Humoral immunity against diphtheria, tetanus and poliomyelitis after antineoplastic therapy in children and adolescents--a retrospective analysis

Serum antibodies against diphtheria- and tetanus-toxin were measured in 71 children and against poliomyelitis viruses 1-3 in 65 children and adolescents 0-18 months after cessation of antineoplastic therapy. Non or marginally protective serum titers were found in 62% of patients against diphtheria, in 18% of patients against tetanus and in 72% of patients against one or more poliomyelitis virus serotypes. Of these patients, 55%, 46% and 75% were immunized adequately according to age against diphtheria, tetanus and poliomyelitis, respectively. In 50% or more of patients a lack of protective immunity against diphtheria, tetanus and poliomyelitis was found which could not be explained by an inadequate immunization status. This suggests that other factors (e.g. influence of underlying illness, antineoplastic therapy or both on lymphocytes) might be responsible for these findings and this deserves further investigation. Measurement of serum antibodies against vaccine-preventable illnesses and consecutive booster immunizations are an essential part of long-term follow up in pediatric patients after antineoplastic therapy.     

Defective immune response to tetanus toxoid in hemodialysis patients and its association with diphtheria vaccination

The incidence of infectious diseases is increased in patients with chronic renal failure. This is thought to be due to an impaired T cell stimulation by antigen presenting cells. Immunization programs are of great significance in the prevention of infections in immunocompromised individuals. However, the immune response to various vaccinations is impaired in patients with chronic renal failure. So far only few studies have focused on seroresponse to tetanus toxoid. Therefore we measured the levels of antitetanus toxoid antibodies in 71 hemodialysis patients with unknown vaccination history. The antibody levels were detected prior to and twelve months after a single "Td" or "Td-d-d" vaccination. Initially only 31 (44%) of the patients had a sufficient protection against tetanus. Of the unprotected patients 15 (38%) seroconverted after immunization, while 25 (63%) did not respond. We found a high association (p < 0.04, Fisher's exact test) between the efficacy of vaccination against diphtheria and tetanus. Out of 38 initially unprotected patients 27 (71%) showed a similar response to both vaccines: 9 (24%) individuals seroconverted, while 18 (47%) did not. Our data clearly demonstrate the need for frequent monitoring of antibody levels after immunization against tetanus and diphtheria in hemodialysis patients.     

Seroprevalence and determinants of diphtheria, tetanus and poliomyelitis antibodies among adults in Berlin, Germany

The immunity levels against diphtheria, tetanus and poliomyelitis were investigated among blood donors (n = 2079) in Berlin. Of all participants, only 60% had full, long-term protection against diphtheria, 72% against tetanus, 87% against poliomyelitis type 1, 77% against poliomyelitis type 2 and 73% against type 3. There was a striking decrease of tetanus and diphtheria immunity levels by age. Immunity levels against tetanus were higher among males, whereas females were better protected against poliomyelitis. After adjusting for confounding effects in logistic regression diphtheria immunity in those aged <40 years was significantly higher in participants from East-Berlin, whereas the immunity levels against poliomyelitis were higher in West-Berlin. These differences reflect the different vaccination policies in East-Germany and West-Germany before 1989. There is a need to improve the immunity levels of the adult population in Berlin.     

Persistence of antibodies at 5-6 years of age for children who had received a primary series vaccination with a pentavalent whole-cell pertussis vaccine and a first booster with a pentavalent acellular pertussis vaccine: immunogenicity and tolerance of second booster with a tetravalent acellular vaccine at 5-6 years of age

