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Pertussis vaccination, although effective, requires new strategies

NEW YORK — The best method to prevent infection with Bordetella pertussis is vaccination, but more information is needed about people’s immune responses to the infection and optimal vaccination strategies, according to a presentation at the Annual Infectious Diseases in Children Symposium.

Patricia Stinchfield, MS, CPNP, CIC, an infectious disease nurse practitioner and senior director of infection prevention and control at Children’s Hospitals and Clinics of Minnesota, said that prior to the introduction and routine use of pertussis vaccines in the United States in the 1940s and 1950s, pertussis was a common disease, with 157 cases per 100,000 people. The introduction of a whole-cell vaccine in 1963 led to a 90% reduction in disease by the 1970s.

The current vaccine formula, which is a killed and purified acellular vaccine, prevents approximately 85% of typical pertussis cases. However, recent findings suggested that although the pertussis vaccine is effective, its protection wanes over time.

“Using the vaccines that we have now is important, but looking ahead, there are other things that we need to do,” Stinchfield said.

Several recent studies have examined different approaches to vaccination in an attempt to improve the effect of immunization.

Stinchfield referenced a randomized clinical study published this year in JAMA Pediatrics, which evaluated the safety and immunogenicity of a monovalent acellular pertussis vaccine in young infants. The researchers of this study suggested that administering the acellular pertussis vaccine at birth could provide higher levels of pertussis antibody at ages 6 and 10 weeks and could reduce severe disease in the first 3 months of life.

Another recent study showed that infants received the highest concentrations of antibodies when their mothers were vaccinated early in the third trimester.

While other vaccine schedules are being investigated, Stinchfield stressed the importance of following the currently recommended vaccine schedule for pertussis vaccination.

“Even if we are giving a vaccine that [is not working optimally], a vaccine that is not given on schedule works even worse,” she said. “That is why we must make sure that our patients have the highest possible vaccine completion rates.” –by Katherine Bortz

References:

CDC: Morbidity and Mortality Weekly Report - Notifiable Diseases and Mortality Tables. https://www.cdc.gov/mmwr/volumes/66/wr/mm6652md.htm?s_cid=mm6652md_w.html. Accessed: December 4, 2018.

Cherry JD. Clin Infect Dis. 2016;doi:10.1093/cid/ciw550.

Stinchfield P. Stopping the whoop: When will pertussis prevention improve? Presented at: Annual Infectious Diseases in Children Symposium. Nov. 17-18, 2018; New York.

Wood N, et al. JAMA Pediatr. 2018;doi:10.001/jamapediatrics.2018.2349.

Disclosure: Stinchfield reports no relevant financial disclosures.

NEW YORK — The best method to prevent infection with Bordetella pertussis is vaccination, but more information is needed about people’s immune responses to the infection and optimal vaccination strategies, according to a presentation at the Annual Infectious Diseases in Children Symposium.

Patricia Stinchfield, MS, CPNP, CIC, an infectious disease nurse practitioner and senior director of infection prevention and control at Children’s Hospitals and Clinics of Minnesota, said that prior to the introduction and routine use of pertussis vaccines in the United States in the 1940s and 1950s, pertussis was a common disease, with 157 cases per 100,000 people. The introduction of a whole-cell vaccine in 1963 led to a 90% reduction in disease by the 1970s.

The current vaccine formula, which is a killed and purified acellular vaccine, prevents approximately 85% of typical pertussis cases. However, recent findings suggested that although the pertussis vaccine is effective, its protection wanes over time.

“Using the vaccines that we have now is important, but looking ahead, there are other things that we need to do,” Stinchfield said.

Several recent studies have examined different approaches to vaccination in an attempt to improve the effect of immunization.

Stinchfield referenced a randomized clinical study published this year in JAMA Pediatrics, which evaluated the safety and immunogenicity of a monovalent acellular pertussis vaccine in young infants. The researchers of this study suggested that administering the acellular pertussis vaccine at birth could provide higher levels of pertussis antibody at ages 6 and 10 weeks and could reduce severe disease in the first 3 months of life.

Another recent study showed that infants received the highest concentrations of antibodies when their mothers were vaccinated early in the third trimester.

While other vaccine schedules are being investigated, Stinchfield stressed the importance of following the currently recommended vaccine schedule for pertussis vaccination.

“Even if we are giving a vaccine that [is not working optimally], a vaccine that is not given on schedule works even worse,” she said. “That is why we must make sure that our patients have the highest possible vaccine completion rates.” –by Katherine Bortz

References:

CDC: Morbidity and Mortality Weekly Report - Notifiable Diseases and Mortality Tables. https://www.cdc.gov/mmwr/volumes/66/wr/mm6652md.htm?s_cid=mm6652md_w.html. Accessed: December 4, 2018.

Cherry JD. Clin Infect Dis. 2016;doi:10.1093/cid/ciw550.

Stinchfield P. Stopping the whoop: When will pertussis prevention improve? Presented at: Annual Infectious Diseases in Children Symposium. Nov. 17-18, 2018; New York.

Wood N, et al. JAMA Pediatr. 2018;doi:10.001/jamapediatrics.2018.2349.

Disclosure: Stinchfield reports no relevant financial disclosures.

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