Vaccinations pertussis

Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The... 

A feature that is common to vaccines, immunosera and human immunoglobulins is the maiked specificity of their actions. Each provides immunity to only one infection. This specificity has led to the development of vaccines and immunosera with several different components such as are present in the widely used diphtheria/tetanus/pertussis vaccines that are used to prevent the infectious diseases that commonly afflict infants and young children. 

Adsorption. The adsorption of the components of a vaccine on to a mineral adjuvant. The mineral adjuvants, or carriers, most often used are aluminium lydroxide, aluminium phosphate and calcium phosphate and their effect is to increase the immunogenieity and decrease the toxicity, local and systemic, of a vaccine. Diphtheria vaccine, tetanus vaccine, diphtheria/tetanus vaccine and diphtheriaAetanus/pertussis vaccine are generally prepared as adsorbed vaccines. 

The single-component bacterial vaccines are listed in Table 15.1. For each vaccine, notes are provided of the basic material fkm which the vaccine is made, the salient production processes and tests for potency and for safety. The multicomponent vaccines that are made by blending together two or more of the single component vaccines are required to meet the potency and safety requirements for each of the single components that they contain. The best known of the combined bacterial vaccines is the adsorbed diphtheria, tetanus and pertussis vaccine (DTPerWac/Ads) that is used to immunize infants, and the adsorbed diphtheria and tetanus vaccine (DTWac/Ads) that is used to reinforce the immunity of school entrants. 

Notes Diphtheria and whooping cough vaccines are seldom used as single-component preparations but as components of diphtheria/tetanus vaccines and diphtheria/tetanus/pertussis vaccines. A combined diphtheria/tetanus/pertussis/Hib vaccine is available. 

Public confidence in the safely of vaccines and immunization procedures is essential if compliance is to match the needs the community. In this respect public concern and anxiety, in the mid 1970s, over the peroeived safety of pertussis vaccine led to a reduction in coverage of the target group from ca. 80% to ca. 30%. Major epidemics of whooping-cough, with over 100000 notified cases, followed in 1977/1979 and 1981/83. By 1992, public confidence had returned, coverage had increased to 92% and there were only 4091 reported cases. 

The primary course of DTP protection consists of three doses of a combined vaccine, each dose separated by at least 1 month and commencing not earlier than 2 months of age. In such combinations the pertussis component ofthe vaccine acts as an additional adjuvant for the toxoid components. Monovalent pertussis and tetanus vaccines, and combined vaccines lacking the pertussis component (DT) are available. If pertussis vaccination is contraindicated or refused then DT vaccine alone should be offered. The primary course of pertussis vaccination is considered sufficient to confer life-long protection, especially since the mortality associated with disease declines markedly after infancy. The risks associated with tetanus and diphtheria infection persist... 

In the 1940s, diphtheria toxoid was combined with tetanus toxoid and whole cell pertussis vaccines, and later with the acellular pertussis vaccine. The diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccine are part of the routine childhood immunization schedule. Diphtheria toxoid is also combined with tetanus toxoid and is commonly used as a booster vaccine. The pediatric product (DT) has a higher amount of diphtheria toxoid than does the adult product (Td). Diphtheria toxoid is not available as an individual vaccine. 

The first pertussis whole cell vaccine was a mixture of killed organisms that was associated with frequent local and systemic reactions. In the late 1980s, an acellular pertussis vaccine was introduced that contains purified pertussis components that are immunogenic but associated with fewer adverse reactions. Acellular pertussis vaccine is available in combination with tetanus and diphtheria toxoids. Pertussis is not available as a separate vaccine component. In the spring of 2005, the Food and Drug Administration (FDA) approved tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines for use in adolescents and adults. 

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) is recommended as a single booster for the following groups in place of a tetanus booster. 

The whole cell pertussis vaccine has been highly associated with temperature elevations however, the prevalence has significantly decreased since the introduction of the acellular pertussis vaccine. Live virus vaccines are also associated with fever. 

Table 13.6 Some traditional vaccine preparations that find medical application. In addition to being marketed individually, a number of such products are also marketed as combination vaccines. Examples include diphtheria, tetanus and pertussis vaccines and measles, mumps and rubella vaccines...

