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- Bergfors, Elisabet, 1945
(författare)
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Aspects of pertussis, pertussis vaccination and adverse events associated with aluminum adsorbed vaccines
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis originates in a clinical study of one of the new acellular pertussis vaccines performed in Göteborg in the 1990s. The monocomponent vaccine, pertussis toxoid adsorbed to aluminium hydroxide, had previously been shown to have an efficacy of 71%. The first aim of the study was to see if the vaccine could induce herd immunity, with protection also of unvaccinated individuals, by mass vaccination of infants and children. A second aim was to study epdemiologic, clinical and immunologic characteristics of parapertussis, a disease related to pertussis. Further aims were to descibe the incidence, clinical picture and prognosis of two rare vaccine-related side effects, persistent pruritic nodules and delayed hypersensitivity to aluminium, in participants in the vaccine trials and in recipients of other aluminium adsorbed diphtheria-tetanus-pertussis vaccines. METHODS. All children in the Göteborg area born during the 1990s were offered three doses of pertussis vaccine. The incidence of pertussis was followed by the number of positive pertussis cultures and hospitalisations due to pertussis before and during the mass vaccination. Parapertussis cases were identified in a previous vaccine efficacy trial and in clinical routine. Children with persistent itching nodules were found through passive reporting and active search for cases. Aluminium allergy was tested with an epicutaneous test. Symptoms were evaluated by examination of afflicted children, yearly structured questionnaires and/or telephone interviews. RESULTS More than 60,000 children were vaccinated with the pertussis vaccine. Numbers of positive cultures decreased drastically during the mass vaccination, both in vaccinated children and in unvaccinated infants and individuals ≥15 years. - 81 patients with parapertussis were identified. The duration of their disease was shorter and their symptoms milder than seen in patients with pertussis. Antibody levels against FHA and pertactin were similar after both diseases while pertussis toxin antibodies only increased in pertussis patients. - Persistent itching nodules at the injection site were found in 645 children (almost 1 % of all vaccinees). The itching was often severe and long lasting (about 4 years) in children followed until recovery. Contact allergy to aluminium was demonstrated in 352 of 455 children tested (77 %) with pruritic nodules and in 17 of 211 (8 %) of asymptomatic siblings, who had received the same vaccine. - 19 cases of itching nodules in recipients of currently used aluminium adsorbed vaccines were described. 15 were tested for aluminium allergy, all with positive results. CONCLUSIONS A monocomponent pertussis toxoid vaccine induced a high degree of herd immunity against pertussis with indirect protection of unvaccinated individuals. Parapertussis is an uncommon disease causing similar, but usually milder, symptoms as pertussis. Antibodies against FHA and pertactin, but not pertussis toxin, were induced. Aluminium adsorbed vaccines from three different producers can cause long-lasting, intensely itching nodules and hypersensitivity to aluminium.
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| 2. |
- Bergfors, Elisabet, 1945, et al.
(författare)
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Nineteen cases of persistent pruritic nodules and contact allergy to aluminium after injection of commonly used aluminium-adsorbed vaccines.
- 2005
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Ingår i: European journal of pediatrics. - : Springer Science and Business Media LLC. - 0340-6199 .- 1432-1076. ; 164:11, s. 691-7
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Tidskriftsartikel (refereegranskat)abstract
- Rare cases of persistent pruritic nodules, sometimes associated with aluminium (Al) allergy, have been reported after the use of several Al adsorbed vaccines. During vaccine trials in the 1990s a high incidence of pruritic nodules (645 cases/76,000 recipients), in 77% associated with Al allergy, was observed after the administration of diphtheria-tetanus / acellular pertussis (DT/aP) vaccines from a single producer. In the present report 19 children with pruritic nodules after vaccination with Al hydroxide-adsorbed DTaP/polio+Hib (Infanrix, Pentavac) are described. The children had intensely itching nodules at the injection site, often aggravated during upper respiratory tract infections, and local skin alterations. So far, the symptoms have persisted for up to 7 years. The median time between vaccination and onset of symptoms was 1 month. 16 children were epicutaneously tested for Al, all with positive reactions indicating delayed hypersensitivity to Al. The condition is not commonly known but is important to recognise, as the child and the family may suffer considerably. Future vaccinations with Al-adsorbed vaccines may cause aggravation of the symptoms and the Al allergy. Al-containing skin products, such as antiperspirants, may cause contact dermatitis. Nodules may be mistaken for tumours. Even though the incidence of itching nodules and Al allergy after administration of Infanrix, Pentavac and other Al-adsorbed vaccines is probably low, research to replace Al adjuvants seems appropriate. We conclude that intensely itching subcutaneous nodules, lasting for many years, and hypersensitivity to aluminium may occur after DTaP/polio+Hib vaccination of infants.
