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Journal of the American Pharmacists... 2024Maternal immunization is an important strategy to safeguard infants against vaccine-preventable diseases such as pertussis, which poses a significant economic burden on...
Maternal immunization is an important strategy to safeguard infants against vaccine-preventable diseases such as pertussis, which poses a significant economic burden on the health care system. Although the Tetanus, Diphtheria, and Pertussis vaccine has been recommended for pregnant individuals since 2018, uptake varies widely across Canadian provinces. As 4.5 million Canadians do not have access to a regular physician, there is a need to find alternate ways of informing pregnant individuals about maternal immunization schedules. Given the wide accessibility of pharmacists across Canada, they should have a leading role in informing pregnant individuals about maternal vaccines. Training guidelines for pharmacists would ensure informative and effective conversations about vaccinations and promote vaccine safety and benefits, facilitating administration. Increased participation from pharmacists can significantly contribute to improving maternal and child health outcomes, with the goal of reducing the burden of vaccine-preventable diseases in Canada.
Topics: Humans; Pharmacists; Pregnancy; Canada; Female; Professional Role; Immunization; Vaccination; Immunization Schedule
PubMed: 38432478
DOI: 10.1016/j.japh.2024.102060 -
Microbial Genomics Dec 2023Pertussis remains a public health concern in South Africa, with an increase in reported cases and outbreaks in recent years. Whole genome sequencing was performed on 32...
Pertussis remains a public health concern in South Africa, with an increase in reported cases and outbreaks in recent years. Whole genome sequencing was performed on 32 isolates sourced from three different surveillance programmes in South Africa between 2015 and 2019. Genome sequences were characterized using multilocus sequence typing, vaccine antigen genes (, , , and ) and overall genome structure. All isolates were sequence type 2 and harboured the pertussis toxin promoter allele . The dominant genotype was 3122 (31/32, 96.9 %), with no pertactin-deficient or other mutations in vaccine antigen genes identified. Amongst 21 isolates yielding closed genome assemblies, eight distinct genome structures were detected, with 61.9 % (13/21) of the isolates exhibiting three predominant structures. Increases in case numbers are probably not due to evolutionary changes in the genome but possibly due to other factors such as the cyclical nature of disease, waning immunity due to the use of acellular vaccines and/or population immunity gaps.
Topics: Humans; Bordetella pertussis; Whooping Cough; South Africa; Pertussis Vaccine; Genomics
PubMed: 38117675
DOI: 10.1099/mgen.0.001162 -
AIDS (London, England) Feb 2024Thanks to widespread use of antiretroviral therapy worldwide, women living with HIV (WLWH) are becoming pregnant and giving birth to HIV-exposed but uninfected (HEU)... (Review)
Review
Thanks to widespread use of antiretroviral therapy worldwide, women living with HIV (WLWH) are becoming pregnant and giving birth to HIV-exposed but uninfected (HEU) newborns. Both pregnancy and HIV infection-related factors such as low CD4+ T-cell count or uncontrolled viral load increase the risk of severe infections such as influenza, COVID-19, and others, making maternal immunization a valuable tool to decrease maternal morbidity among WLWH. Vaccines administered during pregnancy may also benefit the health of HEU infants. Indeed, HEU infants suffer from higher risk of morbidity of infectious origin, including respiratory syncytial virus (RSV), group B streptococcus (GBS), pneumococcus and pertussis infections. Maternal pertussis immunization is recommended in various high-income countries but not in many low-middle income countries where HIV prevalence is higher. GBS and RSV vaccines to be administered during pregnancy are currently in late-phase clinical trials in HIV-uninfected women and could represent a valuable tool to decrease morbidity during infancy. Decreased transfer of vaccine-specific IgG, accelerated waning of vaccine-induced antibody responses, linked to persistent maternal immune activation, and blunting of infant immune response to vaccines could hamper vaccine effectiveness among WLWH and HEU infants. Vaccine hesitancy could limit benefits of maternal immunization and strategies to tackle vaccine hesitancy should be part of HIV routine care. The aim of this review is to summarize the current knowledge regarding the immunogenicity and efficacy of available and upcoming vaccines recommended during pregnancy of WLWH.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; HIV Infections; Immunization; Influenza Vaccines; Vaccination; Whooping Cough; Mothers
PubMed: 38116721
DOI: 10.1097/QAD.0000000000003758 -
Medecine Tropicale Et Sante... Dec 2023Pertussis (whooping cough) is an important cause of morbidity and mortality in infants world-wide, and continues to be a public health concern despite high vaccination...
