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AUGMENTATION DE L’INCIDENCE DE LA COQUELUCHE DANS LE MONDE ?. Diagnostic biologique plus performant Couverture vaccinale insuffisante Adoption des acellulaires dans de nombreux pays Moins efficace ? Durée de protection moins longue ? Modification des souches…vaccins moins efficaces.

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augmentation de l incidence de la coqueluche dans le monde
AUGMENTATION DE L’INCIDENCE DE LA COQUELUCHE DANS LE MONDE ?
  • Diagnostic biologique plus performant
  • Couverture vaccinale insuffisante
  • Adoption des acellulaires dans de nombreux pays
    • Moins efficace ?
    • Durée de protection moins longue ?
  • Modification des souches…vaccins moins efficaces
pourquoi vacciner contre la coqueluche
Pourquoi vacciner contre la coqueluche ?
  • Eradiquer la maladie : Non
  • Protéger d’une maladie grave chez le petit nourrisson +++
  • Protéger d’une maladie gênante chez le grand enfant et l’adulte +
  • Assurer une immunité de groupe protégeant contre les grandes épidémies +
pourquoi vacciner les adultes contre la coqueluche
Pourquoi vacciner les adultes contre la coqueluche ?
  • Eradiquer la maladie
  • Les protéger d’une maladie gênante, exceptionnellement grave
  • Les empêcher de contaminer les petits enfants
  • Assurer une immunité de groupe protégeant contre les grandes épidémies
review of randomized trials
Review of Randomized Trials
  • Conclusions
    • aP vaccines effective in preventing confirmed pertussis
      • Marginally less effective than the best wP vaccines
      • 1,2,3, and 5 component vaccines all effective
        • Notably, no resurgence in Denmark despite monocomoponent vaccine
    • No simple relationship between immunogenicity and efficacy
animal model
Baboon StudyAnimal Model

Attribution: Tod J. Merkel et al

Laboratory of Respiratory and Special Pathogens CBER/FDA

animal model baboon study
wP and aP both protective against diseaseAnimal Model (Baboon Study)

Attribution: Tod J. Merkel et al

Laboratory of Respiratory and Special Pathogens CBER/FDA

animal model baboon study1
aP did not prevent infectionAnimal Model (Baboon Study)

Attribution: Tod J. Merkel et al

Laboratory of Respiratory and Special Pathogens CBER/FDA

animal model baboon study2
Animal Model (Baboon Study)
  • aP did not prevent transmission

Attribution: Tod J. Merkel et al

Laboratory of Respiratory and Special Pathogens CBER/FDA

animal model baboon study3
Animal Model (Baboon Study)
  • Conclusions
    • Infection, wP, aP all protected against symptomatic disease
    • wP provided some sterilizing immunity
      • Less than natural infection
      • Induces Th1 and Th17 memory
    • aP did not prevent infection and transmission
      • Higher Th2 but lower Th1 and Th17 responses
      • Lack of mucosal immunity induction likely has role in pertussis resurgence

References

Warfel JM, Beren J, Kelly VK, Lee G, Merkel TJ. Nonhuman primate model of pertussis. Infect Immun 2012;80(4):1530-1536.

Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci 2014;111(2):787-792.

Warfel JM, Papin JF, Wolf RF, Zimmerman LI, Merkel TJ. Maternal and neonatal vaccination protects newborn baboons from pertussis infection. J Infect Dis 2014.

summary
Summary
  • Pertussis vaccination very effective in reducing disease
    • wP and aP both effective in reducing infant mortality
  • No evidence of broad resurgence at global level
    • Cyclic recurrent patterns of pertussis still observed
  • aP disease prevention
    • Lower initial efficacy and faster waning of immunity
    • Reduced impact on infection and transmission
    • Modelling and baboon data support hypothesis that wP to aP transition is associated with localized disease resurgence
si on veut prot ger les petits enfants
Si on veut protéger les petits enfants
  • Vaccination précoce +++ 6 semaines (moins)
  • Vaccination des femmes enceintes +++
  • Cocooning +