Seroprevalence of Pertussis in the Netherlands: Evidence for Increased Circulation of Bordetella pertussis

Background: In many countries, the reported pertussis has increased despite high vaccination coverage. However, accurate determination of the burden of disease is hampered by reporting artifacts. The infection frequency is more reliably estimated on the basis of the prevalence of high IgG concentrations against pertussis toxin (IgG-Ptx). We determined whether the increase in reported pertussis in the last decade is associated with an increase in the number of infections. Methodology/Principal Findings: In a cross-sectional population-based serosurveillance study conducted in 2006-07, from a randomly selected age-stratified sample of 7,903 persons, serum IgG-Ptx concentrations were analyzed using a fluorescent bead-based multiplex immuno assay. In 2006-07, 9.3 % (95%CI 8.5-10.1) of the population above 9 years of age had an IgG-Ptx concentration above 62.5 EU/ml (suggestive for pertussis infection in the past year), which was more than double compared to 1995-96 (4.0%; 95%CI 3.3-4.7). The reported incidence showed a similar increase as the seroprevalence between both periods. Conclusions: Although changes in the vaccination program have reduced pertussis morbidity in childhood, they have not affected the increased infection rate in adolescent and adult pertussis. Indeed, the high circulation of B. pertussis in the latte

Medical prevention of postoperative recurrence of Crohn\u2019s Disease: The state of the art

Post operative recurrence (POR) is for both patient and treating physician one of the most frustrating complications of Crohn\u2019s disease (CD). Conventional medications have been proven of little benefit to prevent POR. By contrast, anti-TNF agents do appear very effective to prevent this complication. Likely, their use may completely change the management paradigm of POR itself and of the native disease as well. Here we will briefly review the definition, the main modalities of diagnosis and the risk factors for POR. We will then focus on the various medications and approaches used to prevent POR and on possible long term strategies. We will then propose a potential algorithm and discuss some of the current open issues to prevent POR