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  1. 1

    Diphtheria, pertussis, and tetanus vaccination [letter]

    Cutts FT; Begg N

    Lancet. 1992 May 30; 339(8805):1355-6.

    Researchers compared the immune responses of infants vaccinated at 2, 3, and 4 months of age with the diphtheria-pertussis-tetanus (DPT) conjugate vaccine with those of infants vaccinated at 3, 5, and 9 month intervals. The antibody titer for pertussis was the same for both the old and new schedules. Further, no reliable immunological correlates of protection existed for pertussis. Different batches of DPT vaccine and maternal antibodies may have accounted for the variation in immune responses. No one measured maternal antibodies in the infants in the 3, 5, and 9 month group, though. The protective level of antitoxin for tetanus and diphtheria (0.01 neutralizing units/ml) cannot be applied to ELISA assays, since the relationship between the 2 assays is inadequate at levels less than 0.1 IU/ml. 1964 research of 9 injection schedules showed that when infants received the first dose at 3 months rather than later, or when the intervals were 1 month long instead of 2 months, diphtheria and tetanus antitoxin titers were lower 2 weeks after series completion. Therefore, clinical researchers should do lengthy longitudinal studies of infants vaccinated at 2, 3, and 4 months before the clinicians can actually determine the persistence of immunity to school entry. The UK Public Health Laboratory Service is doing a longitudinal study of early and long term antibody responses to the new schedules. In fact, the accelerated vaccination schedule has improved coverage during the first year of life. 20-30% of pertussis cases are less than 6 months old in developing countries. WHO's Expanded Programme on Immunization encourages health workers to begin vaccine series as early in life as possible and to keep the intervals as short as possible. Even though no primary series of 3 doses of DPT protects an infant for a lifetime, health workers should achieve high coverage with early doses and shorter intervals. WHO already advocates giving women of reproductive age in developing countries 5 doses of tetanus toxoid to reduce neonatal deaths.
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  2. 2

    Confronting AIDS: update 1988.

    Institute of Medicine

    Washington, D.C., National Academy Press, 1988. x, 239 p.

    The Committee for the Oversight of AIDS Activities presents an update to and review of the progress made since the publication 1 1/2 years ago of Confronting Aids. Chapter 1 discusses the special nature of AIDS (Acquired Immunodeficiency Syndrome) as an incurable fatal infection, striking mainly young adults (particularly homosexuals and intravenous drug users), and clustering in geographic areas, e.g., New York and San Francisco. Chapter 2 states conclusively that HIV (Human Immunodeficiency Virus) causes AIDS and that HIV infection leads inevitably to AIDS, that sexual contact and contaminated needles are the main vehicles of transmission, and that the future composition of AIDS patients (62,000 in the US) will be among poor, urban minorities. Chapter 3 discusses the utility of mathematical models in predicting the future course of the epidemic. Chapter 4 discusses the negative impact of discrimination, the importance of education (especially of intravenous drug users), and the need for improved diagnostic tests. It maintains that screening should generally be confidential and voluntary, and mandatory only in the case of blood, tissue, and organ donors. It also suggests that sterile needles be made available to drug addicts. Chapter 5 stresses the special care needs of drug users, children, and the neurologically impaired; discusses the needs and responsibilities of health care providers; and suggests ways of distributing the financial burden of AIDS among private and government facilities. Chapter 6 discusses the nomenclature and reproductive strategy of the virus and the needs for basic research, facilities and funding to develop new drugs and possibly vaccines. Chapter 7 discusses the global nature of the epidemic, the responsibilities of the World Health Organization (WHO) Global Program on AIDS, the need for the US to pay for its share of the WHO program, and the special responsibility that the US should assume in view of its resources in scientific personnel and facilities. Chapter 8 recommends the establishment of a national commission on AIDS with advisory responsibility for all aspects of AIDS. There are 4 appendices: Appendix A summarizes the 1986 publication Confronting Aids; Appendix B reprints the Centers for Disease Control (CDC) classification scheme for HIV infections; Appendix C is a list of the 60 correspondents who prepared papers for the AIDS Activities Oversight Committee; and Appendix D gives biographical sketches of the Committee members.
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  3. 3
    Peer Reviewed

    Developments in pertussis vaccines: memorandum from a WHO meeting.

    Griffiths E; Kreeftenberg JG


    The WHO memorandum outlines the present situation regarding pertussis vaccines, discusses ways to evaluate candidate vaccines, and identifies future research needs. Most existing whooping cough vaccines are whole-cell vaccines, combined with diphtheria and tetanus toxoid adsorbed on an aluminum or calcium carrier. As whole bacterial cells, they contain a complex array of at least 7 toxins and antigens, and display a narrow margin between potency and toxicity. The Japanese introduced an acellular vaccine, admittedly sometimes less potent, called the Precipitated Purified Pertussis Vaccine, in 1981. This material contains far less bacterial mass, notably less endotoxin, and consequently produces less fever, erythema and induration. WHO has not yet established minimum requirements for standardization; even the mouse potency assay may not be suitable. There are techniques, however, which will measure amounts of component antigens and toxicity. Conflicting results on assays of potency and immunogenicity will have to be resolved. Besides the obvious need for large clinical trials of defined vaccines, a whole range of research needs were suggested, from genetic studies of the organism to specific details of the host response. It is generally agreed that a less reactogenic and more effective pertussis vaccine is needed and feasible.
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