Pertussis: contagious cough infection pptx

Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It primarily affects the respiratory tract and is known for causing severe, uncontrollable coughing fits that make it hard to breathe.

2. • Understanding PERTUSSIS
• PERTUSSIS in Adolescents and Adults
• PERTUSSIS Vaccination Recommendation
• Knowing the Tdap Vaccine

3. PERTUSSIS: THE DISEASE
•Highly communicable acute infection of the respiratory tract caused
by Bordetella pertussis characterized by paroxysms of coughing,
followed by inspiratory whoop and vomiting
•Stages:
–Catarrhal: runny nose, sneezing, low-grade fever, mild cough
–Paroxysmal: severe spasms of cough, thick mucus, whoops,
vomiting, exhaustion
–Convalescent: gradual recovery with less frequent and less
severe coughing
CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. PHF 2004.

4. Bordetella pertussis
PERTUSSIS: THE DISEASE
CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. PHF 2004.

5. PERIOD OF COMMUNICABILITY
-3-2-10 12 3 45 6 78 9101112
Weeks of cough
Catarrhal
stage
Paroxysmal stage Convalescent stage
Exposure Paroxysmal cough onset
Period of
Communicability
CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. PHF 2004.

6. PERTUSSIS EPIDEMIOLOGY
•Reliable pertussis epidemiological data are
scarce due to:
–Absence of standard for pertussis surveillance
[1]

and variation in surveillance system
performance among countries
[2]

–Variations in case definition
[2]

–Atypical clinical course/ unrecognized infection
in persons >15 years of age
[3]

[1] WHO/V&B/01.19 [2] WHO 2004. WHO/V&B/01.19
[3] Edwards and Decker. In: Vaccines. 4
th
ed; 2004

7. REPORTED PERTUSSIS CASES BY AGE GROUP,
United States, 1983-2005
0
2000
4000
6000
8000
10000
12000
838587899193959799010305
Year
N
u
m
b
e
r

o
f

c
a
s
e
s
<1yr
1- 4yrs
5 - 9yrs
10-19yrs
>20yrs

8. PERTUSSIS
Increasing incidence in older age groups
Age distribution of pertussis seems to have shifted towards
older children, adolescents and adults in countries with high
vaccine coverage
–Waning naturally induced and vaccine-induced immunity, and
increased recognition, are thought to be responsible
Pertussis illness in groups beyond the current immunization
age range is a major public health concern
–They represent important conduits of infection to infants
–Potential source of Pertussis to other adults without
vaccination
Baron S, et al. Pediatr Infect Dis J 1998;17:412–8

9. • Understanding PERTUSSIS
• PERTUSSIS in Adolescents and Adults
• PERTUSSIS Vaccination Recommendation
• Knowing the Tdap Vaccine

10. PERTUSSIS IN ADOLESCENTS AND ADULTS
•CDC definition: 14 days of coughing with either
paroxysms or whooping
•Salient clinical feature of pertussis in adolescents
and adults is prolonged coughing (mean duration of
36-48 days)
–Whoop in 69%
–Post-tussive emesis in 65%
–Adolescents missed average 5 days of school
–Adults missed 7 days of work
W Von Konig Lancet Dec 2002
De Serres. JID 2000; 182: 174-9.

11. PERTUSSIS IN ADOLESCENTS AND ADULTS
•Other symptoms, such as sweating attacks,
syncope* and encephalopathy**
•Almost all pertussis cases in adolescents and
adults happen in patients who have been
previously vaccinated or infected with
Bordetella pertussis
W Von Konig Lancet Dec 2002
De Serres. JID 2000; 182: 174-9.
* loss of consciousness
** disorder or disease of the brain

12. PERTUSSIS IN ADOLESCENTS AND ADULTS
•Complications of adult pertussis due to persistent
coughing:
–rib fracture
–hernia
–incontinence
–back pain
•Other complications are infectious:
–sinusitis
–otitis media
–pneumonia.
W Von Konig Lancet Dec 2002
De Serres. JID 2000; 182: 174-9.

13. COMPLICATIONS OF PERTUSSIS TO
ADOLESCENT
•Complications are common in adolescents
(16%)
–Pneumonia occurs in 2% of patients <30 years of
age
•Hospitalization of adolescents at 1.4% with a
mean stay of 3 days

14. DURATION OF IMMUNITY AFTER
INFECTION or VACCINATION
Immunity against PERTUSSIS is NOT lifetime

15. TRANSMISSION CYCLE OF PERTUSSIS
between ADULTS and INFANTS
W Von Konig Lancet Dec 2002

16. PERTUSSIS IN WORKPLACE
A simple
cough
maybe
PERTUSSIS

17. PERTUSSIS IN WORKPLACE
•Persistent cough will spread the disease
•Unprotected individuals are at increased risk

18. PERTUSSIS IN WORKPLACE
Adult PERTUSSIS = 7 days of missed work
Adult PERTUSSIS = LOSS OF PRODUCTIVITY

19. • Understanding PERTUSSIS
• PERTUSSIS in Adolescents and Adults
• PERTUSSIS Vaccination Recommendation
• Knowing the Tdap Vaccine

