Pertussis is still a worldwide problem: every year there are almost 20-50 million cases and 300.000 deaths.
The incidence is increasing especially between adults and adolescents, with consequences on infants. For this reason, the increasing of a vaccination strategy for adolescent and adult is needed...
To learn more, please visit www.waidid.org.
The Sky Gets Dark Slowly in View of the Emergence of “The Super Omicron Varia...IIJSRJournal
The new Omicron variant of SARS-cov-2 speeding around the world may bring another wave of chaos. It is like walking on a tight rope. The earth is brimming with viruses. The lungs are the paramount respiratory organs. Besides COVID-19, Omicron variant, pollution is another uninvited guest. People are aggrieved by the recurrence of pollution every year. Delhi and most of the cities expressed air emergency. Nothing seems to change. Not a soul is taken care of. The lungs are the organs most affected by COVID‐19. Virus-infected patients are suffering from air hunger. COVID-19 and its variants are the lung annihilate viruses that traumatically lead to lung failure. COVID 19 pandemic sweeps across the globe, Co-infection with respiratory viruses and SARS-CoV-2 and the mutant variants Omicron, raising danger bells around the world. Omicron is an exciting outstanding pandemic co-infected with respiratory viruses, demands crucial public health Intervention.
The Sky Gets Dark Slowly in View of the Emergence of “The Super Omicron Varia...IIJSRJournal
The new Omicron variant of SARS-cov-2 speeding around the world may bring another wave of chaos. It is like walking on a tight rope. The earth is brimming with viruses. The lungs are the paramount respiratory organs. Besides COVID-19, Omicron variant, pollution is another uninvited guest. People are aggrieved by the recurrence of pollution every year. Delhi and most of the cities expressed air emergency. Nothing seems to change. Not a soul is taken care of. The lungs are the organs most affected by COVID‐19. Virus-infected patients are suffering from air hunger. COVID-19 and its variants are the lung annihilate viruses that traumatically lead to lung failure. COVID 19 pandemic sweeps across the globe, Co-infection with respiratory viruses and SARS-CoV-2 and the mutant variants Omicron, raising danger bells around the world. Omicron is an exciting outstanding pandemic co-infected with respiratory viruses, demands crucial public health Intervention.
Omicron / COVID-19 updates as of 29 November 2021. Due to demand/requests, slides are uploaded to update what we know as of 29 November 2021. Hope this helps.
What: Invitation to join the “All Business Briefing” on current COVID-19 conditions and what to expect in the near future
Special Guest Speakers: Orange County Health Department Director Quintana Stewart and Dr. Abhi Mehrotra, Vice Chair, Strategic Initiatives & Operations for UNC Dept. of Emergency Medicine, UNC Health
Why: The purpose of this call is to share timely and relevant information on COVID-19 and the Omicron variant to help you and your business navigate the upcoming months. We will discuss vaccination and hospitalization statistics, optimal testing practices, how to slow the spread and what to expect moving forward.
When: Tuesday, January 11, 2022 from 3:30pm-4:30pm
Why third wave of Covid-19 will occur?
Who are at Risk ?
Why it will affect Children,
What are symptoms and clinical features
How to diagnose and treat children?
How to prevent?
What are Preventive measures ?
What is omicron variant,How much mutations occurs, Nomenclature, Different between Delta and omicron variant,Prevention , Symptoms said by Doctors and Scientists, Treatments, Diagnosis,How particularly detect omicron variant, Features and etc....
ABO Blood Groups and SARS-CoV-2 Infection by Fumiichiro Yamamoto, Ph.D.FumiichiroYamamoto
Scientific knowledge is depicted on the association between A and B glycan antigens of the ABO blood group system important in blood transfusion and cell/tissue/organ transplantation and infection of the SARS-CoV-2 virus responsible for the ongoing epidemic of coronavirus disease COVID-19.
About covid variants types of variants like UK, India , South Africa ,
some information about Variant of Concern and variant of interest , the about Indian variants
COVID-19 genome sequencing laboratory network launches in AfricaSABC News
Addis Ababa/Brazzaville – With several African countries now expanding COVID-19 testing, the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) have launched a network of laboratories to reinforce genome sequencing of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, in Africa.
An overview of coronaviruses. Lecture for University Biomedical Students. Using historical knowledge of coronaviruses to better understand the current SARS-CoV-2 pandemic.
