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Pertussis and Pertussis Vaccines

Pertussis and Pertussis Vaccines. Epidemiology and Prevention of Vaccine-Preventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention. Revised May 2009. Pertussis Clinical Features. Catarrhal stage 1-2 weeks

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Pertussis and Pertussis Vaccines

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  1. Pertussis and Pertussis Vaccines Epidemiology and Prevention of Vaccine-Preventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Revised May 2009

  2. Pertussis Clinical Features • Catarrhal stage 1-2 weeks • Paroxysmalcough stage 1-6 weeks • Convalescence Weeks to months

  3. Pertussis Among Adolescents and Adults • Disease often milder than in infants and children • Infection may be asymptomatic, or may present as classic pertussis • Persons with mild disease may transmit the infection • Older persons often source of infection for children

  4. Pertussis Complications* Condition Pneumonia SeizuresEncephalopathy Hospitalization Death Percent reported 4.9 0.7 0.1 16 0.2 *Cases reported to CDC 2001-2003 (N=28,998)

  5. Pertussis Complications by Age *Cases reported to CDC 1997-2000 (N=28,187)

  6. Pertussis—United States, 1980-2007 Year

  7. Reported Pertussis by Age Group, 1990-2007

  8. Pertussis-containing Vaccines • DTaP (pediatric) • approved for children 6 weeks through 6 years (to age 7 years) • Tdap (adolescent and adult) • approved for persons 10 through 64 years (Boostrix) and 11 through 64 years (Adacel)

  9. DTaP Clinical Trials VE (95% CI) 85% (80-89) 80% (59-90) 84% (76-89) Product Daptacel Tripedia Infanrix Location Sweden Germany Italy

  10. Routine DTaP Primary Vaccination Schedule Minimum Interval --- 4 wks 4 wks 6 mos Dose Primary 1 Primary 2 Primary 3 Primary 4 Age 2 months 4 months 6 months 15-18 months

  11. Pertussis Vaccine Use in Children with Underlying Neurologic Disorders Underlying Condition Prior seizure Suspected neurologic disorder Neurologic event between doses Stable/resolved neurologic condition Recommendation Delay and assess* Delay and assess* Delay and assess* Vaccinate *vaccinate after treatment initiated and condition stabilized

  12. DTaP Adverse Reactions • Local reactions 20%-40% (pain, redness, swelling) • Temp of 101oF 3%-5% or higher • More severe adverse reactions not common • Local reactions more common following 4th and 5th doses

  13. Adverse Reactions Following the 4th and 5th DTaP Dose • Local adverse reactions and fever increased with 4th and 5th doses of DTaP • Reports of swelling of entire limb • Extensive swelling after 4th dose NOT a contraindication to 5th dose

  14. DTaP Contraindications • Severe allergic reaction to vaccine component or following a prior dose • Encephalopathy not due to another identifiable cause occurring within 7 days after vaccination

  15. DTaP Precautions* • Moderate or severe acute illness • Temperature >105°F (40.5°C) or higher within 48 hours with no other identifiable cause • Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours • Persistent, inconsolable crying lasting >3 hours, occurring within 48 hours • Convulsions with or without fever occurring within 3 days *may consider use in outbreaks

  16. Pertussis Among Adolescentsand Adults • Prolonged cough (3 months or longer) • Post-tussive vomiting • Multiple medical visits and extensive medical evaluations • Complications • Hospitalization • Medical costs • Missed school and work • Impact on public health system

  17. Recommendations for Tdap Vaccination of Adolescents • Adolescents 11 or 12 years of age should receive a single dose of Tdap instead of Td* • Adolescents 13 through 18 years who have not received Tdap should receive a single dose of Tdap as their catch-up booster instead of Td* *if the person has completed the recommended childhood DTaP/DTP vaccination series, and has not yet received a Td booster MMWR 2006;55(RR-3):1-43.

  18. Tdap Vaccination of Adults19 Through 64 Years of Age • Single dose of Tdap to replace a single dose of Td • May be given at an interval less than 10 years since receipt of last tetanus toxoid-containing vaccine • Special emphasis on adults with close contact with infants (e.g., childcare and healthcare personnel, and parents) MMWR 2006;55(RR-17):1-37.

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