Reasonable Rascal
09-25-02, 23:18
PERTUSSIS - USA (TEXAS)
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A ProMED-mail post
Date: Tue, 24 Sep 2002 10:16:39 -0700 (PDT)
Source: HoustonChronicle.com [edited]
<http://www.chron.com/cs/CDA/story.hts/health/1587476>
Health officials fight outbreak of pertussis
-------------------------------------
Whooping cough cases are on the rise in Texas, and health officials in Comal County are trying to stem an outbreak in which 5 children have recently come down with the disease and 5 others may have it.
"We've taken a real aggressive stance to try to keep it from getting out of control," said Comal County health nurse Karon Preiss. She said information has been sent home with schoolchildren, and doctors have been asked to be on the lookout for symptoms.
Since January 2001, 9 children in Texas have died of the disease. A total of 615 cases were reported in Texas that year, the most since 1968. This year, 766 cases already have been reported.
The number of reported cases is unusually high, according to David Bastis, a program director in the immunization division of the Texas Department of Health. "Usually we see no deaths or one death," he said.
[Byline: Roger Croteau]
--
[The number of cases and deaths in this continuing outbreak of pertussis is quite noteworthy. It would be very informative to know the age and immunization status of pertussis cases, particularly of the fatalities, as well as the entire cohort of cases. Generally, 2 different circumstances are noted: children who were never adequately immunized against pertussis and those (often older children or adolescents) in whom the immunity of the primary series they had received has waned. In both circumstances, it is common that adults with more atypical pertussis represent the reservoir to infect the children. In addition to reaching 100 percent childhood immunization, immunization of adults with the acellular pertussis vaccine, reasonably well tolerated in this group (unlike the old killed whole cell product), may be the answer.
This reference with abstract is an example of one study from Australia that demonstrated the utility of the product in adults:
Turnbull FM, Heath TC, Jalaludin BB, et al:A randomized trial of two acellular pertussis vaccines (dTpa and pa) and a licensed diphtheria-tetanus vaccine (Td) in adults. Vaccine 2000; 19:628-36
Abstract: A single blinded randomized controlled trial to compare the reactogenicity and immunogenicity of adult formulated dTpa and monovalent pa vaccines with a licensed Td vaccine. 548 healthy adults aged 19-70 years received a single injection of dTpa or separate injections of pa or Td (with the alternate vaccine 1 month later). Local and systemic reactions were monitored for 15 days after each vaccination. Serum antibody levels were measured immediately prior to and 1 month after vaccination. Antibody levels were measured 12 months after vaccination in 100 subjects. There was no difference in the total frequency of symptoms and signs between subjects receiving any of the three vaccines. There was a significantly lower incidence of local reactions following pa (60 percent) than dTpa (80 percent, P=0.002) or Td (93 percent, P=0.0008). The incidence of clinically significant (Grade 2 or 3) swelling (> or =20 mm) was higher for Td (20 percent, P=0.002) than for dTpa (11 percent) or for pa (2 percent), however, there were no other significant differences in the incidence of Grade 2 or 3 reactions between the vaccines. A high anti-pertussis seroconversion rate (>97 percent) against all the studied pertussis antigens was seen 1 month after vaccination with dTpa and pa. A total of 96 and 99 percent of subjects receiving dTpa and Td, respectively, had anti-diphtheria titres > or =0.01 IU/ml, and all but one subject had anti-tetanus titres > or =0.1 IU/ml after 1 month. Twelve months after vaccination the majority (90-100 percent) of the subjects were still seropositive for each antigen and although GMTs had decreased they were substantially higher than pre-vaccination levels. The dTpa vaccine was well tolerated and capable of eliciting an immune response against all the antigens in a broad spectrum of the adult population and could potentially replace Td for routine boosters in adults. - Mod.LL]
[Information on the age distribution and vaccination histories of the reported cases of pertussis in Texas was not available on the Texas State Department of Health webpages on pertussis. <http://www.tdh.state.tx.us/immunize/pertussis.htm> There is mention that 30 percent of the reported cases in 2002 were in children less than 1 year of age. There was a report available online that suggested that several of the fatal cases were below one month of age and that the index case in these households was probably an adult. More information on the epidemiology of this increase in pertussis cases in Texas would be appreciated from official sources. One does wonder if the shortage of vaccine experienced in the earlier part part of this year may have contributed to this outbreak. - Mod.MPP]
**********************
A ProMED-mail post
Date: Tue, 24 Sep 2002 10:16:39 -0700 (PDT)
Source: HoustonChronicle.com [edited]
<http://www.chron.com/cs/CDA/story.hts/health/1587476>
Health officials fight outbreak of pertussis
-------------------------------------
Whooping cough cases are on the rise in Texas, and health officials in Comal County are trying to stem an outbreak in which 5 children have recently come down with the disease and 5 others may have it.