PERTUSSIS PROTECTION - CURRENT SCHEDULES IN EUROPEWAidid
Slide set by Professor Susanna Esposito, president WAidid, presented at the 3rd ESCMID Conference on Vaccines, held in Lisbon (Portugal), 6- 8 March 2015. Learn more: http://goo.gl/8GUwwL
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by
infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF,
which can result from a single severe episode or from multiple recurrent episodes of the illness, is
known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in
resource-poor settings around the world. Although our understanding of disease pathogenesis has
advanced in recent years, this has not led to dramatic improvements in diagnostic approaches,
which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed,
penicillin has been the mainstay of treatment for decades and there is no other treatment that has
been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent
advances — including the use of echocardiographic diagnosis in those with ARF and in screening
for early detection of RHD, progress in developing group A streptococcal vaccines
Omicron / COVID-19 updates as of 29 November 2021. Due to demand/requests, slides are uploaded to update what we know as of 29 November 2021. Hope this helps.
What: Invitation to join the “All Business Briefing” on current COVID-19 conditions and what to expect in the near future
Special Guest Speakers: Orange County Health Department Director Quintana Stewart and Dr. Abhi Mehrotra, Vice Chair, Strategic Initiatives & Operations for UNC Dept. of Emergency Medicine, UNC Health
Why: The purpose of this call is to share timely and relevant information on COVID-19 and the Omicron variant to help you and your business navigate the upcoming months. We will discuss vaccination and hospitalization statistics, optimal testing practices, how to slow the spread and what to expect moving forward.
When: Tuesday, January 11, 2022 from 3:30pm-4:30pm
Why third wave of Covid-19 will occur?
Who are at Risk ?
Why it will affect Children,
What are symptoms and clinical features
How to diagnose and treat children?
How to prevent?
What are Preventive measures ?
What is omicron variant,How much mutations occurs, Nomenclature, Different between Delta and omicron variant,Prevention , Symptoms said by Doctors and Scientists, Treatments, Diagnosis,How particularly detect omicron variant, Features and etc....
ABO Blood Groups and SARS-CoV-2 Infection by Fumiichiro Yamamoto, Ph.D.FumiichiroYamamoto
Scientific knowledge is depicted on the association between A and B glycan antigens of the ABO blood group system important in blood transfusion and cell/tissue/organ transplantation and infection of the SARS-CoV-2 virus responsible for the ongoing epidemic of coronavirus disease COVID-19.
About covid variants types of variants like UK, India , South Africa ,
some information about Variant of Concern and variant of interest , the about Indian variants
COVID-19 genome sequencing laboratory network launches in AfricaSABC News
Addis Ababa/Brazzaville – With several African countries now expanding COVID-19 testing, the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) have launched a network of laboratories to reinforce genome sequencing of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, in Africa.
An overview of coronaviruses. Lecture for University Biomedical Students. Using historical knowledge of coronaviruses to better understand the current SARS-CoV-2 pandemic.
PERTUSSIS PROTECTION - CURRENT SCHEDULES IN EUROPEWAidid
Slide set by Professor Susanna Esposito, president WAidid, presented at the 3rd ESCMID Conference on Vaccines, held in Lisbon (Portugal), 6- 8 March 2015. Learn more: http://goo.gl/8GUwwL
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by
infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF,
which can result from a single severe episode or from multiple recurrent episodes of the illness, is
known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in
resource-poor settings around the world. Although our understanding of disease pathogenesis has
advanced in recent years, this has not led to dramatic improvements in diagnostic approaches,
which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed,
penicillin has been the mainstay of treatment for decades and there is no other treatment that has
been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent
advances — including the use of echocardiographic diagnosis in those with ARF and in screening
for early detection of RHD, progress in developing group A streptococcal vaccines
Maternal Immunization with Tdap Vaccine Dr. Sharda Jain Lifecare Centre
Maternal
Immunization
with Tdap Vaccine
Agenda
Pertussis:Key facts & Epidemiology
Who is at risk?
Source of Pertussis infection
What is Tdap vaccine?
Recommendations for Maternal Immunization with Tdap vaccine
Safety data on Maternal Immunisation with Tdap vaccine
Summary
Update on Pertussis with special reference to QUINVAXEM in IndiaGaurav Gupta
Quinvaxem, Pertussis, Vaccine, Whooping cough, India, acellular, DTwP, DtaP, Tdap, immunization,
Update on pertussis vaccination, Is painless vaccine better than the standard wP vaccine?
Designing vaccines for specific populations and germs - Slides by Professor E...WAidid
The presentation given by Professor Susanna Esposito at ECCMID 2019. A view on vaccines recommendations, combined vaccinations and impact of vaccination practices in the eradication of major infectious diseases.
