Whooping Cough Case Study

Thursday, January 27, 2022 2:11:45 AM

Whooping Cough Case Study

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A child who has never been vaccinated against pertussis, or whooping cough, is 13 times more likely to suffer from an infection of Bordetella pertussis than is a child who is up-to-date on his or her vaccines. But new evidence from a decade-long study at Kaiser Permanente shows that vaccinated children were five times more likely to suffer from whooping cough if it had been more than 3 years since their last vaccine dose. The research was published today in Pediatrics. DTaP vaccine, which protects against pertussis, diphtheria, and tetanus, is given in five doses between the ages of 2 months and 6 years. In this study, researchers from Kaiser Permanente Northern California followed children born between and who were diagnosed as having whooping cough.

The researchers identified pertussis cases, with 99 cases in unvaccinated children, 36 in undervaccinated children, in fully vaccinated children five DTaP doses , and 88 in children who had received six doses of DTaP. Children only partially vaccinated were 1. In and , California experienced two large pertussis outbreaks, with more than 9, cases each. Whole-cell vaccines, Edwards explains, generate more protective T-cell responses. After the introduction of a whole-cell pertussis vaccine in the United States, annual rates of the disease dropped from per , in the s to 1 per , in the s in the United States. Though efficacious, DTwP caused more reactions than DTaP, including febrile seizures and local injection-site reactions.

DTwP is no longer available in the United States or other high-income countries, so other strategies to boost pertussis immunity must be explored, including maternal vaccination and an intranasal booster dose of the vaccine, Edwards said. Figure shows the proportion of disease-free weeks fade-outs for various population sizes from the stochastic formulation of the model.

Panel a compares the symptomatic cases in the aP vaccination era with those in the pre-vaccine era; panel b compares the symptomatic to asymptomatic cases in the vaccine era; panel c compares the asymptomatic cases in the post-vaccine era with those in the pre-vaccine era. These results demonstrate no changes in transmission due to vaccination. These results are likely to be conservative given the low, but unknown, diagnosis rate of asymptomatic infections and known underreporting of symptomatic infections in adults [ 45 ]. How does an inefficient vaccine affect situational awareness? Shaded area indicates a range of reasonable aP vaccination rates. At current aP vaccination coverage levels, the majority of cases are asymptomatic and therefore undetected.

See Additional file 1 for model details. Note that previously published values of R 0 for pertussis range from 16—20 [ 71 ] to closer to 5 in some populations [ 72 ]. Figure 8 illustrates the fold increase in observed symptomatic and unobserved asymptomatic infections after transitioning from a wP to an aP vaccine at equilibrium. This is done to simulate the switch from wP to aP in the US and UK going from high wP coverage to coverage with aP , and indicates that a change in vaccine could partially account for the rise in cases. Can an inefficient vaccine lead to increased transmission? Figure demonstrates the fold increase in observed symptomatic and unobserved asymptomatic infections after transitioning from a wP to an aP vaccine.

We see an increase in symptomatic cases across a large range of aP vaccination coverage levels. The gray band indicates the empirical 5. The model recreates the observed increase in cases. As aP vaccination coverage increases, asymptomatic infections increase up to nearly fold. We see a substantial increase in the observed numbers of symptomatic cases after wP vaccination is replaced by aP vaccination. At low to moderate levels of aP vaccination, there is a 5- to fold increase in symptomatic cases. This is in line with the observed rise in B. This result is similar to previous findings by van Boven et al. It is clear that waning immunity plays a role in the epidemiology of B.

Because the exclusion of waning immunity was a conservative modeling assumption, we focused our analysis on a model where immunity due to vaccination was lifelong. However, as Fig. Importantly, waning immunity would not explain the failure of infant cocooning strategies, the synchrony in age-specific attack rates after the switch to the aP vaccine as presented above, or the observed B. Effects of including waning immunity on symptomatic and asymptomatic infections. Figure shows percent increases in symptomatic and asymptomatic cases at equilibrium after the switch to aP vaccination with inclusion of waning immunity.

In this paper, we have presented empirical evidence — from both case and genomic data — for asymptomatic B. Then, using mathematical and computational transmission models, we have demonstrated that an aP vaccine which blocks symptomatic disease but not asymptomatic transmission is able to account for the observed increase in B. When coupled with the laboratory results on asymptomatic transmission in non-human primates from Warfel et al. Our observation of increased cases due to asymptomatic or subclinical infections has been noted in previous studies of wP vaccination [ 47 — 49 ], as well as examinations of the effects of natural and vaccine-induced protection on the duration of immunity [ 4 , 50 ].

While these previous studies suggest that asymptomatic infections may account for an increase in whooping cough incidence, they do not provide strong evidence of asymptomatic transmission and do not discuss the failure of infant cocooning. Also, these studies were focused on cases occurring during the wP vaccine era. There are several limitations to the data presented in this study. First and foremost is a lack of publicly available data to more fully explore the hypotheses suggested. This lack of available data is well known among researchers studying B. Longer time series of age-stratified data specifically in infants too young to be vaccinated would be required to fully explore how the natural periodicity of B.

