DIPHTHERIA: Now let's compare that to the numbers below for Diphtheria cases .... posted on google by Myrl

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Interesting . . . What I wonder is, if these diseases are so rare now, why infants must be vaccinated? . . . If really necessary, why not wait until their little immune systems have had more time to mature? According to the figures presented at: http://www.whale.to/v/diptheria.htm, there were 68 Diphtheria vaccine deaths in the 29 years between 1919-1948 globally. Now let's compare that to the numbers below for Diphtheria cases: DIPHTHERIA At one time, diphtheria was common in the United States. More than 200,000 cases, primarily among children, were reported in

1921. Approximately 5%-10% of cases were fatal; the highest case-fatality ratios were recorded for the very young and the elderly. Reported cases of diphtheria of all types declined from 306 in 1975 to 59 in 1979; most were cutaneous diphtheria reported from a single state (3). After 1979, cutaneous diphtheria was no longer notifiable. From 1980 to 1989, only 24 cases of respiratory diphtheria were reported; two cases were fatal, and 18 (75%) occurred among persons greater than or equal to 20 years of age. Diptheria is currently a rare disease in the United States primarily because of the high level of appropriate vaccination among children (97% of children entering school have received greater than or equal to three doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP)) and because of an apparent reduction in the

circulation of toxigenic strains of Corynebacterium diphtheriae. Most cases occur among unvaccinated or inadequately vaccinated persons. The age distribution of recent cases and the results of serosurveys indicate that many adults in the United States are not protected against diphtheria. Limited serosurveys conducted since 1977 indicate that 22%-62% of adults 18-39 years of age and 41%-84% of those greater than or equal to 60 years of age may lack protective levels of circulating antitoxin against diphtheria (4-7). Thus, it appears that further reductions in the incidence of diphtheria would require more emphasis on adult immunization programs. Both toxigenic and nontoxigenic strains of C. diphtheriae can cause disease, but only strains that produce toxin cause myocarditis and neuritis. Furthermore, toxigenic strains are more often associated with severe or fatal illness in noncutaneous

(respiratory or other mucosal surface) infections and are more commonly recovered in association with respiratory than from cutaneous infections. C. diphtheriae can contaminate the skin, usually at the site of a wound. Although a sharply demarcated lesion with a pseudomembranous base often results, the appearance may not be distinctive, and infection can be confirmed only by culture. Usually other bacterial species can also be isolated. Cutaneous diphtheria has most commonly affected indigent adults and certain groups of American Indians. A complete vaccination series substantially reduces the risk of developing diphtheria, and vaccinated persons who develop disease have milder illnesses.

Protection lasts at least 10 years. Vaccination does not, however, eliminate carriage of C. diphtheriae in the pharynx or nose or on the skin. TETANUS The occurrence of tetanus in the United States has decreased dramatically from 560 reported cases in 1947, when national reporting began, to a record low of 48 reported cases in 1987 (8). The decline has resulted from widespread use of tetanus toxoid and improved wound management, including use of tetanus prophylaxis in emergency rooms. Tetanus in the United States is primarily a disease of older adults. Of 99 tetanus patients with complete information reported to CDC during 1987 and 1988, 68% were greater than or equal to 50 years of age, while only six were less than 20 years of age. No cases of neonatal tetanus were reported. Overall, the case-fatality rate was 21% (8). The age distribution of recent cases and the results of serosurveys indicate that many U.S. adults are not protected against tetanus. Serosurveys undertaken since 1977 indicate that 6%-11% of adults 18-39 years of age and 49%-66% of those greater than or equal to 60 years of age may lack protective levels of circulating tetanus antitoxin (4-7). The disease continues to occur almost exclusively among persons who are unvaccinated or inadequately vaccinated or whose vaccination histories are unknown or uncertain (8).