To learn more, please visit www.waidid.org
Influenza vaccination and prevention of antimicrobial resistance - Slides by ...WAidid
The lecture presented by Professor Susanna Esposito at AMR 2019 on influenza vaccination and abuse of available antimicrobials.
To learn more, please visit www.waidid.org.
POINT-of-IMPACT testing. A European perspective - Bert NiestersWAidid
At SoGat meeting 2019 Bert Niesters - Professor in Molecular Diagnostic in Clinical Virology, Medical Molecular Microbiologist at University Medical Center Groningen, Department of Medical Microbiology, Division of Clinical Viroloy, The Netherlands - has talked about the developing trends in molecular diagnostics and the impact on the Laboratory.
To learn more, please visit www.waidid.org!
Measles and its prevention - Slideset by professor EdwardsWAidid
In this study Professor Kathryn M. Edwards (Sarah H. Sell and Cornelius Vanderbilt Professor - Division of Pediatric Infectious Diseases - Vanderbilt University Medical Center) provides an update on measles and its prevention.
To learn more, please visit www.waidid.org!
Is the use of antibiotics necessary in the treatment of diarrhoea?WAidid
Slide set presented by professors Per Ashorn (Finland) and Miguel O'Ryan (Chile) at the International Pediatric Association Congress in Panamá City, on March 18th.
To learn more, please visit www.waidid.org!
Are we running out of antibiotics? - Slideset by Professor EspositoWAidid
How does antibiotic resistance happen?
This work, edited by the professor Susanna Esposito, tries to answer this question underlining the importance of prescribing the right drug with the right dose and duration, to avoid any kind of abuse that may cause or increase antibiotic resistance.
To learn more please visit www.waidid.org
Mandatory vaccinations: the italian experience - Slideset by Professor EspositoWAidid
Every year 2.5 million lives are saved by vaccines. In this slideset Professor Susanna Esposito gives an overview on the vaccine coverage in Italy, including the latest laws on mandatory and recommended vaccines.
To learn more please visit www.waidid.org
Efficacy differences between PCV10 and PCV13 - Slideset by Professors Esposit...WAidid
This slideset edited by Professors Esposito, Palmu, De Wals and Sanders for the Second WAidid Congress present some studies that compare in different countries (including Finland, Sweden, Quebec and the Netherlands) efficacy differences between PCV10 and PCV13.
To learn more please visit www.waidid.org
Efficacy and safety of immunomodulators in pediatric age - Slideset by Profes...WAidid
«The first cause of recurrent infections in children is... childhood itself.» (J. Gary Wheeler)
Is it possibe to treat and prevent recurrent respiratory infections (RTIs) in pediatric age? Some studies have shown that immunostimulants/immunomodulators can reduce and prevent RTIs in children.
To learn more please visit www.waidid.org
Vaccination in immunosuppressed adults - Slideset by professor Katie FlanaganWAidid
Immune compromised persons are generally at increased risk of morbidity and mortality from many vaccine preventable diseases, but since many vaccines, especially the live ones, are contraindicated in many immunocompromising situations, the degree of patients' impairment should be assessed each time in order to determine the best vaccination strategy...
To learn more, please visit www.waidid.org.
Potential advantages of booster containing PCV regimen - Professor Shabir MadhiWAidid
This slideset, realized by Professor Shabir Madhi on the occasion of the 11th ISPPD held in Melbourne last April, evaluates the potential advantages of booster containing PCV dosing schedule.
To learn more, visit www.waidid.org!
Lymphogranuloma venereum - Professor Ivan HungWAidid
In the following slides, professor Ivan Hung (WAidid board member) report a case of Lymphogranuloma Venereum and a short review of its possible source of infection, in order not to understimate the risk of infections, mainly in promiscuous behavioural context.
To learn more, visit www.waidid.org.
Bacterial and bacterial-like sepsis in children - Susanna Esposito WAidid
How to detect and prevent bacterial and bacterial-like sepsis in children and adolescents? Professor Susanna Esposito presents in this slideset data on epidemiology, etiology and mortality rates of pediatrical sepsis, and then discusses the possible treatment and the more efficient way of preventing the burden of pediatric sepsis.
To learn more, visit www.waidid.org.
Guidelines on the management of cystic fibrosis in the adult - Professor Fran...WAidid
Forecasts for 2025 in 16 European countries indicate that the number of cystic fibrosis patients will increase by 50% and the number of CF adults will increase by 75%. The transition from a child service to an adult service is crucial, that's why - suggests Professor Blasi (Milan, Italy) in his slideset - there's a strong need to supply a continuing medical education to healthcare workers dealing with CF and to rethink more adequate structures.
To learn more, please visit www.waidid.org!
