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Tropical Medicine & International... Jun 2023There is currently no booster diphtheria or tetanus vaccine for Lao children before adolescence, despite international recommendations. We investigated seroprotection...
OBJECTIVES
There is currently no booster diphtheria or tetanus vaccine for Lao children before adolescence, despite international recommendations. We investigated seroprotection against diphtheria and tetanus among Lao adolescents.
METHODS
Seven hundred seventy-nine serum samples were tested for anti-diphtheria and anti-tetanus antibodies.
RESULTS
Overall, 25.8% of the adolescents had antibody titers corresponding to protection against diphtheria and 30.9% to sufficient immunity against tetanus. Female participants >16 years were more likely to be protected against diphtheria (p < 0.001) and tetanus (p < 0.029).
CONCLUSION
Low protection against diphtheria and tetanus, possibly due to low vaccination coverage or antibody waning, suggests booster doses are warranted before adolescence.
Topics: Child; Humans; Female; Adolescent; Laos; Antibodies, Bacterial; Immunization, Secondary; Tetanus Toxoid; Tetanus; Diphtheria
PubMed: 37199458
DOI: 10.1111/tmi.13882 -
Toxins May 2024Diphtheria toxin (DT) is the main virulence factor of and Moreover, new species with the potential to produce diphtheria toxin have also been described. Therefore,... (Review)
Review
Diphtheria toxin (DT) is the main virulence factor of and Moreover, new species with the potential to produce diphtheria toxin have also been described. Therefore, the detection of the toxin is the most important test in the microbiological diagnosis of diphtheria and other corynebacteria infections. Since the first demonstration in 1888 that DT is a major virulence factor of , responsible for the systemic manifestation of the disease, various methods for DT detection have been developed, but the diagnostic usefulness of most of them has not been confirmed on a sufficiently large group of samples. Despite substantial progress in the science and diagnostics of infectious diseases, the Elek test is still the basic recommended diagnostic test for DT detection. The challenge here is the poor availability of an antitoxin and declining experience even in reference laboratories due to the low prevalence of diphtheria in developed countries. However, recent and very promising assays have been developed with the potential for use as rapid point-of-care testing (POCT), such as ICS and LFIA for toxin detection, LAMP for gene detection, and biosensors for both.
Topics: Diphtheria Toxin; Humans; Diphtheria; Corynebacterium; Corynebacterium diphtheriae
PubMed: 38922140
DOI: 10.3390/toxins16060245 -
JAMA Pediatrics Apr 2023Infants younger than 1 year have the highest burden of pertussis morbidity and mortality. In 2011, the US introduced tetanus toxoid, reduced diphtheria toxoid, and...
IMPORTANCE
Infants younger than 1 year have the highest burden of pertussis morbidity and mortality. In 2011, the US introduced tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during pregnancy to protect infants before vaccinations begin.
OBJECTIVE
To assess the association of maternal Tdap vaccination during pregnancy with the incidence of pertussis among infants in the US.
DESIGN, SETTING, AND PARTICIPANTS
In this ecologic study, a time-trend analysis was performed of infant pertussis cases reported through the National Notifiable Diseases Surveillance System between January 1, 2000, and December 31, 2019, in the US. Statistical analysis was performed from April 1, 2020, to October 31, 2022.
EXPOSURES
Maternal Tdap vaccination during pregnancy.
MAIN OUTCOMES AND MEASURES
Pertussis incidence rates were calculated and compared between 2 periods-the pre-maternal Tdap vaccination period (2000-2010) and the post-maternal Tdap vaccination period (2012-2019)-for 2 age groups: infants younger than 2 months (target group of maternal vaccination) and infants aged 6 months to less than 12 months (comparison group). Incidence rate differences between the 2 age groups were modeled using weighted segmented linear regression. The slope difference between the 2 periods was estimated to assess the association of maternal Tdap vaccination with pertussis incidence among infants.