"We've taken a real aggressive stance to try to keep it from getting out of control," said Comal County health nurse Karon Preiss. She said information has been sent home with schoolchildren, and doctors have been asked to be on the lookout for symptoms.
Since January 2001, 9 children in Texas have died of the disease. A total of 615 cases were reported in Texas that year, the most since 1968. This year, 766 cases already have been reported.
The number of reported cases is unusually high, according to David Bastis, a program director in the immunization division of the Texas Department of Health. "Usually we see no deaths or one death," he said.
[Byline: Roger Croteau]
--
[The number of cases and deaths in this continuing outbreak of pertussis is quite noteworthy. It would be very informative to know the age and immunization status of pertussis cases, particularly of the fatalities, as well as the entire cohort of cases. Generally, 2 different circumstances are noted: children who were never adequately immunized against pertussis and those (often older children or adolescents) in whom the immunity of the primary series they had received has waned. In both circumstances, it is common that adults with more atypical pertussis represent the reservoir to infect the children. In addition to reaching 100 percent childhood immunization, immunization of adults with the acellular pertussis vaccine, reasonably well tolerated in this group (unlike the old killed whole cell product), may be the answer.
This reference with abstract is an example of one study from Australia that demonstrated the utility of the product in adults:
Turnbull FM, Heath TC, Jalaludin BB, et al:A randomized trial of two acellular pertussis vaccines (dTpa and pa) and a licensed diphtheria-tetanus vaccine (Td) in adults. Vaccine 2000; 19:628-36
Abstract: A single blinded randomized controlled trial to compare the reactogenicity and immunogenicity of adult formulated dTpa and monovalent pa vaccines with a licensed Td vaccine. 548 healthy adults aged 19-70 years received a single injection of dTpa or separate injections of pa or Td (with the alternate vaccine 1 month later). Local and systemic reactions were monitored for 15 days after each vaccination. Serum antibody levels were measured immediately prior to and 1 month after vaccination. Antibody levels were measured 12 months after vaccination in 100 subjects. There was no difference in the total frequency of symptoms and signs between subjects receiving any of the three vaccines. There was a significantly lower incidence of local reactions following pa (60 percent) than dTpa (80 percent, P=0.002) or Td (93 percent, P=0.0008). The incidence of clinically significant (Grade 2 or 3) swelling (> or =20 mm) was higher for Td (20 percent, P=0.002) than for dTpa (11 percent) or for pa (2 percent), however, there were no other significant differences in the incidence of Grade 2 or 3 reactions between the vaccines. A high anti-pertussis seroconversion rate (>97 percent) against all the studied pertussis antigens was seen 1 month after vaccination with dTpa and pa. A total of 96 and 99 percent of subjects receiving dTpa and Td, respectively, had anti-diphtheria titres > or =0.01 IU/ml, and all but one subject had anti-tetanus titres > or =0.1 IU/ml after 1 month. Twelve months after vaccination the majority (90-100 percent) of the subjects were still seropositive for each antigen and although GMTs had decreased they were substantially higher than pre-vaccination levels. The dTpa vaccine was well tolerated and capable of eliciting an immune response against all the antigens in a broad spectrum of the adult population and could potentially replace Td for routine boosters in adults. - Mod.LL]
[Information on the age distribution and vaccination histories of the reported cases of pertussis in Texas was not available on the Texas State Department of Health webpages on pertussis. <http://www.tdh.state.tx.us/immunize/pertussis.htm> There is mention that 30 percent of the reported cases in 2002 were in children less than 1 year of age. There was a report available online that suggested that several of the fatal cases were below one month of age and that the index case in these households was probably an adult. More information on the epidemiology of this increase in pertussis cases in Texas would be appreciated from official sources. One does wonder if the shortage of vaccine experienced in the earlier part part of this year may have contributed to this outbreak. - Mod.MPP]