General contraindications to vaccine administration include a history of anaphylactic reaction to a previous dose or an unexplained encephalopathy occurring within 7 days of a dose of pertussis vaccine. Immunosuppression and pregnancy are temporary contraindications to live vaccines. Whenever possible, transplant patients should be immunized before transplantation. Live vaccines generally are not given after transplantation. 

In children, primary immunization against tetanus is usually done in conjunction with diphtheria and pertussis vaccination using DTaP or a combination vaccine that includes hepatitis B and polio vaccines. A 0.5-mL dose is recommended at 2, 4, 6, and 15 to 18 months of age. 

Acellular pertussis vaccine is usually administered in combination with diphtheria and tetanus toxoids (as DTaP). 

The primary immunization series for pertussis vaccine consists of four doses given at ages 2, 4, 6, and 15 to 18 months. A booster dose is recommended at age 4 to 6 years. Adults up to age 64 should receive a pertussis-containing vaccine with their next tetanus vaccine. 

This varies from occasional mild symptoms with rubella and measles vaccines to possible brain damage with pertussis vaccine. 

Acel-Imune Diphtheria, tetanus toxoids acellular pertussis vaccine Jan. 6, 1992 Takeda Chemical Industries /American Cyanamid... 

The strength may be in terms of total protective units per milliliter or per dose (e.g., pertussis vaccine). This is the number required to protect the body from a lethal dose of the organism. 

Pertussis vaccine is intended for infants and children 6 weeks through 6 years at 16 protective units (PU) administered over four injections for active immunization. Calculate how many milliliters of injection are required for each administration if the vaccine is supplied at a dose of 60 PU/7.5 mL vial. 

The tri-immunal preparation from Wyeth-Ayerst contains 6.7 Lf units of diphtheria toxoid, 5 Lf units of tetanus toxoid, and 4 protective units of pertussis vaccine in each dose of 0.5 mL. In a 7.5-mL dosage form of the tri-immunal preparation, how many Lf units of diphtheria toxoid are present ... 

In the above preparation, how many Lf units of pertussis vaccine are present ... 

It has been known for some time that mice receiving injections of pertussis vaccine develop a very high sensitivity to histamine poisoning. In Table 16 are given the total deaths divided by the total number of mice injected with histamine at different levels for five different strains of mice.3 5 The most marked resistance is shown by the CF strain which has not been rendered materially susceptible to histamine by the pertussis vaccine. The LD50 for this treated strain is about 200 times that for the TF strain. It should be noted that there are intrastrain differences also. For example, in the BF strain, 2 animals out of 10 were killed with 0.125 mg. of histamine, whereas 5 out of 10 survived a dosage 64 times as high. This shows that for different individual mice within this strain differences in the amounts of histamine required to kill may be of the order of 100-fold. 

Histamine Poisoning in Pertussis Vaccine Treated Mice... 

Examples of killed or inactivated vaccines are cholera vaccine containing dead strains of Vibrio cholerae, hepatitis A vaccine with inactivated hepatitis A virus, pertussis vaccine with killed strains of Bordetella pertussis, typhoid vaccine with killed Salmonella typhi, and influenza vaccine with various strains of inactivated influenza viruses (see Exhibit 4.2 for a discussion of influenza viruses and vaccines and Exhibit 4.3 on avian influenza H5N1). 

Pauwels, R., van der Straeten, M., Platteau, B., and Bazin, H. (1983) The non-specific enhancement of allergy. In vivo effects of Bordetella pertussis vaccine on IgE synthesis. Allergy. 38, 239-246. 

Olin, P., Rasmussen, F., Gustafsson, L., Hallander, H.O., and Heijbel, H. (1997) Randomised controlled trial of two-component, three-component, and five-component acellular pertussis vaccines compared with whole-cell pertussis vaccine. Ad Hoc Group for the Study of Pertussis Vaccines. Lancet. 350, 1569-1577. 

In a study of the mechanism whereby BordeteUa pertussis vaccine increased acute ozone toxicity in rats, Thompson ascribed the effects to /3-adrenergic blockade, and not to an immune-mediated response. It was further noted that both atropine and reserpine reduced mortality, whidi suggested that the acute lethal effects of ozone were due to shock and circulatory collapse, rather than pulmonary edema. 

Thompson, G. E. Experimental acute pulmonary edema in the rat. Effect of Bordetetta pertussis vaccine on ozone mortality. Arch. Environ. Health 23 154-160. 

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