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Protecting the Unprotected

Talk @ Nice
by

Alberto Tozzi

on 4 June 2015

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Transcript of Protecting the Unprotected

Infants
Adolescents Young adults Adults Elderly Vaccinated persons Children 1998 1999 2000 2001 2002 2003-2007
< 1 year 1-4 years 5-9 years 10-14 years > 14 years 20% 40%
60% 80% 100% 0% Infant start Transmission Vaccine-induced protection Waning immunity Limited natural immunity 0 3 months Children Adolescents Adults Complications Death long lasting aspecific mostly cough protecting the unprotected Dr Alberto E Tozzi preventive and predictive medicine
research area coordinator Vaccine 1 2 3 doses -24% -31% -40% Celentano et al, 2005 Preterm infants respond to pertussis vaccine as well as term infants Vermeulen, 2010 EUVAC-NET Cases over 14
are increasingly Adult booster doses preconceptional immunization post-partum immunization health-care workers immunization misdiagnosed EUVAC-NET immunizations as soon as possible in child-care workers immunization cocoon strategy Sotir 2008 booster dose Adolescent 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-29 30-39 40-49 50-59 60-69 258 212 208 313 385 989 2239 1265 1160 547 333 45 56 97 28 28 1000 500 2500 1500 2000 0 universal Sin 2009 routine immunization timely immunization Child reinforce pre-school boosters at 4-6 years Immunization hesitancy Attack rate according to time since last vaccine dose in years after pertussis vaccinations Time since last vaccine dose in years Attack rate % 6 7 8 9 10 <10 1.9 6.3 14.7 19.0 32.0 17.6 23.1 ≤5 4 early therapy access to lab diagnosis EUVAC-NET mothers
13 fathers
7 brothers
18 sisters
10 Aunts
15 Cousins (male)
11 Cousins (female)
16 Uncles
9 Grandmothers
6 Grandfathers
2 51 cases in infants <1 1-4 5-9 10-14 15-19 20+ 0 5 10 15 20 25 30 35 40 Incidence per 100,000 inhabitants Cases per 100,000 population Age group Wisconsin outbreak pertussis 2003: highest incidence in adolescents Incidence increases after 4 years of age Disclosures of interest The presenter has received research grants from GSK and Wyeth as an investigator in clinical trials and other vaccine studies
The presenter has acted as lecturer for GSK and Wyeth
Infants are often exposed to infection when they are too young to be vaccinated EUVAC-NET France 100-300/100.000 in infants < 3 months primary cause of mortality in infants < 2 months proportion of recognised cases in adolescents and adults 508/100.000 Bonmarin, 2007 Floret, 2001 Gilberg, 2002 UK case fatality rate 6.7/1,000 Pertussis hospitalizations (14 countries) (2,777) 82/1,000 Norway 20/1,000 Latvia 692/1,000 Pertussis deaths (in 19 countries) 0.8/100,000 (30) 26 in < 1 yr 2 in 1-4 yrs 2 in > 30 yrs 2003-2007 2003-2007 up to 17 new cases Wearing 2009 PLoS Pathog 2009 14/30
Mothers
9/25
Fathers 11/27
Siblings 1/4
Grandparents 30 cases in infants
7/14
4/9
5/11
1/1
PCR + cough Mothers and siblings are frequent sources of infection... Bosdure E, Med Mal Infect. 2008 Pertussis is highly transmissible School B Family C
Hotel staff
Housing project
Jail
Methamphetamine users
Yaari, 2006 contacts may happen outside the family Vaccine
Polio DT Pertussis HBV HiB MMR/measles
Vaccination coverage to 12 months Vaccination coverage 12 to 24 months 67.0% 67.0% 67.0% 67.0% 67.0% 67.0% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0% ICONA study, Italy 2008
Pre
Post
Post Antibody Time point
Tdap3v Value Tdap5v Value
Pre
Post
Post Pre
Post
Post 7.3
63.6
77.2
31.6
624.4
96.9
13.4
401.0
93.2
8.1
32.2
47.1
34.8
368.4
94.0 14.3
351.9
91.7
PT GMC
% BR FHA GMC
% BR % BR GMC
PRN Tdap booster doses are immunogenic in adults Blatter, 2009
Bosdure E, Med Mal Infect. 2008 (pediatricians have an important role!) ...so are other relatives... ...and NHIS 2007 57 57 44 18-49 50-64 65+ 100 90 80 70 60 50 40 30 20 10 0 Tetanus coverage in adults is difficult to achieve Symptom Intensity Tdap3v Tdap5v p-Value
Pain Redness Swelling Fatigue Fever Gastrointestinal Headache Grade 3
≥50 mm
≥50 mm
Grade 3
≥39.1°C
Grade 3
Grade 3
1.6%
1.6%
1.4%
2.5%
0.1%
1.2%
2.2%
1.2%
2.3%
1.3%
2.8%
2.3% 0.4%
1.5%
0.274
0.022
0.021
0.077
0.045
0.791
0.267 adults well tolerated doses Tdap in are booster Blatter, 2009
Top 2010 HCW are difficult to reach Contacts often occur in the first month of life Lai-man R Chuk, Commun Dis Intell 2008
Likelihood of being hospitalized for pertussis compared with doses 0 any contact with health facilities at school taking advantage of other programs (HPV) before travelling Influenza vaccination within past 2 years
Belief that the vaccine is safe and effective
History of pertussis immunization
Tetanus vaccine in past 10 years
Contact with pediatric patients
Knowledge score ≥60
Knowledge that pertussis occurs in immunized adults
Disagree that pertussis is rare
Disagree that vaccines can cause autoimmune disease
<0.0001
<0.0001
0.007
0.0263
0.3758
0.023
0.0129
0.0766
<0.0001 more represented in Europe at p value Derived from Hewlett, 2005; Wendelboe, 2005 Pertussis: pertussis immunization starts here Age group generally
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