However, these data either do not exist or are unavailable to researchers. A second issue is that clearly not enough time has elapsed since the switch to aP to draw definitive conclusions about the resumption of cycles of B. While the data appear most consistent with asymptomatic transmission from aP vaccinated individuals, it may be many years before enough time has elapsed to be able to rule out this hypothesis. We acknowledge that this resurgence is not universal and that countries vary greatly in reporting rates, vaccine composition or schedule, historical and current vaccination coverage levels, and the genetic diversity of B. The initial increase in US B. However, the empirical evidence we presented, specifically the phylodynamic results, wavelet analysis, changing attack rates, and failure of cocooning, all occurred after the aP switch.

It may also be the case that a large factor in the observed resurgence is the improvement in B. Disentangling the effects of this variation, in order to evaluate hypotheses to explain the resurgence, will require high resolution case and genetic data. Although the phylodynamic results from the US provide support for an increase in the asymptomatic population size after the switch to the aP vaccine, that analysis has a number of important caveats.

First, genomic data were only available through , leaving nearly the last decade without samples. As a result, we are unable to statistically conclude that sampling rates are lower. Third, an increase in underreporting could also explain a decrease in the estimated sampling rate; however, due to changes in B. Nevertheless, the well-documented issues associated with underreporting of B.

Lastly, data availability prevented us from performing phylodynamic analyses in different countries. For example, predictions could be tested for those countries where: a resurgence is also occurring such as the UK [ 1 ], case counts remain fairly constant and low such as Italy [ 1 ], molecular evidence highlights the importance of vaccine escape such as Australia [ 30 , 53 ], and where the wP vaccine is still in use such as Kenya [ 54 ]. As is the case with all models, the one used in this study makes a number of simplifying assumptions. However, most of these assumptions render our conclusions conservative. Relaxing this assumption is analogous to having lower coverage overall, and thus our estimates of fold increase after the aP switch are conservative. Our model does not explicitly account for evolution of the B.

For example, it has been posited that B. Mooi et al. Despite this evidence, including evolution would merely increase the number of individuals susceptible to both symptomatic and asymptomatic infection and would yield exactly the opposite pattern of population genomic variation than seen empirically. Our model also assumes that symptomatic and asymptomatic infections have the same basic reproduction number. Although coughing may increase transmission, the total bacterial load in the nasopharynx of B. The same study suggested that the duration of higher bacterial loads may be longer in asymptomatic individuals, and that there may not be differences in routes of transmission between asymptomatic and symptomatic individuals.

However, and perhaps more importantly, being asymptomatic suggests that individuals may not alter their behavior and thus contact more individuals than a symptomatic individual [ 58 ]. Therefore, it seems equally plausible to conclude that the R 0 for aP vaccinated individuals is higher [ 47 ]. Future studies should make estimating the distribution of effective reproductive numbers for symptomatic and asymptomatic individuals a priority. It is important to note that distinguishing true asymptomatic infections from attenuated, symptomatic infections, especially in older age groups, is challenging.

If infections were truly asymptomatic, interventions based on teaching clinicians about the potential range of clinical presentations of B. Finally, our study assumes a constant probability of symptomatic infection, whereas previous work has shown the probability of becoming symptomatic may depend on the history of exposures of an individual [ 59 ]. Future work should explore the probability of symptomatic infection and its potential changes over the life of an individual. That there has been a rise in whooping cough incidence in many countries around the globe is irrefutable.

The findings presented in Warfel et al. Specifically, our results would explain the negative outcomes found in recent studies of postnatal cocooning [ 35 , 36 ] and would further complicate efforts to achieve herd immunity and possible eradication [ 60 ]. Long-term solutions to B. In the years before a new vaccine is ready for clinical use, other options are necessary for reducing incidence, including vaccination of pregnant women [ 63 , 64 ] or potentially a switch back to wP vaccination as a priming dose [ 65 — 67 ].

Clearly, more research is necessary, but if our results hold, public health authorities may be facing a situation similar to that of polio, where vaccinated individuals can still transmit infection [ 68 ]. This suggests further modifications of recommendations to clinicians for protecting unvaccinated children [ 69 ] and ensuring that aP coverage remains high. Our results on the potential surveillance bias associated with B. In light of current evidence and our results, we cannot dismiss the potential far-reaching epidemiological consequences of asymptomatic transmission of B.

Jackson DW, Rohani P. Perplexities of pertussis: recent global epidemiological trends and their potential causes. Epidemiol Infect. Google Scholar. Pertussis: increasing disease as a consequence of reducing transmission. Lancet Infect Dis. Article PubMed Google Scholar. World Health Organization. Progress Towards Global Immunization Goals - PLoS Comput Biol. Wearing HJ, Rohani P. Estimating the duration of pertussis immunity using epidemiological signatures.