RESULTS
A total of 57 460 pertussis cases were reported in infants younger than 1 year between 2000 and 2019; 19 322 cases (33.6%) were in infants younger than 2 months. During the pre-maternal Tdap vaccination period, annual pertussis incidence did not change among infants younger than 2 months (slope, 3.29 per 100 000 infants per year; P = .28) but increased slightly among infants aged 6 months to less than 12 months (slope, 2.10 per 100 000 infants per year; P = .01). There was no change in the difference in incidence between the 2 age groups (slope, 0.08 per 100 000 infants per year; P = .97) during the pre-maternal Tdap vaccination period overall. However, in the post-maternal Tdap vaccination period, incidence decreased among infants younger than 2 months (slope, -14.53 per 100 000 infants per year; P = .001) while remaining unchanged among infants aged 6 months to less than 12 months (slope, 1.42 per 100 000 infants per year; P = .29). The incidence rate difference between the 2 age groups significantly decreased during the post-maternal Tdap vaccination period (slope, -14.43 per 100 000 infants per year; P < .001). Pertussis incidence rate differences were significantly different between the pre-maternal and post-maternal Tdap vaccination periods (slope difference, -14.51 per 100 000 infants per year; P = .01).
CONCLUSIONS AND RELEVANCE
In this study, following maternal Tdap vaccine introduction, a sustained decrease in pertussis incidence was observed among infants younger than 2 months, narrowing the incidence gap with infants aged 6 months to less than 12 months. These findings suggest that maternal Tdap vaccination is associated with a reduction in pertussis burden in the target age group (<2 months) and that further increases in coverage may be associated with additional reductions in infant disease.
Topics: Pregnancy; Female; Infant; Humans; Whooping Cough; Incidence; Diphtheria-Tetanus-acellular Pertussis Vaccines; Pertussis Vaccine; Tetanus; Diphtheria; Vaccination
PubMed: 36745442
DOI: 10.1001/jamapediatrics.2022.5689 -
Annals of Medicine and Surgery (2012) Jun 2023Diphtheria, a vaccine-preventable bacterial infection caused by usually starts with sore throat and fever and often results in breathing difficulties, heart rhythm...
Diphtheria, a vaccine-preventable bacterial infection caused by usually starts with sore throat and fever and often results in breathing difficulties, heart rhythm problems, and rarely membranous pharyngitis. Although nursing these complications can help most people survive diphtheria, but it can be deadly in 5-10% of cases with higher death rates observed in children under 5 years of age or adults above 40. For the year 2022, 92 cases have been reported by seven European countries. Sixty-six of the reported cases presented with cutaneous diphtheria caused by while cases of respiratory diphtheria have also been reported, including one fatal case. The increase in diphtheria cases can be linked to an increased volume of migrants from diphtheria-endemic countries causing transmission of pathogens from countries of origin to recipient countries. Today the authors can treat diphtheria infections by using antibiotics and also prevent the disease with a vaccine. General population should be given awareness and educated in regard to disease prevention and appropriately implement administration of Diphtheria and Tetanus Toxoids and Pertussis Vaccines among people at risk for their own protection and urgently call for an action to eliminate the disease before its further spread as an outbreak.
PubMed: 37363467
DOI: 10.1097/MS9.0000000000000832 -
Vaccine Jan 2023Maternal tetanus-diphtheria-and-acellular-pertussis (Tdap) vaccination is offered to all pregnant women during their second trimester in the Netherlands since December...
BACKGROUND
Maternal tetanus-diphtheria-and-acellular-pertussis (Tdap) vaccination is offered to all pregnant women during their second trimester in the Netherlands since December 2019. We assessed second trimester Tdap vaccination reactogenicity and compared with third trimester data from a similar study. For safety assessment, adverse pregnancy outcomes were compared with national data from 2018, before Tdap vaccine-introduction.
METHODS
Pregnant women were included between August 2019-December 2021 and received Tdap vaccination between 20 and 24w gestational age (GA). Participants completed a questionnaire on solicited local reactions and systemic adverse events (AEs) within one week after vaccination. Results were compared with historical data on reactogenicity from women vaccinated between 30 and 33w GA (n = 58). Regarding safety-related outcomes, each participant was matched to four unvaccinated pregnant women from the Dutch Perinatal Registry, based on living area, parity and age.