The main objective of this study was to assess in 5-6-year-old French children (n=162) the persistence of antibodies induced by a primary series vaccination (at 2-4 months of age) with a pentavalent whole-cell pertussis combined vaccine (DTwcP-IPV-Hib; Pentacoq) and a first booster (at 12-16 months of age) with a pentavalent two-component acellular pertussis combined vaccine (DTacP-IPV-Hib; Pentavac). The second objective was to evaluate in these 5-6-year-old French children the safety and the immunogenicity of a tetravalent pertussis combined vaccine (DTacP-IPV, Tetravac) given as a second booster. RESULTS: before the 2nd booster, more than 90% of children had antibody titers above the defined threshold for polyribosyl ribitol phosphate (PRP), tetanus, diphtheria and poliomyelitis; antibody titers were very low for pertussis. One month after the second booster, all children had sero-protective post-booster titers for tetanus, diphtheria and poliomyelitis types 1-3; over 90% of children had a four-fold rise in titers against DTacP-IPV antigens. Adverse events were mostly solicited reactions, with no serious adverse event. A strong anamnestic response was also observed after the second booster injection with Tetravac, with a satisfactory safety profile. CONCLUSION: Pentavac and Tetravac (acellular pertussis containing vaccines) may thus be administered as first and second boosters respectively, in children primed with Pentacoq (whole-cell pertussis containing vaccine).     

2015年新建县948例入园儿童计划免疫效果评价

目的 了解入园儿童接种乙型肝炎(乙肝)、脊髓灰质炎(脊灰)、百日咳、白喉、破伤风疫苗(以下简称“五防”疫苗)后抗体阳性率与疫苗“首针及时接种率、全程接种率、全程及时接种率”的吻合程度,评价儿童预防接种效果和免疫状况。方法 选取2015年新建县长堎地区新近入园的948例儿童作为研究对象,利用间接ELISA法检测血清标本中抗体阳性水平,通过查验儿童预防接种证收集预防接种信息,并进行比较分析。结果 948例入园儿童中,脊灰、百日咳、白喉、破伤风抗体阳性率均超过90%,乙肝抗体阳性率低于65%。除城镇儿童白喉、破伤风抗体阳性率显著高于农村(P<0.05)外,性别、户籍、居住地对“五防”疫苗的抗体阳性率影响不大(P>0.05)。全程接种乙肝、百白破三联疫苗的入园儿童乙肝、白喉、破伤风IgG抗体阳性率显著高于未全程接种者(P<0.05)。首针、全程是否及时接种“五防”疫苗对入园儿童这5种IgG抗体阳性率的影响不大(P>0.05)。结论 948例入园儿童脊灰、百日咳、白喉、破伤风免疫效果较好,而乙肝抗体阳性率相比较低。全程接种率相比首针及时接种率和全程及时接种率对评价儿童乙肝、白喉、破伤风疫苗免疫效果更有意义,值得关注并推广。     

Vaccination of allogeneic haematopoietic stem cell transplant recipients: report from the international consensus conference on clinical practice in chronic GVHD

Patients lose protective immunity to vaccine-preventable diseases after haematopoietic stem cell transplantation (HSCT). Therefore, revaccination of HSCT recipients represents an important strategy for reducing morbidity and mortality associated with these infections. Since there is little consensus on vaccine recommendations and practices for allogeneic HSCT recipients with active chronic graft-versus-host disease (GVHD) the German-Austrian-Swiss-Consensus Conference on Clinical Practice in Chronic GVHD developed an immunization schedule with the aim to provide optimal patient care. The proposed vaccine recommendations include immunization against Haemophilus influenzae type b, pertussis, pneumococci, meningococci, tetanus, diphtheria, hepatitis A and B, measles, mumps and rubella, influenza, poliomyelitis, varicella-zoster virus, human papilloma virus, and tick-borne encephalitis with a particular focus on vaccination of patients with active chronic GVHD.     

Serological evaluation of poliomyelitis oral and inactivated vaccines in an urban low-income population at Rio de Janeiro, Brazil

Oral and inactivated poliomyelitis vaccines (OPV and IPV), were given to 160 children two months old, in a low income population at Rio de Janeiro. The vaccination was repeated 2 and 4 months later, always in association with diphtheria, tetanus and pertussis (DPT) vaccine. Blood specimens were collected before vaccination at the time of the third dose of vaccine and later at the time of measles vaccination, when the children were nine months old. The serological response to two doses of IPV showed high titres of antibody in all but one child and 100% conversion after three doses. Although poliomyelitis has been controlled in Brazil by the use of OPV in large mass campaigns, the results obtained with IPV support the possibility of its use in the basic immunization schedule, providing lower costs could be achieved for the inactivated vaccine.     