PLoS Pathog. Article Google Scholar. Adaptation of Bordetella pertussis to vaccination: a cause for its reemergence? Emerg Infect Dis. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci. Secondary analyses of the efficacy of two acellular pertussis vaccines evaluated in a Swedish phase III trial. Evidence of Bordetella pertussis infection in vaccinated 1-year-old Danish children. Eur J Pediatr. Prevalence of asymptomatic Bordetella pertussis and Bordetella parapertussis infections among school children in China as determined by pooled real-time PCR: A cross-sectional study.

Scand J Infect Dis. The incidence of Bordetella pertussis infections estimated in the population from a combination of serological surveys. J Infect. Am J Prev Med. Epidemiological evidence for herd immunity induced by acellular pertussis vaccines. Public Health England, Whooping cough pertussis statistics. Project Tycho. Contagious diseases in the United States from to the present. N Engl J Med. Hethcote HW. My blood pressure and heart rate skyrocketed. I had anxiety and insomnia, chronic headaches, and I couldn't eat much. Everything ached. The coughing fits were so severe that my back would seize up, and I actually dislocated some of my ribs. I was in constant pain. There were times when I was so weak from coughing that I needed to use a wheelchair.

After the coughing fits finally stopped, I was officially "over" whooping cough, but it left damage that's still affecting me. My lungs are permanently scarred, which makes me extra sensitive to airborne irritants and compromises my breathing. The damage also makes my lungs easily irritated, so I continue to get dry coughs that can last for weeks. My doctor says that while it's pretty bad, there's nothing I can do about it except ride it out and make sure I stay hydrated. I'll likely always have to carry inhalers and EpiPens.

These days, I tell everyone to get their Tdap tetanus, diphtheria, and pertussis vaccine booster because while the condition may start out as "just a cough," it can snowball to the point where you feel like you are going to suffocate to death. This illness is no joke, and it doesn't just affect babies and children. I was 32 years old when I got it. I couldn't work or concentrate. It robbed me of activities I'd previously took joy in. The symptoms can last for months or even a year or more. I'm told that I'm one of the lucky ones since my case of whooping cough only lasted for six months.

There are an average of 24 million cases and , deaths from pertussis worldwide each year. All are unnecessary—an effective vaccine exists. As someone who was part of that statistic, I want to tell everyone: Don't believe the lies on the Internet about vaccines. Get your booster shots. Chocolate, fruits, and even a sultry music playlist are among some of the most talked-about aphrodisiacs. Popular belief is that they help set the mood by boosting feel-good chemicals in the body to rev up your libido.

But, how much of this is true? And do they really work? There isn't a ton of science to support the efficacy of some of the most common aphrodisiacs. However, keep in mind that they may work as long as you believe they do, aka the placebo effect. Placebos are a real thing, and in fact, here's why doctors continue to prescribe placebos. That said, here's the lowdown on aphrodisiacs to consider when you're ready to get down and dirty. You may be surprised to learn how color perception can influence desire: Lynn Anderson , PhD, author and naturopath, says, "Pink is a soothing color and sets the mood for relaxation.

Orange is associated with the sex center also known as the sacral chakra ; it stimulates appetite and reduces fatigue. So if you want to relax your partner and serve them a sexually stimulating dinner, set the table with pink carnations and think pumpkin pie for dessert. They're loaded with the mineral magnesium, and that's key, says Suzanne C. Amino acids increase the production of nitric oxide, which is important for expanding blood vessels and increasing blood flow everywhere. Here's your excuse to take a vacation ASAP: An Expedia study of more than 30 million travelers finds that travel can boost sex drive by reducing cortisol levels and improving self-perception.

Over one million travelers reported traveling increased their sex drive, which is likely due to an increase in confidence and improved mood, study researchers speculate. There's nothing like globetrotting with your partner to stir those romantic feelings. And here's how you can avoid getting sick on vacation. Hit the gym: A study published in Annals of Behavioral Medicine found that women with a dulled libido due to their antidepressant medication a common side effect of some types of antidepressants could boost their sexual interest and satisfaction by doing three minute sweat sessions per week.

That's real evidence: The researchers concluded that moderately intense exercise activates the sympathetic nervous system SNS , which facilitates blood flow to the genital region. To turn up the romance, turn on the tunes: After studying images of the brain, researchers at McGill University in Montreal found that listening to music releases the feel-good neurotransmitter, dopamine. Meanwhile, a study in the Journal of Research in Music Education suggests music releases serotonin. The only catch is that everyone has different music tastes, so try involving your partner in compiling your lovemaking playlist.

Yes, the fruit has a suggestive shape. However, a study in the International Journal of Aromatherapy suggests the most potent banana-related aphrodisiac may come from the smell of banana bread.

Also, these studies were Monuments Men Reflection on Children In Poverty occurring during the wP vaccine era. Whooping Cough Case Study testing negative Essay On Pigs In Animal Farm the flu, and ridded of Police Brutality Problem Essay fever, Bharati Mukherjees Two Ways To Belong In America and his family were sent home. Such as permanent disability, hospitalization, Self-Preservation: The Importance Of Human Nature threatening illness or even death.