Pertussis (whooping cough) is an important cause of morbidity and mortality in infants world-wide, and continues to be a public health concern despite high vaccination coverage. The disease, caused by bacterium is present in all countries. Before vaccines became widely available in the 1950s, pertussis was one of the most common childhood diseases worldwide. According to WHO, estimation of deaths was 4 millions/year in 1950 and 100 000/year in 2015. But morbidity remains important with a high circulation of the bacterium determining atypical clinical forms after whole cell or acellular vaccines use. This is due mainly to the absence of booster doses in adolescents and adults. Major progress are generalisation of PCR and vaccination of mother during pregnancy. A resurgence of pertussis is observed after generalisation of acellular vaccines use. In China the progression of allele was found in all areas following the use of acellular vaccine. This allele, rare before acellullar vaccine, is linked to a macrolide resistance, and reaches more than 30% of strains isolated in hospitalised children.These evolutions must be evaluated in clinical forms and genotyping of all strains, in all areas.
Topics: Adolescent; Adult; Child; Infant; Female; Pregnancy; Humans; Whooping Cough; Anti-Bacterial Agents; Drug Resistance, Bacterial; Macrolides; Vaccines, Acellular
PubMed: 38390013
DOI: 10.48327/mtsi.v3i4.2023.446 -
Journal of Medical Virology Jun 2024The scarce and conflicting data on vaccine-associated facial paralysis limit our understanding of vaccine safety on a global scale. Therefore, this study aims to...
The scarce and conflicting data on vaccine-associated facial paralysis limit our understanding of vaccine safety on a global scale. Therefore, this study aims to evaluate the global burden of vaccine-associated facial paralysis and to identify the extent of its association with individual vaccines, thereby contributing to the development of a more effective vaccination program. We used data on vaccine-associated facial paralysis from 1967 to 2023 (total reports, n = 131 255 418 418) from the World Health Organization International Pharmacovigilance Database. Global reporting counts, reported odds ratios (ROR), and information components (ICs) were computed to elucidate the association between the 16 vaccines and the occurrence of vaccine-associated facial paralysis across 156 countries. We identified 26 197 reports (men, n = 10 507 [40.11%]) of vaccine-associated facial paralysis from 49 537 reports of all-cause facial paralysis. Vaccine-associated facial paralysis has been consistently reported; however, a pronounced increase in reported incidence has emerged after the onset of the coronavirus disease 2019 (COVID-19) pandemic, which is attributable to the COVID-19 mRNA vaccine. Most vaccines were associated with facial paralysis, with differing levels of association, except for tuberculosis vaccines. COVID-19 mRNA vaccines had the highest association with facial paralysis reports (ROR, 28.31 [95% confidence interval, 27.60-29.03]; IC, 3.37 [IC, 3.35]), followed by encephalitis, influenza, hepatitis A, papillomavirus, hepatitis B, typhoid, varicella-zoster, meningococcal, Ad-5 vectored COVID-19, measles, mumps and rubella, diphtheria, tetanus toxoids, pertussis, polio, and Hemophilus influenza type b, pneumococcal, rotavirus diarrhea, and inactivated whole-virus COVID-19 vaccines. Concerning age- and sex-specific risks, vaccine-associated facial paralysis was more strongly associated with older age groups and males. The serious adverse outcome and death rate of vaccine-associated facial paralysis were extremely low (0.07% and 0.00%, respectively). An increase in vaccine-induced facial paralysis, primarily owing to COVID-19 mRNA vaccines, was observed with most vaccines, except tuberculosis vaccines. Given the higher association observed in the older and male groups with vaccine-associated facial paralysis, close monitoring of these demographics when administering vaccines that are significantly associated with adverse reactions is crucial.
Topics: Humans; Facial Paralysis; Pharmacovigilance; Male; World Health Organization; Female; Adult; Middle Aged; Adolescent; Young Adult; Databases, Factual; Child; Child, Preschool; Aged; Incidence; Vaccines; Global Health; COVID-19; Infant; Vaccination; SARS-CoV-2
PubMed: 38783823
DOI: 10.1002/jmv.29682 -
Emerging Microbes & Infections Dec 2023Immunization during pregnancy (IP) against pertussis is recommended in many countries to protect infants. Although maternal antibodies can influence the infants'...