Katie Flanagan - Malaria vaccines current status and challengesWAidid
Vaccines are considered the most cost-effective means of control, prevention, elimination, eradication of infectious diseases: for this reason, a malaria vaccine would greatly assist in the drive to eradicate malaria from the world. Professor Flanagan presents in this slideset the current status and challenges of developing malaria vaccines.
To learn more, visit www.waidid.org!
New perspectives in the treatment of multidrug-resistant tuberculosis - Profe...WAidid
The slideset offers an overview of MDR-TB: the epidemiology, the efficacy of the available treatments, and the new perspectives in the management of the pathology.
The slideset underlines, moreover, the existence of a free cost online instrument developed by ERS together with WHO to help clinician from all Europe to manage difficult-to-treat TB cases: TB Consilium.
Indicators of acute otitis media severity - Prof. Tal MaromWAidid
The slideset of professor Marom investigates the possibility and ways to establish the severity of AOM and focuses on the differences between pneumococcal vs non-pneumococcal AOM.
FInd more on www.waidid.org
The role of macrolide in the era of antimicrobial resistance - Professor Susa...WAidid
The slideset by Professor Esposito is about the emerging antimicrobial resistance and the role of macrolide in this context. The slides focus on Mycoplasma pneumoniae and macrolide resistance, explaining the practical implications for real life.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The importance of pertussis booster vaccine doses throughout life - Slideset by Professor Susanna Esposito
1. THE IMPORTANCE OF PERTUSSIS
BOOSTER VACCINE DOSES
THROUGHOUT LIFE
Susanna Esposito
Pediatric Clinic, University of Perugia
Perugia, Italy
2. Agenda
Global burden of pertussis
Impact of pertussis in infants, adolescents and adults
Reservoir of Bordetella pertussis and disease
transmission
Conclusions
3. Pertussis ‒ The Global Problem
Remains endemic worldwide
Estimated 20‒50 million cases and 300 000 deaths each year1-3
Major public health problem, even in countries with
sustained high vaccination coverage4
Incidences (2/100,000) in Japan to 124/100,000 in Switzerland)1,5
Vaccination has reduced the global burden of pertussis by
over 90% compared to the pre-vaccine era6
However, major pertussis epidemics have been reported over
the last decades in many countries, including Europe, Japan,
North and South America, Australia and New Zealand1‒11
1. Celentano LP, et al. PIDJ 2005;24:761–5. 2. Crowcroft NS, Pebody RG. Lancet 2006;367:1926–36. 3. WHO. WHO-recommended surveillance standard of pertussis.
Available at: http://www.who.int/immunization_monitoring/diseases/pertussis_surveillance/en/ (last accessed April 2013). 4. Tan T, et al. PIDJv2005;24:S10–18. 5. Sato Y &
Sato H. Biologicals 1999;27:61‒69; 6. Wkly Epidemiol Rec 2010;85:385‒400. 7 Sato H, Sato Y. Clin Infect Dis 1999;28(suppl 2):S124–30. 8. Kamiya H, et al. EID
2012;18:1166‒1169. 9. Hozbor D, et al. J Infect 2009;59:225–31. 10. Hellenbrand W, et al. BMC Infect Dis 2009;9:22. 11. Grant CG & Reid S. NZ Med J 2010;123:46 ‒61
4. Global incidence of pertussis is decreasing as vaccination
coverage increases
0
10
20
30
40
50
60
70
80
90
0
500000
1000000
1500000
2000000
2500000
1980
1990
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Number of cases WHO/UNICEF estimate
Numberofcases
Vaccinationcoverage(%)
(3primaryDTPdoses)
WHO IVB 2010 http://whqlibdoc.who.int/hq/2010/WHO_IVB_2010_eng.pdf (accessed July 2011)
1980:
• almost 2 million reported cases
• low (~20%) vaccination coverage
2009:
• 106K reported cases
• high (~80%) vaccination coverage
Number of reported cases
5.
6. Pertussis Morbidity and Mortality in Infants
Highest incidence of morbidity and mortality consistently in infants
< 6 months of age who are too young to have completed their primary
immunization series
Of the estimated 300 000 deaths yearly worldwide, most are in young infants;
90% in developing countries with case-fatality rates estimated to be as high
as 4% of infants < 12 months of age
Highest complications and hospitalization rate (70%)
Annually since 1990, 93‒100% of pertussis-related deaths in the US have
occurred in < 4 months of age
The number of deaths being reported in the infant population has been
steadily rising since the 1980s
Broder et al. MMWR 2006; 55(RR03); 1-34. Celentano LP, et al. Pediatr Infect Dis J 2005;24:761–5. Crowcroft NS, Pebody RG. Lancet 2006;367:1926–36. WHO. WHO-
recommended surveillance standard of pertussis. Available at: http://www.who.int/immunization_monitoring/diseases/pertussis_surveillance/en/ (Accessed April 2013).