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| 3. |
- Lapidus, L, et al.
(författare)
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Alcohol intake among women and its relationship to diabetes incidence and all-cause mortality: the 32-year follow-up of a population study of women in Gothenburg, Sweden
- 2005
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Ingår i: Diabetes Care. ; 28, s. 2230-2235
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Tidskriftsartikel (refereegranskat)abstract
- Department of Primary Health Care, Sahlgrenska Uni, Göteborg University, Box 454 S-405 30 Göteborg, Sweden. leif.lapidus@swipnet.se OBJECTIVE: The purpose of the study was to explore the predictive value of women's alcohol habits in relation to incidence of diabetes and all-cause mortality. Special attention was paid to potential confounding factors such as age, heredity, education, socioeconomic group, physical inactivity, smoking, blood pressure, serum lipids, and, in particular, obesity. RESEARCH DESIGN AND METHODS: A longitudinal population study consisting of a representative sample of 1,462 women aged 38-60 started in Göteborg, Sweden, in 1968-1969 monitoring for diabetes and mortality over 32 years. RESULTS: Alcohol intake, expressed as intake of wine, hard liquor, or total grams of alcohol, was significantly negatively associated to 32-year diabetes incidence independent of age. However, the apparently protective effect of the alcohol variables was attenuated when BMI was included as a covariate. The inverse relationship between wine intake and diabetes did not remain after adjustment for physical activity or socioeconomic group. Beer and wine intake were significantly negatively associated to mortality. Increase of alcohol intake between the examination in 1968-1969 and 1980-1981 was significantly inversely related to the mortality between 1980-1981 and 2000-2001 and independent of all covariates. No relationship was observed between an increase in alcohol intake and diabetes incidence. However, after adjustment for age, family history, and basal alcohol consumption altogether, a significant inverse relationship was observed between increase of alcohol and diabetes incidence. CONCLUSIONS: The initially significant inverse associations observed between alcohol and diabetes as well as mortality were dependent on a number of confounding factors, of which BMI seems to be the most important. PMID: 16123495 [PubMed - indexed for MEDLINE]
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| 4. |
- Trollfors, Birger, 1947, et al.
(författare)
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Diphtheria, tetanus and pertussis antibodies in 10-year-old children before and after a booster dose of three toxoids: implications for the timing of a booster dose.
- 2006
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Ingår i: European journal of pediatrics. - : Springer Science and Business Media LLC. - 0340-6199 .- 1432-1076. ; 165:1, s. 14-8
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Tidskriftsartikel (refereegranskat)abstract
- In an open study, 502 10-year-old children, who had received primary vaccination against diphtheria and tetanus in infancy and had varying histories of pertussis disease and vaccination, were vaccinated with diphtheria-tetanus vaccine (DT) alone or with the addition of 20 microg or 40 microg of pertussis toxoid. Diphtheria toxin neutralising antibodies, pertussis toxin IgG and tetanus toxoid IgG antibodies were measured before and 1 month after the booster. All toxoids were highly immunogenic. In pertussis toxoid recipients, median levels of pertussis toxin IgG increased to 16.5 U/ml (DTaP20) and to 36 U/ml (DTaP40) in children with non-detectable (<1 U/ml) antibodies before vaccination and to >400 U/ml in children (both DTaP20 and DTaP40) with detectable antibodies before vaccination. A total of 60 children (12%) with non-detectable (<0.01 IU/ml) diphtheria antibodies and 36 children (7%) with non-detectable (<0.01 IU/ml) tetanus antibodies before the booster had lower median antibody concentrations post-vaccination than children with detectable antibodies before the booster (diphtheria: 5.12 vs. 20.48 IU/ml; tetanus: 4.0 vs. 10.0 IU/ml). There were no differences in diphtheria and tetanus antibodies after vaccination between children who did and did not receive pertussis toxoid. CONCLUSION: 10-year-old children with non-detectable diphtheria and tetanus antibodies before the booster had lower post-vaccination antibodies than those with detectable antibodies before the booster indicating a poor immunological memory. Addition of pertussis toxoid to diphtheria-tetanus vaccine did not affect the antibody responses to diphtheria and tetanus toxoids when the three toxoids were combined as a booster. Even though immunity to diphtheria and tetanus was only estimated by surrogate markers (serum antitoxin antibodies) the results indicate that a lower age for the booster dose of diphtheria-tetanus vaccine or diphtheria-tetanus acellular pertussis vaccine should be considered.
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