Environmentally and occupationally acquired diseases in adolescents and adulthood: control of diphtheria, tetanus, pertussis, and poliomyelitis through regular booster vaccinations--a European perspective

Despite the success of childhood vaccination in industrialized countries, diphtheria, tetanus, pertussis (whooping cough), and poliomyelitis (polio) still affect adults and adolescents whose immunity has waned. The resurgence in the 1990s of diphtheria in the area of the former Soviet Union and its subsequent control with immunization campaigns, demonstrates the value of continued adult vaccination. Tetanus cannot be eradicated from the soil reservoir, necessitating routine primary vaccination and regular booster doses to maintain protective immunity. Although Europe has been certified endogenous polio-free since June 2002, polio imported from endemic areas continues to pose a serious threat for vulnerable populations. Booster polio vaccination is required in adolescence and adulthood. Pertussis among adults and adolescents is underestimated, representing a considerable health burden. The consequences can be more serious as this pool of susceptible adolescents and adults is a major source of pertussis transmission to newborns not yet protected by vaccination. The now available acellular pertussis-based combination vaccine covering diphtheria, tetanus, polio, and pertussis, suitable for adults and adolescents, provides the ideal tool for implementing booster immunization programs. Strong recommendations for adolescent and adult boosters are needed to overcome the continued threat of these diseases.     

Tetanus and diphtheria antitoxin levels following a hospital-based adult immunization program.

A hospital-based program to immunize adults against tetanus unless specific contraindications to immunization are present has been in effect at Parkland Memorial Hospital since 1959. Adsorbed tetanus toxoid was used from 1959 to 1970, and was replaced at that time by adult type adsorbed combined tetanus/diphtheria toxoid. In the present survey, the titers of diphtheria and tetanus antitoxins were determined in sera from 97 adults admitted to the Medical Service. Titers of diphtheria antitoxin less than 0.0125 units per ml were found in only seven patients and less than 0.0125 units per ml of tetanus antitoxin in only 17 patients. This high prevalence of immunity especially to tetanus appears to reflect our practice of routine immunization of adults. Although the recommended frequency of tetanus boosters has recently been reduced for adults who have completed a full primary immunization series, susceptibility to diphtheria or tetanus or both is not uncommon among adults in the US. Unless contraindications are present, we therefore urge routine immunization of all adults seeking medical care and of all hospital personnel as a means of diminishing the risk of diphtheria and tetanus in those adult populations with a significant incidence of susceptibility to these diseases.     

Diphtheria,tetanus, poliomyelitis,yellow fever and hepatitis B seroprevalence among HIV1-infected migrants. Results from the ANRS VIHVO vaccine sub-study

BackgroundFew data are available on the seroprotection status of HIV1-infected patients with respect to vaccine-preventable diseases.ObjectiveTo describe, in a population of HIV1-infected migrants on stable, effective ART therapy, the seroprevalence of diphtheria, poliomyelitis, tetanus, yellow fever antibodies and serostatus for hepatitis B, and to identify factors associated with seroprotection. Vaccine responses against diphtheria, tetanus, poliomyelitis and yellow fever were also studied.MethodsSub-Saharan African patients participating in the ANRS-VIHVO cohort were enrolled prior to travel to their countries of origin. Serologic analyses were performed in a central laboratory before and after the trip. Univariate and multivariate logistic regression was used to identify factors associated with initial seroprotection.Results250 patients (99 men and 151 women) were included in the seroprevalence study. Median age was 45 years (IQR 39-52), median CD4 cell count was 440/μL (IQR 336-571), and 237 patients (95%) had undetectable HIV1 viral load. The initial seroprevalence rates were 69.0% (95%CI 63.2–74.7) for diphtheria, 70.7% (95%CI 65.0–76.3) for tetanus, and 85.9% (95%CI 81.6–90.2) for yellow fever. Only 64.4% (95%CI 58.5–70.3) of patients had protective antibody titers against all three poliomyelitis vaccine strains before travel. No serological markers of hepatitis B were found in 18.6% of patients (95%CI 13.7–23.3). Patient declaration of prior vaccination was the only factor consistently associated with initial seroprotection.ConclusionsWe found a low prevalence of seroprotection against diphtheria, poliomyelitis, tetanus and hepatitis B. HIV infected migrants living in France and traveling to their native countries need to have their vaccine schedule completed.     