California Department of Public Health, Immunization Branch. Available at: http://www.immunizeca.org/wp-content/uploads/2011/01/CDPH_Pertussis_Pertussis_task_force_1-
11-2011.pdf (Accessed May 2013). MMWR 2002;51:73‒76. MMWR 2002;51:616-619. Vitek CR, et al. Pediatr Infect Dis J 2003;22:628‒634
7. Age (years)
Region 0–4 5–14 15–59 ≥60 Total
African Region 83,586 0 135 27 83,748
Region of the Americas 2,356 0 1 3 2,360
Eastern Mediterranean
Region
18,904 0 0 2 18,906
European Region 121 0 2 3 126
South-East Asia Region 89,385 0 0 0 89,385
Western Pacific Region 580 0 1 8 589
World 194,931 0 139 43 195,113
WHO Global Health Observatory Data Repository http://apps.who.int/ghodata/?vid=10015 (accessed July 2011)
The greatest number of pertussis deaths
occur in infants and young children
Estimated pertussis deaths per region and age-group in 2008
The highest pertussis mortality is in infants/young children
8. Complications of Pertussis in Children
4 Years of Age in the US, 1997‒2000
Age Hospitalization Pneumonia Seizures Encephalopathy Death
No. with
Pertussis
< 6 M 4,543 847 103 15 56 7,203
6‒11 M 301 92 7 1 1 1,073
1‒4 Y 324 168 36 3 1 3,137
CDC. MMWR 2002;51(4):73‒76
9. Department of Health Sciences
University of Florence
Risk factor for death
- Lack of pertussis vaccination,
- premature birth,
- low birth weight,
- younger age
- higher peak leukocytosis
- Early antibiotic treatment
WBC> 70 400/μl was particularly predictive,
especially if birth weight was low
a rapid increase in pulse and respiratory
rates was associated with death risk
while leukocytosis may just be a
marker of Ptx activity, Ptx inhibition of
inhibitory G protein signaling affecting
heart and lung function may be the
proximate cause of death.
Risk factors associated with infant deaths from
pertussis: a case-control study
Winter K. Clin Infect Dis 2015;61:1099–1106.
10. Preterm and LBW infants are at increased risk of infection and
hospitalisation from vaccine preventable diseases1
Disease Increase in risk for preterm infants
Invasive
pneumococcal
disease
Rotavirus
gastroenteritis
Influenza
Pertussis
2x hospitalisation in preterm vs full term infants2
infection in very preterm (<32 weeks) infants4
9x
severe disease in preterms6
hospitalisation in LBW/VLBW infants1,5
2.6x
2.5x
severe disease with a history of prematurity3
5x
1. Gagneur A et al. Hum Vaccin Immunother 2015;11:2556–2563; 2. Riise OR et al. Pediatr Infect Dis 2017;36:e151–e156; 3. Marshall H et al. Pediatr Infect Dis 2015;34:339–345; 4. Shinefield H et al. Pediatr Infect Dis J 2002;21:182–186;
5. Newman R et al. Pediatrics 1999;103:E3; 6. Garcia M et al. Epidemiol Infect 2015;143:2939–2949 1
0
11. Pertussis is shifting to older children and adults: Europe 1998–
2007
Adapted from Zepp et al. Lancet Infect Dis 2011:11;557–70 (Derived from EUVAC NET data: http://www.euvac.net/graphics/euvac/pdf/pertussis1.pdf and
http://www.euvac.net/graphics/euvac/pdf/pertussis2.pdf)
<1 year 1–4 years 5–9 years 10–14 years ≥15 years
42% in ≥15 year olds
1998
1999
2000
2001
2002
2003–2007
0% 20% 40% 60% 80% 100%
~15% in ≥15 year olds
12. Age group
Clinical
characteristic
Adolescents (%)
(10‒19 years)
Adults (%)
( 20 years)
Paroxysms 82–100 74–100
Whoop 30–67 8–82
Apnea 19–86 29–92
Cyanosis 6–15 0–12
Vomiting 45–71 10.5–70
Hospitalization 1.4–7.5 3.5–5.7
Clinical Symptoms of Pertussis in Adolescents and
Adults
1.Aoyama T, et al. AJDC 1992;146:163‒166; 2. Farizo KM, et al. Clin Infect Dis1992; 14:708‒719; 3. Postels-Multani S, et al. Infection1995;23:139‒142; 4. Schmitt-Grohé, et al.
