1. Duration of Protection After First
Dose of Acellular Pertussis Vaccine
in Infants

2. PERTUSSIS

4. PERTUSSIS
 an acute respiratory tract infection that was
described by Sydenham as pertussis, meaning
intense cough, it is preferable to whooping
cough because most infected individuals do not
“whoop.”

5. ETIOLOGY
 Bordetella pertussis .
 Bordetella parapertussis that contributes
significantly to 5% of pertussis.
 All are gram-negative coccobacilli that are
recovered best on Bordet- Gengou media.

6.  In very young children, the prolonged
coughing fits and vomiting can interfere
with sleeping and feeding patterns.

7. EPIDEMIOLOGY
 Spread by direct contact or droplet infections
during cough.
 Infants less than one year of age constitute 50-
70% of diagnosed cases.

8. DROPLET PRECAUTIONS
 Surgical mask ( N 95 not necessary)
 Gloves / Consider Gown
 Frequent hand washing
 Transmission risk within ~ 3 feet or less of a
cough , sneeze, face to face talking .

9. PERIOD OF COMMUNICABILITY
 The disease occurs 3-12 days after exposure to an
infected individual
 The coughing stage lasts for approximately six
weeks before subsiding. In some countries, this
disease is called the 100 days' cough or cough
of 100 days .

10. CLINICAL MANIFESTATIONS
 The incubation period of pertussis has a mean of
7 and a range of 6-20 days.
 Classically, divided into:
1- Catarrhal,
2- Paroxysmal, and
3- Convalescent stages.

11. CATARRHAL STAGE
 The term "catarrh" meaning"to flow."
 Nasal congestion
 Runny nose
 Mild fever
 Eye redness and excess eye watering

12. PAROXYSMAL STAGE (2-4WK)
The term "paroxysm" means a sudden, violent
burst. The paroxysms or "fits" of coughing may...
 start as a dry, intermittent, annoying cough that
increases in intensity and frequency
 occur at least once an hour
 cause the child to turn red, blue, or purple

13. CONTD….
 cause the eyes to bulge and water excessively
 cause significant distress in the child
 vomiting after coughing

14. CONT……..
Young infants may have small bursts of cough or
no cough before developing...
 Gasping
 Choking
 Turning red, blue or purple
 Apnea (episodes of not breathing)

15. CONVALESCENT STAGE (≥2 WK)
 The coughing fits become less frequent and less
intense. Young infants may develop louder
coughing but typically the breathing difficulty
improves.

16. DIAGNOSIS
 Clinical diagnosis is during paroxysmal stage.
 H/O incomplete vaccination.
 H/o contact.
 CBC shows leukocytosis.
 Fluorescent antibody staining of nasopharyngeal
secretions.
 nasopharyngeal swab.
 X-ray chest

17. TREATMENT
 Hospitalization is especially for infants less than
6 months.
 supplemental oxygen or even mechanical
venitlation may be necessary for severe disease.
 All individuals with confirmed pertussis should
be treated with antibiotics such as erythromycin,
azithromycin or clarithromycin.
 Antibiotics reduce the severity of illness and
also reduce the spread of the illness.

18. ANTIBIOTICS
 Erythromycin [50mg/kg/day] for 14 days may
eliminate pertussis organisms from the
nasopharynx within 3-4 days.
 Supportive care : avoidance of factors that
provoke attacks of coughing,
 maintenance of the hydration and nutrition,
 oxygen if there is distress, gentle suction for
viscid secretions.

19. COMPLICATIONS
Infants less than 6 months of age are at the highest
risk for complications. These include:
 Apnea
 Ear infections
 Pneumonia
 Seizures
 Encephalopathy
 Death (approximately 1% of infants less than 2
months of age)

20. SHOULD EXPOSED FAMILY MEMBERS BE
TREATED?
 Yes.
 Family members and close contacts of an infected
child should be treated with antibiotics to
prevent spread of the illness.
 This is true even for vaccinated individuals.

21. ISOLATION
 Patients with suspected pertussis are placed in
respiratory isolation with use of masks by all
health care personnel entering the room.
 Screening for cough should be performed and
isolation until 5 days after initiation of
macrolide therapy.

22. COND….
 Children and staff with pertussis in child-care
facilities or schools should be excluded until
macrolide prophylaxis has been taken for 5 days.

23. CAN PERTUSSIS BE PREVENTED?
 The pertussive vaccine is effective for at least 5
years.
 This helps prevent infection in the age group
where pertussis infection is most severe.
 The pertussis vaccine is part of the DTaP vaccine
(along with tetanus and diphtheria).

24. VACCINATION SCHEDULE
 The DTaP vaccine should be given in five doses
 at ages 2 months, 4 months, 6 months, 15 to 18
months, and 4 to 6 years.
 A booster dose is recommended at 11 to 12 years
of age.

26. DTaP Vaccine
Tdap Vaccine

27. WHAT KIND OF VACCINE IS DTAP?
 The diphtheria and tetanus components are
inactivated toxins called a toxoids.
 For the pertussis component of DTaP and Tdap
vaccines, purified components of the bacterium
are grown and then inactivated.