RESULTS
Among 723 participants who completed the questionnaire, 488 (67.5 %) experienced ≥ 1 local reaction with pain at the injection site as most reported reaction (62.3 %), and 460 (63.6 %) experienced ≥ 1 systemic AE with stiffness in muscles/joints (38.9 %), fatigue (28.9 %), headache (14.5 %) and common cold-like symptoms (11.0 %) most frequently reported. 4 women (0.6 %) reported fever (≥38.0˚C). Symptoms were considered mild and transient within days. No difference in AEs were found between vaccination at 20-24w versus 30-33w GA. 723 participants were matched to 2,424 unvaccinated pregnant women with no increased rates of premature labor, small-for-gestational-age, or other adverse pregnancy outcomes.
CONCLUSIONS
Second trimester maternal Tdap vaccination appears safe and well-tolerated. Comparison between second versus third trimester vaccination yielded no reactogenicity concerns.
Topics: Female; Humans; Pregnancy; Diphtheria-Tetanus-acellular Pertussis Vaccines; Diphtheria; Tetanus; Whooping Cough; Pregnancy Trimester, Second; Netherlands; Vaccination; Bacterial Vaccines
PubMed: 36604217
DOI: 10.1016/j.vaccine.2022.12.061 -
Acta Medica Indonesiana Jul 2019Human immunodeficiency virus (HIV) is one example of an emerging infection with total of 386 district of all province in Indonesia reported having such infection; with...
Human immunodeficiency virus (HIV) is one example of an emerging infection with total of 386 district of all province in Indonesia reported having such infection; with cumulative number of HIV infected patient from the year 1987 to 2014 is 150,296 while AIDS is 55,799 patients. The access to care only available for 153,887 patients among all HIV/AIDS patients of whom 70% are eligible for anti-retroviral (ARV) treatment and of these only half adhered to ARV treatment. In addition to that, there is an increased risk of other emerging diseases such as Zika virus, Monkey pox or Hanta pulmonary syndrome since a sporadic cases were reported around the region.Beside new diseases, tuberculosis, dengue virus, malaria and diphteria are continuously reported in Indonesia and classified as re-emerging illnesses. On this edition data on diphteria epidemiology in Indonesia will be shown by Karyanti et al.6 A recent outbreak of diphteria in Indonesia which involved almost all province in the country has led to a response named ORI (outbreak response of Immunization). Regardless of immunization, proper treatment including the distribution of anti-toxin and antibiotics are needed to stop the spread of this particular bacteria, further decreasing the mortality rate. In conclusion, the author of this paper mentioned that immunization gap needs to be handle systematically. Immunization data released on 2017 showed that complete immunization was given only to 20% of targeted group, while almost 75% were either unvaccinated or unknown. During the outbreak of diphteria in Indonesia, the WHO also reported several countries with similar problem such as Bangladesh, Haiti and Yamen. It was shown that a coordination between doctors in clinic/hospital with public health officer to conduct an epidemiological investigation, in conjunction with giving prophylaxis and assuring the logistics of anti-diphteria toxin and antibiotics were accessible were the key of success in eliminating diphteria like it was in Bangladesh.Adherence to treatment are multifactorial for all illnesses. First, is the duration of treatment and the potential adverse event due to the medication. The Ministry of Health of the Republic of Indonesia has support the early diagnosis of HIV and delivering treatment as soon as possible, in order to avoid transmission of the disease. Second, looking at another side of the story for HIV infected patients, receiving ARV treatment as a long life treatment could possibly cause an adverse event somewhere along the line. Budiman et.al reported factors that might contribute to liver injury. His study shows that measuring baseline liver function test AST routinely might minimize the toxicity of ARV to patients particularly with a low body mass index. Last, despite the adherence to treatment and procedures in minimizing the risk of adverse event to medication, we are now facing the primary resistance virus that transmitted in the community as mentioned by Megasari et al.8 on her report regarding the transmission of drug resistance HIV virus to naïve patients in Bali.The Indonesian government through the Indonesian Ministry of Health has established a collaboration and one health approaches to tackle the threat of diseases in the country, particularly in infectious diseases.