Surveys of emergency rooms suggest that 1%-6% of all persons who receive medical care for injuries that can lead to tetanus receive less than the recommended prophylaxis (9,10). In 1987-1988, 58% of tetanus patients with acute injuries did not seek medical care for their injuries; of those who did, 81% did not receive prophylaxis as recommended by ACIP guidelines (8). In 4% of tetanus cases reported during 1987 and 1988, no wound or other condition was implicated. Nonacute skin lesions such as ulcers, or medical conditions such as abscesses were reported in association with 14% of cases. Neonatal tetanus occurs among infants born under unhygienic conditions to inadequately vaccinated mothers. Vaccinated mothers confer protection to their infants through transplacental transfer of maternal antibody. From 1972 through 1984, 29 cases of neonatal tetanus were reported in the United States (11). No cases of neonatal tetanus were reported in the period 1985-1989. Spores of Clostridium tetani are ubiquitous. Serologic tests indicate that naturally acquired immunity to tetanus toxin does not occur in the United States. Thus, universal primary vaccination, with subsequent maintenance of adequate antitoxin levels by means of appropriately timed boosters, is necessary to protect persons among all age-groups. Tetanus toxoid is a highly effective

antigen; a completed primary series generally induces protective levels of serum antitoxin that persist for greater than or equal to 10 years. PERTUSSIS Disease caused by Bordetella pertussis was once a major cause of infant and childhood morbidity and mortality in the United States (12,13). Pertussis became a nationally notifiable disease in 1922, and reports reached a peak of 265,269 cases and 7,518 deaths in 1934. The highest number of reported pertussis deaths (9,269) occurred in 1923. The introduction and widespread use of standardized whole-cell pertussis vaccines combined with diphtheria and tetanus

toxoids (DTP) in the late 1940s resulted in a substantial decline in pertussis disease, a decline which continued without interruption for nearly 30 years. By 1970, the annual reported incidence of pertussis had been reduced by 99%. During the 1970s, the annual numbers of reported cases stabilized at an average of approximately 2,300 cases each year. During the 1980s, however, the annual numbers of reported cases gradually increased from 1,730 cases in 1980 to 4,157 cases in 1989. An average of eight pertussis-associated fatalities was reported each year throughout the 1980s. It is not clear whether the increase in reported pertussis reflects a true increase in the incidence of the disease or improvement in the reporting of pertussis. However, these data underestimate the true number of cases, because many are unrecognized or

unreported, and diagnostic tests for B. pertussis -- culture and direct-immunofluorescence assay -- may be unavailable, difficult to perform, or incorrectly interpreted. Because direct- fluorescent-antibody testing of nasopharyngeal secretions has been shown in some studies to have low sensitivity and variable specificity, it should not be relied on as a criterion for laboratory confirmation (14,15). In addition, reporting criteria have varied widely among the different states. Laboratory diagnosis based on serologic testing is not widely available and is still considered experimental (16). In 1990, to improve the accuracy of reporting, the U.S. Council of State and Territorial Epidemiologists adopted uniform case definitions for pertussis (17). Before widespread use of DTP, less than 20% of cases and 50%-70% of pertussis deaths

occurred among children less than 1 year of age (13,18). For the period 1980-1989, 47% of reported illnesses from B. pertussis occurred among children less than 1 year of age, and 72% occurred among children less than 5 years of age; 61 (77%) of 79 deaths reported to CDC occurred among children less than 1 year of age (19). Infants less than 2 months of age were at highest risk of complications, with a case-fatality rate of 1.3%. Although incidence based on reported cases increased among all age-groups during the 1980s, the most striking increases occurred among adolescents and adults (19). Whether this represented a true increase or more complete recognition and reporting is not clear. Pertussis is highly communicable (attack rates of greater than 90% have been reported among unvaccinated household contacts) and can cause severe

disease, particularly among very young children. Of 10,749 patients less than 1 year of age reported nationally as having pertussis nationally during the period 1980-1989, 69% were hospitalized, 22% had pneumonia, 3.0% had greater than or equal to one seizure, 0.9% had encephalopathy, and 0.6% died (19). The high rate of hospitalization for infants with pertussis has been observed in several population-based studies (20-22). Because of the substantial risks of complications of the disease, completion of a primary series of DTP vaccine early in life is essential. Among older children and adults, including those previously vaccinated, B. pertussis infection may result in symptoms of bronchitis or upper-respiratory-tract infection. Pertussis may not be diagnosed because classic signs, especially the inspiratory whoop, may be absent.