20. Adolescent Tdap Booster Recommendations
1,3
Adolescents 10 to 19 years old - single dose of Tdap instead of
Td vaccine:
 those who have not yet received Tdap should receive 1
of Tdap vaccine, followed by Td (tetanus and diphtheria
toxoid) every 10 yrs thereafter
Adolescents with no history of Pediatric DTP/DTaP or Tdap
•Should receive a series of 3 vaccinations: single dose of Tdap,
followed by Td 4 weeks after and a second Td at 6 – 12 months.
•Tdap can be substituted for any one of the 3 doses in the series
Wound Management: Tdap preferred over Td
PERTUSSIS BOOSTER RECOMMENDATIONS
Advisory Committee on Immunization Practices; PFV, PPS, PIDSP Childhood Immunization Schedule 2012

21. PERTUSSIS BOOSTER RECOMMENDATIONS
Adult and Healthcare Tdap Booster Recommendations
Adults 19 to 64 years old
•Single dose of Tdap instead of Td if the last Td is >10 years ago
•Tdap can be given regardless of time elapsed since last vaccine
•Adults who have or anticipate having close contact with an infant
<12 months
•Single dose of Tdap to reduce the risk of transmitting Pertussis
Health care personnel
•Single dose of Tdap
Wound Management: Tdap preferred over Td
Advisory Committee on Immunization Practices; PFV, PSMID, PHICS Adult and Healthcare Workers Vaccination Recommendations

22. PERTUSSIS BOOSTER RECOMMENDATIONS
to HEALTCARE WORKERS

23. PERTUSSIS BOOSTER RECOMMENDATIONS
to HEALTCARE WORKERS

24. • Understanding PERTUSSIS
• PERTUSSIS in Adolescents and Adults
• PERTUSSIS Vaccination Recommendation
• Knowing the Tdap Vaccine

25. PRODUCT DESCRIPTION
Product
Targeted population
•Booster for active immunization for the
prevention of tetanus, diphtheria and pertussis
•Adolescents and adults, extended to paediatric
•Can be given for tetanus post exposure
Dose & administration
single injection of one dose (0.5 ml) by the intramuscular
route
Characteristics
•Presentation: vial
•Shelf life: 3 years
•Storage: 2°C to 8°C. Do not freeze

26. Component DTaP-IPV-Hib DTaP-IPV Tdap
D 30IU 30 IU 2 Lf
T 40IU 40 IU 5 Lf
PT (µg) 25ug 25ug 2.5ug
FHA (µg) 25ug 25ug 5ug
PRN (µg) — — 3ug
FIM 2 + 3 (µg) — — 5ug
DIFFERENCE BETWEEN PEDIATRIC
and BOOSTER VACCINES

27. Antigen
Geometric mean antibody titre (EU/mL)
DTaP Sweden
1
7 Mo olds
Post dose 3
Adacel
Ados
Adacel
Adults
Adacel
Polio
Ados
Adacel
Polio
Adults
PT 49.4 181 139 172 115
FHA 39.1 333 333
243
229
PRN 116 362 269 253 210
FIM 2&3 351 1471 930 1199 633
Pertussis Ab after 3 doses of DTaP in Sweden 1 Efficacy trial and after 1 dose of Adacel
in Canadian Ados and Adults trials
(ref; Halperin et al. Expert Opin. Biol. Ther. 2006;6(8):807-21)
Adapted from Gustafsson 1996, Ollin 1997, Mills 1998, Halperin 2000 (Vaccine) and Halperin 2000 (PIDJ)
PROTECTIVE EFFICACY

28. SAFE AND WELL TOLERATED
Pichichero etal. JAMA 2005;293: 3003-11.

29. Claims on are supported
by Clinical data
Conclusion Adacel
Ado.
data
Adult
data
Well tolerated in all age groups √ √ √
As immunogenic as Td √ √ √
Highly immunogenic √ √ √
Concomitant with Hep B (safety + immuno) √ √ √
Concomitant with Flu (safety + immuno) √ √ √
Long term Ab persistence : up to 5 y at present √ √
Interval study (safety): 18 Mo √ √
1 Mo post: Ab titers > titers in efficacy trial Sweden √ √ √

30. Conclusions
•Pertussis causes substantial morbidity and
incidence is increasing in adolescents and
adults
•Pertussis presentation is atypical in adults
with complications
•Pertussis can spread to unprotected
individuals
•Pertussis can cause absenteeism and loss of
productivity

31. Conclusions
•Sanofi pasteur Tdap Key Safety and
Immunogenicity Results
–Safe and well tolerated among adolescents and
adults
–Safety profile similar to that of licensed Td
vaccine
–Robust antibody responses to all included
antigens (Tetanus, diphtheria, pertussis)

32. Thank You
BOOSTER SHOT
MEANS A LOT