Topics: Communicable Diseases, Emerging; Cost of Illness; Diphtheria; HIV Infections; Humans; Indonesia; Tuberculosis
PubMed: 31699941
DOI: No ID Found -
Vaccine: X Apr 2022Latvia is among European countries with outbreaks of diphtheria and measles. Healthcare workers (HCW) are exposed to infections and can transmit them to unvaccinated...
Seroprevalence of diphtheria and measles antibodies and their association with demographics, self-reported immunity, and immunogenetic factors in healthcare workers in Latvia.
Latvia is among European countries with outbreaks of diphtheria and measles. Healthcare workers (HCW) are exposed to infections and can transmit them to unvaccinated patients. We assessed the seroprevalence of antibodies against diphtheria and measles and their association with demographics, self-reported immunity, the presence of the allele, and level of interferon regulatory factor 5 (IRF5) in Latvian HCW. Anti-diphtheria and anti-measles IgG antibodies and the level of IRF5 in serum were tested by enzyme immunoassay. The presence of the allele was detected by a real-time polymerase chain reaction. The study involved 176 HCW, including 29% doctors and 44% nurses. Among HCW, 95.5% were seropositive for diphtheria. However, only 65.9% had full seroprotection against it. The seronegativity for measles (21.6%) was higher than for diphtheria (4.5%) without differences in gender and medical staff groups. Older age was associated with waning immunity against diphtheria and a higher rate of seropositivity for measles. Considered immunogenetic factors did not affect the level of antibodies, and variability of the level of IRF5 in serum can reflect ageing processes. Self-reported vaccination status had a low informative value regarding full seroprotection against diphtheria and seropositivity for measles indicating the need for pre-vaccination IgG screening in planning the booster vaccination.
PubMed: 35243323
DOI: 10.1016/j.jvacx.2022.100149 -
American Journal of Obstetrics and... Mar 2022Despite the importance of prenatal care, quality measurement efforts have focused on the number of prenatal visits, or prenatal care adequacy, rather than the services...
BACKGROUND
Despite the importance of prenatal care, quality measurement efforts have focused on the number of prenatal visits, or prenatal care adequacy, rather than the services received. It is unknown whether attending more prenatal visits is associated with receiving more guideline-based prenatal care services. The relationship between guideline-based prenatal care and patients' clinical and sociodemographic characteristics has also not been studied.
OBJECTIVE
This study aimed to measure the receipt of guideline-based prenatal care among pregnant patients and to describe the association between guideline-based prenatal care and the number of prenatal visits and other patient characteristics.
STUDY DESIGN
This was a retrospective descriptive cohort study of 176,092 pregnancy episodes between 2016 and 2019. We used de-identified administrative claims data on commercial enrollees across the United States from the OptumLabs Data Warehouse. We identified the following 8 components of prenatal care that are universally recommended by the American College of Obstetricians and Gynecologists and other guideline-issuing organizations: testing for sexually transmitted infections, obstetric laboratory test panel, urine culture, urinalysis, anatomy scan ultrasound, oral glucose tolerance test, tetanus, diphtheria, and pertussis vaccine, and group B Streptococcus test. We measured the proportion of pregnant patients who received each of these guideline-based services at the appropriate gestational age. We measured the association between guideline-based services and the number of prenatal visits and prenatal care adequacy. We described variation of guideline-based care according to patient age, comorbidities, high deductible health plan enrollment, and their county's rurality, health professional shortage area status, racial composition, median income, and educational attainment.
RESULTS
The 176,092 pregnancy episodes were mostly among patients aged 25 to 34 years (63%) with few pregnancy comorbidities (81%) and living in urban areas (92%). Guideline-based care varied by service, from 51% receiving a timely urinalysis to 90% receiving an anatomy scan and 91% completing testing for sexually transmitted infections. Patients with at least 4 prenatal visits received, on average, 6 of the 8 guideline-based services. Guideline-based care did not increase with additional prenatal visits and varied by patient characteristics. Rates of tetanus, diphtheria, and pertussis vaccination were lower in counties with high proportions of minoritized populations, lower education, and lower income.
