OBJECTIVE To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine used on the Brazilian National Immunizations Program, chiefly the incidence of hypotonic-hyporesponsive episodes. METHOD Follow-up of a cohort of 21,064 infants (20,925 or 99.7% adhered to the study protocol), within 48 hours of vaccination with diphtheria-tetanus-whole...

1. In guinea pigs, aminomethylpteroylglutamic acid (methotrexate) is capable of blocking the development of delayed skin hypersensitivity, the primary antibody response, and the specific febrile response to ovalbumin and diphtheria toxoid. The primary antibody response is more easily inhibited than is the development of delayed skin hypersensitivity. 2. The effect of methotrexate on immunologic...

We report the case of a 32-year-old woman who presented upon returning from India with cutaneous ulcers on the feet and pharyngitis. Microbiological testing showed the causative organism to be a toxigenic strain of Corynebacterium diphtheriae. She was treated successfully with penicillin and diphtheria antitoxin. This case emphasises the importance of maintaining a high index of suspicion for s...

Historically, diphtheria was a major cause of morbidity and mortality in the prevaccine era. However, in recent times there has been a resurgence of diphtheria, especially in the newly independent states of the former USSR. Diphtheritic polyneuropathy can be a serious complication in patients who have a severe infection. In patients with pertussis, seizures and encephalopathy can occur as a com...

BACKGROUND During the 1990s, the United States switched from combined diphtheria, tetanus toxoids, whole-cell pertussis (DTwP) vaccines to combined acellular pertussis (DTaP) vaccines because of safety concerns. After a 2010-2011 pertussis outbreak, we sought to evaluate whether disease risk in 10 to 17 year olds differed between those who previously received DTwP from those who received DTaP. ...

IMPORTANCE Undervaccination is an increasing trend that potentially places children and their communities at an increased risk for serious infectious diseases. OBJECTIVE To examine the association between undervaccination and pertussis in children 3 to 36 months of age. DESIGN Matched case-control study with conditional logistic regression analysis. SETTING Eight managed care organization...

BACKGROUND In the United States, the proportion of Bordetella pertussis isolates lacking pertactin, a component of acellular pertussis vaccines, increased from 14% in 2010 to 85% in 2012. The impact on vaccine effectiveness (VE) is unknown. METHODS We conducted 2 matched case-control evaluations in Vermont to assess VE of the 5-dose diphtheria, tetanus, and acellular pertussis vaccine (DTaP) ...

The Advisory Committee on Immunization Practices recommends administering diphtheria, tetanus and acellular pertussis (DTaP) vaccines to children at 2, 4, 6, 15-18 months, and 4-6 y of age; preferably with the same-brand vaccine for the whole series. We estimated age-appropriate DTaP dose completion and the proportion of children receiving a "mixed" DTaP vaccination series (ie, including DTaP v...

The currently available pertussis vaccines are highly efficacious. However, whole cell vaccines display some reactogenicity and acellular vaccines are less toxic, but elevated costs limit their use in developing countries. Instituto Butantan, Brasil, has developed a new technology to remove lipopolysaccharides from the whole cell vaccine using a simplified and not expensive methodology, which a...

Four strains of Corynebacterium diphtheriae were sent to UK participants in the UK National External Microbiological Quality Assessment Scheme, who were asked to examine the strains for toxin production by in vitro methods. Laboratories achieved 162/176 (92%) and 160/175 (91%) correct results with two rapid toxin producers and 145/175 (82%) with a slow toxin producer. With a non-toxigenic strai...