Clin Infect Dis 1995;21:860‒866; 5. Trollfors B & Rabo E. Br Med J Clin Res Ed 1981;283:696‒697.; 6. Yih WK, et al. J Infect Dis 2000;182:1409‒1416; 7. DeSerres G, et al. J
Infect Dis 2000;182:174‒179
13. Pertussis Transmission to Young Infants
Prospective international multicenter study
of laboratory confirmed pertussis cases in
≤ 6 M and their household and non-
household contacts – France, Germany,
US, Canada
95 index cases and 404 contacts – source
case was identified for 61.5% of index
cases
mean age of the infant index case was
2.9 M (35 - < 2 mos; 38 - 2 to 3 mos; 22 - 4 to 6
mos)
Wendelboe AM, et al. Pediatr Infect Dis J 2007;26:293-299
Source cases
Parents
55%
Siblings - 16%
Aunts/
Uncles - 10%
Friends/
Cousins - 10%
Grandparents - 6%
Part-time
caregivers
2%
14. Pertussis incidence and mortality is underestimated and
underreported
Pertussis burden is likely to be underestimated due to:1
1. Lima et al. The Burden of Pertussis in the Asia-Pacific Region. ESPID 2010;
2. Cherry Pediatr Infect Dis J 2006;25:361–2; 3. Stefanoff et al. ESPID 2011 abstract
Low disease
awareness
Limited facilities
for laboratory
analysis
No common
case-definition
Lack of surveillance
data
Few reliable
reporting systems
In general the actual incidence of pertussis could be 40–160-fold higher than
official figures2,3
15. Diagnosis of Pertussis: time sequence
Cough 3 weeks 4 weeks
culture and PCR
PCR and
serologic
tests
serologic tests
16. The development of less reactogenic Pa vaccines replaced Pw products in most
developed countries to address concerns about Pw-associated adverse events1
Acellular pertussis vaccines contain selected components of B. pertussis that play an
important role in the pathogenesis of the disease1
– These vaccines contain a limited number of B. pertussis proteins; some contain one
pertussis component, whereas some contain as many as five1
Acellular pertussis vaccines
Acceptance
by parents
and
physicians
Improved
compliance
with
vaccination
programmes
Increased
vaccination
coverage
Better
disease
control
DTPa, diphtheria-tetanus-acellular pertussis; DTPw, diphtheria-tetanus-whole-cell pertussis
1. Poolman & Hallander. Expert Rev Vaccines 2007; 6: 47–56
17. 0
50,000
100,000
150,000
200,000
250,000
300,000
Numberofcases
Year
CDC, National DiseasesSurveillance System Reported Pertussis
Cases: 1922‒2012*
0
10,000
20,000
30,000
40,000
1990 1995 2000 2005 2010
Tdap
DTaP
*2012 data are provisional
SOURCE: CDC, National Diseases Surveillance System (NNDSS) and Supplemental Pertusssis Surveillance System and 1922-1949, passive reports to the Public Health
Service. NNDSS, National Notifiable Diseases Surveillance System. http://www.cdc.gov/pertussis/surv-reporting.html (last accessed May 2013)
1922 1930 1940 1950 1960 1970 1980 1990 2000 2012
DTP
18. Vaccination with DTPa has been effective at
reducing pertussis disease as observed by impact
data in Sweden
In Sweden, the impact of the pertussis vaccination programme was regained by
DTPa vaccination
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Cases,per100000
0
50
100
150
200
250
300
350
DTPw DTPa
Year
DTPw, diphtheria-tetanus-whole-cell pertussis
Rohani et al. Science 2010; 330: 982–5 (Figure reproduced with permission)
19. Pertussis vaccines have been shown to be efficacious in a
number of trials against WHO-defined typical pertussis
0
10
20
30
40
50
60
70
80
90
100
Absolutevaccineefficacy;%,95%CI
Stockholm
1986
Stockholm
1992
Italy
1992
G’burg
1991
Senegal
1990
Erlangen
1991
Mainz
1992
Munich
1993
2
w
w
w
w
5–11 m, then
8–12 weeks
later
2,4,6 m 2,4,6 m 2,4,6 m 3,4,5 m
3,5,7 &
17 m
3,5,7 &
15-24 m
X acP – n-component acellular pertussis vaccine
w wcP – whole-cell Pertussis vaccine
Vaccination schedule
Household
contact
study
Randomised controlled trials
1
w w
1
4
2
2
2
3 3
3
4
Minimum observed mean efficacy of
3-component vaccines
Open-label, non-
randomised trial
3,5
&
12 m
Partially randomised
trialsa
GSK formulation
DTPa vaccines have similar efficacy and effectiveness following infant
vaccination as compared with that of DTPw, with fewer side effects1
aRandomised for relative risk of DTPa vs DTP
CI, confidence interval; DTP, diptheria-tetanus-pertussis; DTPa, diptheria-tetanus-acellular pertussis; G’Burg, Gothenburg; M, months
Edwards & Decker, In: Vaccines. 2008: 467–517
20. Department of Health Sciences
University of Florence
Pertactin-negative Bordetella pertussis
strains: evidence for a possible selective
advantage.
