eliminate pertussis organisms from the nasopharynx within 3-4 days.  Supportive care : avoidance of factors that provoke attacks of coughing,  maintenance of the hydration and nutrition,  oxygen if there is distress, gentle suction for viscid secretions.
  18. 18. COMPLICATIONS Infants less than 6 months of age are at the highest risk for complications. These include:  Apnea  Ear infections  Pneumonia  Seizures  Encephalopathy  Death (approximately 1% of infants less than 2 months of age)
  19. 19. SHOULD EXPOSED FAMILY MEMBERS BE TREATED?  Yes.  Family members and close contacts of an infected child should be treated with antibiotics to prevent spread of the illness.  This is true even for vaccinated individuals.
  20. 20. ISOLATION  Patients with suspected pertussis are placed in respiratory isolation with use of masks by all health care personnel entering the room.  Screening for cough should be performed and isolation until 5 days after initiation of macrolide therapy.
  21. 21. COND….  Children and staff with pertussis in child-care facilities or schools should be excluded until macrolide prophylaxis has been taken for 5 days.
  22. 22. CAN PERTUSSIS BE PREVENTED?  The pertussive vaccine is effective for at least 5 years.  This helps prevent infection in the age group where pertussis infection is most severe.  The pertussis vaccine is part of the DTaP vaccine (along with tetanus and diphtheria).
  23. 23. VACCINATION SCHEDULE  The DTaP vaccine should be given in five doses  at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years.  A booster dose is recommended at 11 to 12 years of age.
  24. 24. DTaP Vaccine Tdap Vaccine
  25. 25. WHAT KIND OF VACCINE IS DTAP?  The diphtheria and tetanus components are inactivated toxins called a toxoids.  For the pertussis component of DTaP and Tdap vaccines, purified components of the bacterium are grown and then inactivated.
  26. 26. HOW IS THIS VACCINE GIVEN?  The DTaP vaccine is given as an Intramuscular injection.  Dose is .5ml
  27. 27. FOR CHILDREN, HOW MANY DOSES OF DTAP VACCINE ARE REQUIRED?  Children up 2 months – 6 years:  A series of 4 doses given at 2, 4, 6, and 15-18 months of age.  A 5th shot, or booster dose, is recommended at 4-6 years of age, unless the fourth dose was given late (after the fourth birthday).  A booster dose of Td (adult tetanus and diphtheria) is recommended every ten years. The new Tdap vaccine can be substituted for one booster dose of adult Td.
  28. 28. SHOULD ADULTS WHO WEREN'T IMMUNIZED AS CHILDREN RECEIVE THIS VACCINE AS ADULTS?  Children 7 years and older without documentation of DTaP vaccination should receive a primary series of three doses of Tetanus-diphtheria toxoid (Td).  The first 2 doses should be separated by 4 - 8 weeks, and the 3rd dose given 6 - 12 months after the second dose.  Tdap vaccine can be substituted for one of these three doses, preferably the first dose for persons 11 years and older.
  29. 29. HOW SAFE IS THIS VACCINE The most common reactions are Soreness, redness, and swelling at the injection site. Mild fever Loss of appetite Tiredness Vomiting
  30. 30. WHO SHOULD NOT RECEIVE VACCINE?  People who have had a serious allergic reaction to one dose of DTaP, DT, Td, or Tdap vaccine.  Persons with a moderate or severe illness should postpone receiving the vaccine until their condition has improved.
  31. 31. WHAT ADVERSE SIDE EFFECTS HAVE BEEN REPORTED WITH THIS VACCINE?  Moderate to serious reactions include:  Crying for three hours or more  High fever  Collapse or shock-like state  Convulsions within three days
  32. 32. VACCINES IN PAKISTAN DPT +Tetanus+, Pertussis Hep B + Hemophilus Influenza Quinvaxem Novartis Free from Govt./ Also available in private market for Rs 1800/- Diptheria, Tetanus, Pertussis, Polio, Hepatitis B, and Haemophilus Influenzae B Vaccine Infanrix Hexa Glaxo Smith Kline Rs.1750/- Pertussis Vaccine Acelluvax Chiron Biocine Novartis Rs. 1490/-
  33. 33. Duration of Protection After First Dose of Acellular Pertussis Vaccine in Infants
  34. 34.  published online February 10, 2014;  Type of study case-control study.  Place of study Australia.
  35. 35. INCLUSION CRITERIA  aged 2 to 47 months  between January 2005 and December 2009 to controls from a population based immunization register by date of birth and region of residence .  coughing illness lasting 2 weeks.  detection by polymerase chain reaction [PCR] test or  isolation by culture or suggestive laboratory
  36. 36. CASES  All pertussis notifications for children aged,4 years with a diagnosis date between January 1, 1995 and December 31, 2010 were included.
  37. 37. EXCLUSION CRITERIA  Cases where immunization status was not recorded in the notification data set supplied by states and territories were excluded  Any doses received by a control after the date of disease onset in their matched case were not included in the total..
  38. 38.  5226 notified cases.  642 were excluded.  4584 cases for matched analysis.
  39. 39. STATICALLY DATA  were performed using the Pearson x2 test and a significance level of P <.05.  The model was stratified by the age groups to estimate the odds ratio (OR) for receipt of 1, 2, or 3 vaccine doses for notified pertussis cases compared with their matched controls.
  40. 40. DISCUSSION we sampled 20 age-matched controls for each case to maximize precision. We selected eligible controls born on the day before or the day after the birth date of the index case to ensure that cases were not matched to themselves. The vaccination status of controls was ascertained using the ACIR.
  41. 41.  National data from the ACIR between 2000 and 2010 showed that after 2 months of age, the proportion of children aged up to 12 months recorded as having received no doses of DTaP remained nearly constant, with the first dose received before 3 months of age in 87% .
  44. 44. WHAT’S KNOWN ON THIS SUBJECT: Waning effectiveness of 5 doses of acellular pertussis vaccines is well documented after 6 years of age, but data are lacking for fewer doses in younger children.
  45. 45. WHAT THIS STUDY ADDS:  In 2- to 3-month-old infants, 1 dose of the diphtheria–tetanus–acellular pertussis vaccine gave significant protection against hospitalized pertussis. The effectiveness of 3 doses decreased from 84% between 6 and 11months to 59% after 3 years.
  46. 46. STRONG POINTS OF STUDY  largest reported observational study .  both against severe disease in infants and against all laboratory-confirmed pertussis.  We had large numbers of cases.  much greater sensitivity
  47. 47. LIMITATIONS OF STUDY  the lack of gender specification.  socioeconomic data for cases and controls.
  48. 48. CONCLUSIONS  DTaP provided good protection against pertussis in the first year of life from the first dose. Without a booster dose, the effectiveness of 3 doses waned more rapidly from 2 to 4 years of age than previously documented for children .6 years of age who had received 5 doses.
  49. 49. ANNUALLY REPORTED CASES  Pakistan  Source from W.H.O  Cases reported 4,334  Total population 159,196,3362