Extensive local reactions have been reported after booster doses of diphtheria and tetanus toxoid and acellular pertussis vaccine, but few data are available on revaccination after these reactions. Of 20 children with extensive local reactions after dose 4, only 4 experienced entire upper arm swelling and 7 had swelling >5 cm after dose 5. These reactions were well tolerated and support revaccination.
"The consensus view from studies in the mouse model is that wP vaccines and 69 previous infection confer better protective immunity than aP vaccines because they induce 70 Th1 cells and associated opsonizing antibodies, with a minor contribution by Th17 cells 71 (Table 1). In contrast, the less effective aP vaccines induce a mixed Th2 and Th17 responses 72 (Ross et al., 2013), but the Th2 component appears to be redundant to protection and, together 73 with associated IgE (Ryan et al., 2000), may even be the culprits in rare type hypersensitivity 74 reactions seen in children after a 4 th or 5 th dose of the aP vaccines (Rennels et al., 2008). This 75 pattern of immune responses induced by the pertussis vaccines is generally similar in humans 76 and mice. "
[Show abstract][Hide abstract] ABSTRACT: Current acellular pertussis vaccines have various shortcomings, which may contribute to their sub-optimal efficacy and waning immunity in vaccinated populations. This calls for the development of new pertussis vaccines capable of inducing long-lived protective immunity. Immunization with whole cell pertussis vaccines and natural infection with Bordetella pertussis induce distinct and more protective immune responses when compared with immunization with acellular pertussis vaccines. Therefore, the immune responses induced with whole cell vaccine or after infection can be used as a benchmark for the development of third generation vaccines against pertussis. Here, we review the literature on the immunology of B. pertussis infection and vaccination and discuss the lessons learned that will help in the design of improved pertussis vaccines.
Pathogens and Disease 09/2015; DOI:10.1093/femspd/ftv067 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Combination vaccines allow the administration of multiple vaccine antigens without the need for multiple injections. Recently, a combined diphtheria toxoid, tetanus toxoid, acellular pertussis and inactivated poliomyelitis vaccine (DTaP-IPV), Kinrix, has been licensed in the USA for use as the fifth DTaP dose and fourth IPV dose in children 4-6 years of age. Clinical trials have shown Kinrix to be immunogenic in 4-6-year-old children, with a safety profile comparable with that of separate DTaP and IPV vaccination. The use of Kinrix reduces by one the number of injections required to provide this age group with all recommended immunizations. Strategies such as the use of combined vaccines can help to maintain high levels of coverage against diphtheria, tetanus, pertussis and poliomyelitis diseases.
[Show abstract][Hide abstract] ABSTRACT: Boostrix is a three-pertussis component, combined, reduced-antigen content tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administered as a single intramuscular dose in adolescents or adults aged 10-64 years. Large, well designed trials conducted in the US in adolescents aged 10-18 years and in adults aged 19-64 years showed that serum concentrations of anti-pertussis antibodies approximately 1 month after Boostrix administration were noninferior to those previously shown to have a protective effect in infants following a primary regimen of combined diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. Protective serum concentrations of anti-diphtheria and anti-tetanus antibodies were achieved in essentially all (>or=99.9%) adolescents randomized to receive Boostrix or tetanus and diphtheria toxoids (Td) vaccine, and Boostrix was noninferior to Td vaccine for these endpoints. Similarly high seroprotection rates against diphtheria and tetanus were demonstrated with Boostrix and a five-pertussis component Tdap booster vaccine (Adacel) in a large, randomized study in adults; Boostrix was noninferior to Adacel for these outcomes. Reactogenicity data indicate that the vaccine is generally well tolerated in terms of solicited local and general symptoms in both adults and adolescents. Moreover, the importance of single-dose booster vaccination with a Tdap vaccine (such as Boostrix) in these populations is highlighted in current immunization guidelines. Therefore, as a single-dose booster vaccine, Boostrix provides a useful option to reduce pertussis morbidity and maintain the standard of care for tetanus and diphtheria protection in individuals aged 10-64 years.
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