CONCLUSION
In this commercially insured population, receipt of guideline-based care was not universal, did not increase with the number of prenatal visits, and varied by patient- and area-level characteristics. Measuring guideline-based care is feasible and may capture quality of prenatal care better than visit count or adequacy alone.
Topics: Cohort Studies; Diphtheria; Female; Humans; Pregnancy; Prenatal Care; Retrospective Studies; Sexually Transmitted Diseases; Tetanus; United States
PubMed: 34614398
DOI: 10.1016/j.ajog.2021.09.038 -
Acta Medica Indonesiana Jul 2019in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of...
BACKGROUND
in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of diphtheria cases in 2010-2017 despite the Diphteria, Tetanus, Pertussis (DTP) immunization program applied in Indonesia for children. This study aimed to evaluate the epidemiology of diphtheria cases which occurred in Indonesia during 2010-2017.
METHODS
this was a retrospective study of diphtheria cases in Indonesia. The following source of data about diphtheria disease burden and vaccine coverage was obtained from Ministry of Health Republic of Indonesia, Indonesian Pediatric Society and World Health Organization South East Asia Regional Office.
RESULTS
the number of diphtheria cases in Indonesia were distributed across 30 provinces with a total of 811 cases in 2011; 1,192 cases in 2012; 296 cases in 2014; and 939 cases in 2017. Based on age group, the highest number of case fatality rate were in age group of 5-9 years old. Diphtheria immunization coverage in Indonesia among children was fluctuated, reported as 67.7 % in 2007, 61.9 % in 2010, 75.6% in 2013 and 61.3% in 2018. In addition to that, the organization of internal medicine has recommend booster of DPT immunization every 10 years for those children that had received complete DPT vaccination during childhood, however this was not applied. As the countermeasure towards this trend, the Ministry of Health implemented three rounds of Outbreak Response Immunization (ORI) targeted for the age group of 0-1-6 months old and 1-18 years old in 2017 and tailor approached for adults that had exposed to cases. Banten, DKI Jakarta and West Java were the first three provinces to implement this program considering their condensed population and high risk of disease transmission.
CONCLUSION
in Indonesia, there was dramatic increase of diphtheria case in 2010-2017, where immunization in children should be reinforced by increasing coverage more than 95% and adult boosted vaccination approaches should be initiated to prevent the spread of these fatal diphtheria diseases in Indonesia.
Topics: Adolescent; Adult; Child; Child, Preschool; Diphtheria; Diphtheria-Tetanus-Pertussis Vaccine; Disease Outbreaks; Female; Humans; Indonesia; Infant; Male; Retrospective Studies; Vaccination Coverage; Young Adult
PubMed: 31699943
DOI: No ID Found -
IJID Regions Mar 2022To identify risk factors for diphtheria related to sociodemographic, immunization and household status, and source of infection in Sana'a.
OBJECTIVE
To identify risk factors for diphtheria related to sociodemographic, immunization and household status, and source of infection in Sana'a.
METHODS
A retrospective matched case-control study (1:2 ratio) was conducted. Cases were defined as patients who met the World Health Organization's definition of confirmed diphtheria living in Sana'a between January and November 2019. Controls were defined as subjects without a history of diphtheria infection, living in the same neighbourhood, and matched with cases by age and sex. Crude odds ratios, adjusted odds ratio (aOR) and 95% confidence intervals (CI) were calculated to evaluate associations between risk factors and diphtheria.
RESULTS
In total, 76 confirmed cases and 152 controls were enrolled in this study. Multi-variate analysis found significant associations between diphtheria infection and sharing a bedroom with at least two people (aOR 2.8, 95% CI 1.2-6.6), non-vaccination (aOR 2.6, 95% CI 1.2-6.0) and contact with a diphtheria case (aOR 10.6, 95% CI 2.6-43.6).
CONCLUSIONS
This study found that vaccination, not sharing a bedroom with at least two people, and isolation of diphtheria cases to prevent contact with non-infected individuals were the most important measures for protection of the community from diphtheria. Raising community awareness about vaccination, transmission and preventive measures is recommended.
PubMed: 35757080
DOI: 10.1016/j.ijregi.2021.11.010