2- to 4-fold greater odds of having PRN– B.
pertussis when fully vaccinated according to
schedule
vaccinated persons have greater susceptibility to
PRN– strains compared with PRN+ strains.
Martin SW. Clin Infect Dis 2015;60:223-227.
87% of 2012 isolates included in our
analysis were pertactin-deficient
21. Department of Health Sciences
University of Florence
Loconsole D. Pediatr Infect Dis J. 2017 Sep 21. [Epub ahead of print]
Resurgence of Pertussis and Emergence of the
Ptxp3 Toxin Promoter Allele in South Italy.
The hypervirulent strain was also found in vaccinated
people. This suggests bacterial adaptation to the vaccine
and raises questions about acellular vaccine effectiveness
Of the 661 cases recorded in 2006-2015, 80.3% required hospitalization;
of these, 45.4% were aged <1 year. Of the 80 sequenced samples, the
allelic profile ptxA1-ptxP3-prn2 was detected in 74.
22. Number of paediatric pertussis cases by age and
vaccination status: California, 2010
0
200
400
600
800
1000
1200
1400
1600
Cases
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
6 doses
5 doses
1-4 doses
0 dose
Age in years
Winter K, et al. J Pediatr. 2012; 161: 1091–6
Figure reproduced with permission from Mosby Inc.
23. 18.7% positivity for Bordetella
pertussis in children 7-17 years
old with chronic cough
Principi N et al., J Med Microbiol 2017
25. Department of Health Sciences
University of Florence
100 children
Antibody responses to pertussis toxoid
were undetectable in 49% of children at
the 5 year follow up visit,
responses were predicted to be
undetectable in 69% (95% CI 45–88%) of
children by the time of their teenage
booster at 13–14 years of age.
Vorsey M. Vaccine 2016;34:4221-8
The predicted persistence and kinetics of antibody
decline 9 years after pre-school booster vaccination in
UK children.
27. Department of Health Sciences
University of Florence
Underimmunization drives community outbreaks of
pertussis.
Long SS. J Pediatr 2017;183:3. Robinson SG. J Pediatr 2017;183:159-63
hypothesized that
during a widespread
pertussis outbreak in
Oregon in 2012,
spread of infection
between communities
was driven by social
networks of people
less likely to
immunize their
children. They further
posited that if this
hypothesis was
correct, cases of
pertussis among the
underimmunized
would be expected to
cluster in the early
stages of an outbreak.
Results showed that unimmunized and underimmunized cases
had calendar onset of disease 41 days earlier than fully or
mostly immunized cases
351 pertussis cases in children 2 months - 10 years
childhood cases of pertussis can be proxies or signals
for pertussis disease within the social networks in which
children or their families are located
28. Department of Health Sciences
University of Florence
all adolescents and adults receive the Tdap
vaccine to replace the scheduled tetanus and
diphtheria toxoids vaccine (Td) booster
all people who have or anticipate having
close contact with infants <12 months of age
receive a single dose of Tdap,
all immediately postpartum women who have
not previously received a Tdap vaccine
receive a dose prior to leaving the hospital.
Recommendations have now been
expanded to routinely immunize all
adults 65 years of age and older
with a single dose of Tdap;
administer a booster dose of Tdap
with each pregnancy, regardless
of interval between pregnancies,
ideally after the 20th week of
gestation.