百白破混合制剂免疫持久性研究

70~80年代末,在观察基地比较吸附DPT间隔1月、2月接种2针和未吸附DPT接种3针、2针的免疫效果和免疫持久性,经血清学效果测定表明,四组儿童基免后能产生良好的白喉、破伤风抗体应答,而接种非吸附DPT儿童的百日咳抗体产生较差。加免后,三种抗体明显上升,白喉抗体至少可持续8年,破伤风抗体可维持5年左右,而百日咳抗体仅能维持3年左右。另对吸附DPT间隔2月接种2针与未吸附DPT接种3针比较,基免后白喉、破伤风、百日咳三种抗体均以吸附DPT效果较好,加免后则无显著差异。     

南通市流动儿童免疫规划相关疾病免疫水平监测结果分析

目的评价南通市外来从事规模种植业农民、砖窑厂工人及渔船民0～7岁子女免疫规划相关疾病免疫水平,为制订流动儿童预防接种管理措施提供依据。方法采用分层整群抽样调查法,对南通市9个县(市、区)外来人口集聚地流动儿童抗体水平进行检测并作统计学分析。结果乙肝抗-HbsAg阳性率76.17%;脊髓灰质炎Ⅰ、Ⅱ、Ⅲ型抗体阳性率和抗体几何平均滴度(GMT)分别为96.11%、97.28%、94.94%和1∶439.43、1∶295.34、1∶93.613;白喉抗体阳性率和抗体GMT分别为76.71%、1∶10.836;百日咳抗体阳性率和抗体水平分别为22.41%、15.976IU/ml;破伤风抗体阳性率和抗体GMT分别为67.87%、1∶33.644;麻疹抗体阳性率和抗体水平分别为94.74%、1 105.1mIU/ml;A群流脑抗体阳性率和抗体GMT分别为64.78%、1∶11.522;乙脑抗体阳性率和抗体GMT分别为62.89%、1∶11.704。结论脊灰、麻疹阳性率和抗体水平均较高,对这部分人群的保护较好。而乙肝、白喉、百日咳、破伤风、A群流脑、乙脑阳性率偏低,显示本市上述行业流动儿童免疫覆盖水平不足,易受到相关传染病的侵袭,预防接种工作有待于进一步加强。     

Regional variations of adult population vaccinal status

OBJECTIVE: The authors had for aim to study the regional variations of vaccination coverage in adult population. METHODS: Cross-sectional epidemiological study, including a representative sample of 2122 general practitioners and analyzed according to eight French regions. RESULTS: Six thousand two hundred sixty-nine patients, 44 +/- 15 old, were included in the study. 90.5% of the patients were vaccinated against diphtheria, 94.4% against tetanus, and 92.6% against poliomyelitis. No difference between regions was noted but the rate of patients with up to date vaccination strongly differed, ranging from 54.8% (Paris/Ile de France) to 64.3% (South West) for diphtheria, from 60.4% (Paris/Ile de France) to 73% (South West) for tetanus, and from 58.8% (Paris/Ile de France) to 69.8% (South West) for poliomyelitis. Vaccination coverage against measles, parotiditis, hepatitis A and B, typhoid fever, yellow fever also significantly differed between regions and the only ones evenly distributed were vaccination against tuberculosis, meningococcus, and pneumococcus. CONCLUSION: These results show insufficient vaccination coverage against diphtheria, tetanus, and poliomyelitis in all regions and show other important variations in vaccination coverage between regions, especially for hepatitis A and B.     

Immunization practices in solid organ transplant recipients

Vaccine-preventable diseases are a significant cause of morbidity and mortality in solid organ transplant recipients who undergo immunosuppression after transplantation. The primary strategy for immunizing transplant recipients is to deliver all potential vaccines prior to transplantation. However, time constraints limit the number of vaccines that may be delivered. In such cases, the administration of live attenuated vaccines that are contraindicated after transplantation should be prioritized. Simultaneous vaccination is also encouraged to maximize the number of vaccines delivered. Immunity induced by both inactivated and live vaccines wane after transplantation. The limited but available evidence suggests that immunization using inactivated vaccines in transplant recipients is both effective and safe. An increasing number of studies also suggest that once patients are under minimal immunosuppression, live attenuated vaccines may be given effectively and safely. The need for serologic monitoring and booster immunizations remain issues for future research.     