Immunization during pregnancy (IP) against pertussis is recommended in many countries to protect infants. Although maternal antibodies can influence the infants' antibody responses to primary vaccinations, their effect on the development of functional antibodies and B cells remain poorly studied. We investigated the maternal immune response to IP and the effect of IP and pre-existing antibodies on infants' primary vaccine responses in an open-label, non-randomized trial. Forty-seven mothers received tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy, and 22 mothers were included as controls. Sixty-nine infants received primary doses of DTaP at three and five months of age. Geometric mean concentrations of antibodies to pertussis toxin, filamentous haemagglutinin, pertactin, diphtheria, and tetanus toxins, pertussis toxin neutralizing antibodies (PTNAs), and plasma and memory B-cell frequencies were studied at delivery, and at three, five and six months. Levels of antibodies, PTNAs, and frequencies of memory B-cells were significantly increased at delivery and up to six months after in mothers with IP compared to those without IP (all < 0.05, except for PT-specific memory B-cells). In vaccinated pregnant women, high pre-existing antibody levels were positively correlated with higher antibody responses after IP. IP blunted the infants' antibody and plasma B-cell responses to all vaccine antigens, except for tetanus toxin. This blunting effect was the strongest in infants with high concentrations of maternal antibodies. In conclusion, IP resulted in significantly higher concentrations of antibodies in infants up to three months of age (all < 0.05); but was associated with blunting of various infants' vaccine responses.
Topics: Humans; Infant; Female; Pregnancy; Diphtheria-Tetanus-acellular Pertussis Vaccines; Whooping Cough; Pertussis Toxin; Diphtheria; Antibodies, Bacterial; Vaccination; Immunization
PubMed: 37060181
DOI: 10.1080/22221751.2023.2204146 -
Microbes and Infection 2023Bordetella pertussis still circulates worldwide despite vaccination. Fimbriae are components of some acellular pertussis vaccines. Population fluctuations of...
INTRODUCTION
Bordetella pertussis still circulates worldwide despite vaccination. Fimbriae are components of some acellular pertussis vaccines. Population fluctuations of B. pertussis fimbrial serotypes (FIM2 and FIM3) are observed, and fim3 alleles (fim3-1 [clade 1] and fim3-2 [clade 2]) mark a major phylogenetic subdivision of B. pertussis.
OBJECTIVES
To compare microbiological characteristics and expressed protein profiles between fimbrial serotypes FIM2 and FIM3 and genomic clades.
METHODS
A total of 19 isolates were selected. Absolute protein abundance of the main virulence factors, autoagglutination and biofilm formation, bacterial survival in whole blood, induced blood cell cytokine secretion, and global proteome profiles were assessed.
RESULTS
Compared to FIM3, FIM2 isolates produced more fimbriae, less cellular pertussis toxin subunit 1 and more biofilm, but auto-agglutinated less. FIM2 isolates had a lower survival rate in cord blood, but induced higher levels of IL-4, IL-8 and IL-1β secretion. Global proteome comparisons uncovered 15 differentially produced proteins between FIM2 and FIM3 isolates, involved in adhesion and metabolism of metals. FIM3 isolates of clade 2 produced more FIM3 and more biofilm compared to clade 1.
CONCLUSION
FIM serotype and fim3 clades are associated with proteomic and other biological differences, which may have implications on pathogenesis and epidemiological emergence.