29. Pertussis incidence, British Columbia
0
20
40
60
80
100
120
140
160
2003 2006
15–19 year olds
10–14 year olds
Pertussisincidence
(casesper100,000))
-84%
-84%
Greenberg et al, Pediatr Infect Dis J 2009; 28: 521–8
30. dTpa elicited a robust increase in pertussis
antibodies when administered as a decennial booster
Australia1 Finland2
1. Booy et al. Vaccine 2011; 29: 45–50
2. Mertsola et al. Clin Infect Dis 2010; 51: 656−62 *Data are presented for group originally vaccinated with dTpa
Seropositivity
threshold
(5 El.U/mL)
In both studies, the decennial booster was generally well tolerated
AntibodyGMCs(El.U/mL)(log)
with95%CIs*
Ambro/FreeDigitalP
hotos.net
31. Cost-effectiveness of Adult Pertussis Vaccination
A German model has suggested that an adult pertussis
vaccination program would be cost effective
A one-time adult vaccination strategy would prevent 498,000 cases
A decennial adult vaccination strategy would prevent 1 million
cases
The programs would cost
€366 million and €687 million, respectively
€160 and €200 per case prevented, respectively
Lee GM, et al. Vaccine 2008;26(29–30):3673–9
32. Countries with cocooning recommendations
1. Australian Immunisation Handbook 9th edition 2008; Part 2.3.2, available from: http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-
specialgroups (accessed June 2011); 2. Kinkhoest (pertussis) – vaccinatie. Available from: http://www.zorg-en-gezondheid.be/Ziektes/Vaccinaties/Vaccins-A-Z/Kinkhoest-
%28pertussis%29---vaccinatie/ (accessed June 2011; 3. Haut conseil de la santé publique. Bulletin Épidémiologique Hebdomadaire 2009;16–17:46–76; 4.
Impfempfehlungen der Ständigen Impfkommission am Robert Koch-Institut/Stand: Juli 2010. Epidem Bull 2010;30:279–98; 5. New Zealand Ministry of Health
Immunisation Handbook 2011; Ch 6; 6. CDC. MMWR 2011;60:13–5; 7. http://www.cdc.gov/vaccines/recs/provisional/default.htm (accessed August 2011); 8. WHO
vaccination schedule, available from: http://apps.who.int/immunization_monitoring/en/globalsummary /ScheduleSelect.cfm (accessed June 2011)
Country with
cocooning
recommendatio
n
Country without
cocooning
recommendation
33. Department of Health Sciences
University of Florence
Hasala,2008 the results of neonatal
vaccination with DTaP vaccine in 50 infants
between 2 to 14 days of age. The
administration of an additional dose at birth
was safe and well tolerated, but was
associated with lower geometric mean
antibody concentration for toxin and pertactin
fimbrae, diphtheria
efficacia del vaccino della
vaccinati alla nascita [n: 45]
età anti-PT anti-FHA anti-PRN
3 mesi 8.7 4.3 13.0
5 mesi 41.2 29.4 70.6
6 mesi 60.9 39.5 82.6
12 mesi 87.5 42.5 85.0
Belloni C et al. Pediatrics 2003; 111: 1042-1045
pertosse somministrato alla nascita
Vaccination in the neonates
35. Department of Health Sciences
University of Florence
total of 21 studies were included in this review.
OR 0.47 to 1.50 for preterm birth (less than 37 weeks of gestation)
0.65-1.00 for small for gestational age (birth weight less than the 10th percentile)
0.36-0.85 for stillbirth
0.16-1.00 for neonatal death
0.76-1.20 for low birth weight (less than 2,500 g)
0.20-0.91 for congenital anomalies
All lower 95% confidence intervals (CIs) were less than 1.0.
Of three retrospective studies assessing chorioamnionitis after vaccination, one showed a
small but statistically significant increase.
Safety of Tetanus, Diphtheria, and Pertussis Vaccination
During Pregnancy: A Systematic Review.
McMillan M. Obstetrics & Gynecology 2017; 129:560-73
36. Department of Health Sciences
University of Florence
What determines uptake of pertussis vaccine in
pregnancy? A cross sectional survey in an ethnically
diverse population of pregnant women in London.
Donaldson B. Vaccine 2015;33: 5822–8
Awareness of the programme was 63% (126/200) with actual uptake of the vaccine only
26.0% (52/200).
34.0% (68/200) of women were offered the vaccine at their GP practice, only 24% reported
a meaningful discussion with their GP about it
Feeling uninformed, lack of professional encouragement and uncertainties of risk and
benefit of the vaccine were the greatest barriers to uptake.
37.
38. Conclusions
Pertussis remains a major public health problem especially in
adolescents and adults where the incidence of disease is increasing and
causing a substantial disease burden
Most infants are infected by an adolescent or adult contact
Development of improved surveillance systems and recognition of
adolescent and adult pertussis disease is needed
In order to control spread of disease, vaccine strategies focused on
increasing vaccination rates in the adolescent and adult populations are
critical
Educational interventions are required for HCW and patients to increase
awareness of adolescent and adult pertussis disease and importance of
Tdap vaccination