Quadruple vaccines containing pertussis and poliomyelitis vaccines

Quadruple vaccines (DTP-P), prepared by mixing crude adsorbed Salk poliomyelitis vaccines, heat-killed pertussis vaccines and adsorbed purified diphtheria and tetanus toxoids were found to be toxic for mice. However, by using purified poliomyelitis and heat-killed formalinized pertussis components, vaccines were prepared that were non-toxic. The pertussis component of these vaccines retained potency over extended periods of storage. Stable, potent DTP-P vaccines offer an excellent alternative to DTP and live poliomyelitis vaccine in the basic immunization of infants and children.     

Immunization status of children under 7 years in the Vikas Nagar area, North India

BACKGROUND: Immunization has played a major part in reducing childhood morbidity and mortality worldwide. Knowledge of vaccine coverage and reasons for poor uptake are essential for the achievement of herd immunity. METHOD: An observational study was carried out in September 2003, in 10 villages in the Vikas Nagar area around Herbertpur Christian Hospital in Uttaranchal, North India. We aimed to assess vaccination rates and potential socio-cultural, economic and religious influences on vaccine uptake. A total of 470 families were visited and details of immunization status of the oldest child under 7 years in each household were taken. Age range of children included was 9 months to 6 years. RESULTS: The overall primary immunization rate was 77.2%, children receiving the first booster was 73.1% and children receiving the second booster was 58.4%. The most common vaccinations to be missed were the diphtheria, pertussis, tetanus at 18 months and diphtheria, tetanus at 5 years. Measles was the most frequently omitted vaccination in the primary course (19.4%). Poor education was the most frequent reason given by parents for failure to vaccinate. Immunization rates did not differ according to gender of the child. A lower immunization rate was found in Muslim families (65.4% primary) compared with Hindu (85.2%). Parental literacy had a beneficial effect such that up to 20% more children were immunized. CONCLUSION: These results highlight the potential importance of literacy, and religious or cultural influences on the success of the Expanded Programme of Immunization, and will have important implications for areas with similar cultural demographics.     

河南省健康人群白喉和破伤风抗体水平调查

目的为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法采用分层整群随机抽样的方法,1998~2002年调查了河南省21个县(区、市)2~39岁3 510人的白喉和破伤风抗体水平。结果白喉和破伤风抗体总阳性率分别为80.5%和77.9%,阳性率均是2~3岁最高,25~39岁最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.101IU/ml和0.073IU/ml,均是8~9岁最高,25~39岁最低。结论河南省白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强白喉疫苗的免疫,并在新生儿破伤风高危县对育龄期妇女开展破伤风疫苗免疫。     

临沂市健康人群白喉和破伤风抗体水平调查

目的为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法采用分层随机抽样的方法,2001、2003、2004年调查了临沂市10个县(区)0~39岁847人的白喉和破伤风抗体水平。结果白喉和破伤风抗体总阳性率分别为77.80%和74.03%,阳性率均是0~4岁组最高,20~39岁组最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.0997U/ml和0.0674U/ml,均是8~10岁组最高,20~39岁组最低。结论临沂市白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强百日咳、白喉的免疫,并在新生儿破伤风高危县区对育龄期妇女开展破伤风疫苗免疫。     

The expanded WHO vaccination program and the vaccination strategy in East Germany

Evaluating the current stage and future trends of WHO's Expanded Programme on Immunization (EPI), conclusions for national immunization strategies have been considered. The global eradication of poliomyelitis is an important target. In 1988, an Immunization Advisory Group of the Ministry of Health has been founded. Recommendations regarding the update of immunization schedule have been elaborated. Changes are foreseen for BCG (deletion of revaccination), rubella (implementation of immunization for all girls aged 11/12 years), diphtheria (diphtheria/tetanus booster for adults), and measles (2-shot-strategy for young children and schoolchildren.