28. HOW IS THIS VACCINE GIVEN?
 The DTaP vaccine is given as an Intramuscular
injection.
 Dose is .5ml

29. FOR CHILDREN, HOW MANY DOSES OF
DTAP VACCINE ARE REQUIRED?
 Children up 2 months – 6 years:
 A series of 4 doses given at 2, 4, 6, and 15-18 months
of age.
 A 5th shot, or booster dose, is recommended at 4-6
years of age, unless the fourth dose was given late
(after the fourth birthday).
 A booster dose of Td (adult tetanus and diphtheria) is
recommended every ten years. The new Tdap vaccine
can be substituted for one booster dose of adult Td.

30. SHOULD ADULTS WHO WEREN'T IMMUNIZED AS
CHILDREN RECEIVE THIS VACCINE AS ADULTS?
 Children 7 years and older without documentation of
DTaP vaccination should receive a primary series of
three doses of Tetanus-diphtheria toxoid (Td).
 The first 2 doses should be separated by 4 - 8 weeks,
and the 3rd dose given 6 - 12 months after the second
dose.
 Tdap vaccine can be substituted for one of these three
doses, preferably the first dose for persons 11 years
and older.

31. HOW SAFE IS THIS VACCINE
The most common reactions are
Soreness, redness, and swelling
at the injection site.
Mild fever
Loss of appetite
Tiredness
Vomiting

32. WHO SHOULD NOT RECEIVE VACCINE?
 People who have had a serious allergic reaction
to one dose of DTaP, DT, Td, or Tdap vaccine.
 Persons with a moderate or severe illness should
postpone receiving the vaccine until their
condition has improved.

33. WHAT ADVERSE SIDE EFFECTS HAVE BEEN
REPORTED WITH THIS VACCINE?
 Moderate to serious reactions include:
 Crying for three hours or more
 High fever
 Collapse or shock-like state
 Convulsions within three days

34. VACCINES IN PAKISTAN
DPT +Tetanus+,
Pertussis Hep B +
Hemophilus
Influenza
Quinvaxem
Novartis
Free from Govt./
Also available in
private market for
Rs 1800/-
Diptheria, Tetanus,
Pertussis, Polio,
Hepatitis B, and
Haemophilus
Influenzae B Vaccine
Infanrix Hexa Glaxo Smith Kline
Rs.1750/-
Pertussis Vaccine
Acelluvax
Chiron Biocine Novartis
Rs. 1490/-

35. Duration of Protection After First
Dose of Acellular Pertussis Vaccine in
Infants

36.  published online February 10, 2014;
 Type of study case-control study.
 Place of study Australia.

37. INCLUSION CRITERIA
 aged 2 to 47 months
 between January 2005 and December 2009 to
controls from a population based immunization
register by date of birth and region of residence .
 coughing illness lasting 2 weeks.
 detection by polymerase chain reaction [PCR]
test or
 isolation by culture or suggestive laboratory

38. CASES
 All pertussis notifications for children aged,4
years with a diagnosis
date between January 1, 1995 and December
31, 2010 were included.

39. EXCLUSION CRITERIA
 Cases where immunization status was not
recorded in the notification data set supplied by
states and territories were excluded
 Any doses received by a control after the
date of disease onset in their matched
case were not included in the total..

40.  5226 notified cases.
 642 were excluded.
 4584 cases for matched analysis.

41. STATICALLY DATA
 were performed using the Pearson x2 test and a
significance level of P <.05.
 The model was stratified by the age groups to
estimate the odds
ratio (OR) for receipt of 1, 2, or 3 vaccine
doses for notified pertussis cases compared
with their matched controls.

42. DISCUSSION
we sampled 20 age-matched controls
for each case to maximize precision.
We selected eligible controls born
on the day before or the day after the
birth date of the index case to ensure
that cases were not matched to themselves.
The vaccination status of controls
was ascertained using the ACIR.

43.  National data from the ACIR between
2000 and 2010 showed that after 2 months of age,
the proportion of children aged up to 12 months
recorded as having received no doses of DTaP
remained nearly constant, with the first dose
received before 3 months of age in 87% .

44. PERTUSSIS NOTIFICATION RATES IN CHILDREN
AGED <4 YEARS, 1995–2010, AUSTRALIA.

45. PERTUSSIS HOSPITALIZATION RATES IN
CHILDREN AGED <4 YEARS, 1995–2010,
AUSTRALIA.

49. WHAT’S KNOWN ON THIS SUBJECT:
Waning effectiveness of 5 doses of acellular
pertussis vaccines is well documented after 6
years of age, but data are lacking for fewer doses
in younger children.

50. WHAT THIS STUDY ADDS:
 In 2- to 3-month-old infants, 1 dose of the
diphtheria–tetanus–acellular pertussis vaccine
gave significant protection against hospitalized
pertussis. The effectiveness of 3 doses decreased
from 84% between 6 and 11months to 59% after 3
years.

51. STRONG POINTS OF STUDY
 largest reported observational study .
 both against severe disease in infants and
against all laboratory-confirmed
pertussis.
 We had large numbers of cases.
 much greater sensitivity

52. LIMITATIONS OF STUDY
 the lack of gender specification.
 socioeconomic data for cases and controls.

53. CONCLUSIONS
 DTaP provided good protection against pertussis
in the first year of life from the first dose.
Without a booster dose, the effectiveness of 3
doses waned more rapidly from 2 to 4 years of
age than previously documented for children .6
years of age who had received 5 doses.

54. ANNUALLY REPORTED CASES
 Pakistan
 Source from W.H.O
 Cases reported 4,334
 Total population 159,196,3362