Topics: Humans; Bordetella pertussis; Whooping Cough; Serogroup; Fimbriae Proteins; Phylogeny; Proteome; Proteomics; Virulence Factors, Bordetella; Pertussis Vaccine; Fimbriae, Bacterial
PubMed: 37245862
DOI: 10.1016/j.micinf.2023.105152 -
Vaccine Nov 2023Pregnant women are generally excluded from clinical research over safety concerns. However, demands to include them in clinical vaccine development have intensified... (Review)
Review
Pregnant women are generally excluded from clinical research over safety concerns. However, demands to include them in clinical vaccine development have intensified after recent COVID-19, Ebola, and Lassa fever outbreaks given the disproportionate effect of these diseases on pregnant women and/or their foetuses. Numerous studies highlighted the scarcity of safety data for therapeutic interventions in pregnant women. Nevertheless, only a small number have assessed the number of vaccine trials including this population. Therefore, we searched for phase 3 and 4 vaccine clinical trials in healthy populations registered between 2018 and 2023 in clinicaltrials.gov and the International Clinical Trial Registry Platform. Out of 400 registered vaccine trials matching our inclusion criteria, 217 (54 %) were industry-sponsored, and 222 (56 %) had COVID-19 as a target. We found 22 studies (6 %) that either were designed for pregnant women or included them as part of a larger population. Out of these 22 trials, 13 were designed specifically for pregnant women; seven of these were maternal vaccines aiming at protecting the foetus, namely pertussis (3), Respiratory Syncytial Virus (RSV) (3), and meningitis plus tetanus (1) vaccines, and six others targeted either flu (3), COVID-19 (2) or Ebola (1). Only the RSV and Ebola vaccine trials were industry-sponsored. We also found that nine studies targeting the general population included pregnant women. These focused on COVID-19 (3), flu (2), COVID-19 + flu (2), Ebola (1), and Hepatitis B (1). None of these studies was industry-sponsored. Our findings show that a gap still exists in terms of pregnant women's inclusion in vaccine trials. Such a gap needs to be tackled urgently to minimise the devastating effects that a future infectious disease outbreak could have on this population. This study can inform future demands for increased inclusion, especially in industry-sponsored trials, as it provides an overview of the current vaccine trials scene.
Topics: Humans; Pregnancy; Female; Pregnant Women; Ebola Vaccines; Hemorrhagic Fever, Ebola; Pregnancy Complications, Infectious; COVID-19; Respiratory Syncytial Virus, Human
PubMed: 37903681
DOI: 10.1016/j.vaccine.2023.10.057 -
Human Vaccines & Immunotherapeutics Dec 2023Patients with obstructive airway diseases (OAD), like chronic obstructive pulmonary disease (COPD) and asthma, may be at increased risk of pertussis infection. Pertussis... (Meta-Analysis)
Meta-Analysis
Patients with obstructive airway diseases (OAD), like chronic obstructive pulmonary disease (COPD) and asthma, may be at increased risk of pertussis infection. Pertussis may also trigger COPD and asthma exacerbations. Vaccination against pertussis could help protect OAD patients from the additional burden of pertussis, but there may be hesitancy related to vaccine safety and immunogenicity in such patients. We performed a meta-analysis on 5 clinical trials in adults receiving reduced-antigen tetanus-diphtheria-acellular pertussis vaccine (Tdap, , GSK), from which we selected participants on active OAD treatment. We compared immunogenicity and reactogenicity outcomes of the meta-analysis with data from the overall populations of Tdap-vaccinated adults from 6 Tdap trials (including the 5 in the meta-analysis). The meta-analysis comprised 222 adults on active standard OAD treatment. One month post-Tdap, 89.0% and 97.2% of these adults, respectively, achieved seroprotective anti-diphtheria and anti-tetanus antibody concentrations; 78.3%-96.1% showed booster responses across the 3 pertussis antigens. These rates were consistent with those in the comparator population. The most frequently reported solicited local and systemic adverse events within 4 days post-Tdap were injection site pain (47.7%) and fatigue (19.3%), with low rates of grade 3 intensity (0.9% and 2.8%). This was consistent with Tdap reactogenicity in the comparator population. Evaluation of unsolicited and serious adverse events within 1 month post-Tdap did not identify safety concerns. In conclusion, Tdap was immunogenic and well tolerated in adults under active standard OAD treatment, with immunogenicity and safety profiles consistent with those in a comparator population representing the general adult population.
Topics: Adult; Humans; Whooping Cough; Immunization, Secondary; Diphtheria-Tetanus-acellular Pertussis Vaccines; Diphtheria; Tetanus; Vaccination; Bacterial Vaccines; Pulmonary Disease, Chronic Obstructive; Asthma; Antibodies, Bacterial
PubMed: 36746754
DOI: 10.1080/21645515.2022.2159731 -
Nature Communications Jan 2024A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the... (Meta-Analysis)
Meta-Analysis
A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38-1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization's short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.
Topics: Infant; Pregnancy; Female; Infant, Newborn; Humans; Whooping Cough; Vaccination; Parturition; Respiratory Tract Infections; Vaccines; Immunization
PubMed: 38297003
DOI: 10.1038/s41467-024-44943-7