Older preschool children and school-age siblings who are not fully vaccinated and who develop pertussis can be important sources of infection for infants less than 1 year of age. Adults also play an important role in the transmission of pertussis to unvaccinated or incompletely vaccinated infants and young children (23). Controversy regarding the safety of pertussis vaccine during the 1970s led to several studies of the benefits and risks of this vaccination during the 1980s. These epidemiologic analyses clearly indicate that the benefits of pertussis vaccination outweigh any risks (24-28). PREPARATIONS USED FOR VACCINATION Diphtheria and tetanus toxoids are prepared by formaldehyde treatment of the respective toxins and are standardized for potency according to the regulations of the U.S. Food and Drug Administration. The limit of flocculation (Lf) content of each toxoid (quantity of toxoid as assessed by flocculation) may vary among different products. The concentration of diphtheria toxoid in preparations intended for adult use is reduced because adverse reactions to diphtheria toxoid are apparently directly related to the quantity of antigen and to the age or previous vaccination history of the recipient, and because a smaller dosage of diphtheria toxoid produces an adequate immune response among adults. Pertussis vaccine is a suspension of inactivated B.

pertussis cells. Potency is assayed by comparison with the U.S. standard pertussis vaccine in the intracerebral mouse protection test. The protective efficacy of pertussis vaccines for humans has been shown to correlate with this measure of vaccine potency. Diphtheria and tetanus toxoids and pertussis vaccine, as single antigens or various combinations, are available as aluminum-salt- adsorbed preparations. Only tetanus toxoid is available in nonabsorbed (fluid) form. Although the rates of seroconversion are essentially equivalent with either type of tetanus toxoid, the adsorbed toxoid induces a more persistent level of antitoxin antibody. The following preparations are currently available in the United States: Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed (DTP) and Diphtheria and Tetanus Toxoids Adsorbed (DT) (for pediatric use) are for use among infants and children less than 7 years of age. Each 0.5-mL dose is formulated to contain 6.7-12.5 Lf units of diphtheria toxoid, 5 Lf units of tetanus toxoid, and less than or equal to 16 opacity units of pertussis vaccine. A single human immunizing dose of DTP contains an estimated 4-12 protective units of pertussis vaccine. Tetanus and Diphtheria Toxoids Adsorbed for Adult Use (Td) is for use among persons greater than or equal to 7 years of age. Each 0.5-mL dose is

formulated to contain 2-10 Lf units of tetanus toxoid and less than or equal to 2 Lf units of diphtheria toxoid. Pertussis Vaccine Adsorbed (P), * Tetanus Toxoid (fluid), Tetanus Toxoid Adsorbed (T), and Diphtheria Toxoid Adsorbed (D) ** (for pediatric use), are single-antigen products for use in special instances when combined antigen preparations are not indicated. ____________ Distributed by the Division of Biologic Products, Michigan Department of Public Health. Contact Dr. Myers, Chief, Division of Biologic Products, Bureau of

Laboratories and Epidemiological Services, Michigan Department of Public Health, Lansing, Michigan 48909 (telephone: 517-335-8120). http://www.cdc.gov/mmwr/preview/mmwrhtml/00041645.htm No virus found in this outgoing message. Checked by AVG. Version: 7.5.524 / Virus Database: 269.23.3/1391 - Release Date: 4/22/2008 8:15 AM