Immunization against Pertussis: An Almost Solved Problem or a Headache in Public Health

Whooping cough or pertussis is a serious infectious disease of the human respiratory tract, caused by Gram-negative bacteria Bordetella pertussis and Bordetella parapertussisHU. The current pertussis vaccines may consist of dead cells of B. pertussis (whole cell pertussis vaccines—wPs) or purified antigens from the bacterium (acellular pertussis vaccines—aPs). The aPs are less reactogenic and have been widely used in developed countries for more than two decades, but their high cost of production makes them prohibitive for developing countries, and the accelerated rate of epidemic outbreaks has led to the hypothesis that aPs are less effective than the wP ones. Considering cost-effectiveness, some authors have pointed out questions about the possibility of reintroduction of wP vaccines into the primary doses of pertussis vaccination. The Butantan Institute in São Paulo, Brazil, developed a wP vaccine with low endotoxicity (Plow) obtained by chemical extraction of the lipooligosaccharide (LOS) fraction from the outer membrane of the bacterial cell, showing to be less reactogenic and equally immunogenic and protective as the traditional wP vaccine. The Plow may possibly be introduced into the vaccination schedule for immunization of adolescents and young adults in Brazil, an important epidemiological contribution to reducing the circulation of B. pertussis

Pesquisa de Escherichia coli enteropatogênica dos sorotipos clássicos e invasores e de Shigella, em fezes, pela técnica de imunofluorescência indireta

BV UNIFESP: Teses e dissertaçõe

Anticorpos anti-toxina termo-labil (LT) de Escherichia coli, em soros humanos, na cidade de São Paulo

BV UNIFESP: Teses e dissertaçõe

Detection of classic and invasive E. coli and Shigella serotypes in stools by indirect immunofluorescence

A imunofluorescência indireta (IFI) de sorotipos enteropatogênicos clássicos e invasores de E. coli e de Shigella foi comparada com os métodos tradicionais de coprocultura e soroaglutinação. Os resultados da IFI concordaram com os da coprocultura em 128 dos 140 casos testados para E. coli enteropatogênica (91%) e em 108 dos 112 testados para Shigella (96%). Todos os casos com reações positivas por coprocultura foram confirmados por IFI. No grupo controle, onde não haviam sido isolados tais patógenos por coprocultura, foram evidenciados por IFI, 12 casos com reações positivas para E. coli enteropatogênica e 4 para Shigella, incluindo-se 2 com infecção mista: E. coli 026/Sh. dysenteriae e E. coli 0124/Sh. dysenteriae. Foi discutida a alta sensibilidade e especificidade da IFI quando comparada aos métodos tradicionais, sendo sugerido o valor desta técnica em estudos epidemiológicos envolvendo os microrganismos em questão e sua importância no estabelecimento de diagnóstico precoce na diarréia infantil aguda.IIF in the detection of invasive and classic enteropathogenic E. coli and Shigella serotypes was compared with traditional coproculture methods. IIP results agreed with the coproculture findings in 128 out of 140 cases tested for enteropathogenic E. coli (91%) and in 108 out of 112 for Shigella (96%). All cases with positive reactions by coproculture were confirmed by IIP. In the control group it were obtained by IIF 12 cases with positive reactions for enteropathogenic E. coli and 4 cases for Shigella, including two cases of mixed infection by E. coli 026/Sh. dysenteriae and E. coli 0124/Sh. dysenteriae. It was discussed the high sensitivity and specificity of the IIF when compared with the traditional methods, being suggested that IIF is a valuable tool in epidemiological studies involving these organisms and an important aid in the stablishment of an early presumptive diagnosis of the acute infantile diarrhea

Vacinas pertussis acelular e pertussis "low": eventos adversos e o papel das mutações

Objective: to discuss the current PAHO recommendation that does not support the substitution of traditional cellular DTP vaccine by acellular DTP, and the role of mutations, in humans, as the main cause of rare adverse events, such as epileptic-like convulsions, triggered by pertussis vaccine.\ud Data review: the main components related to toxic effects of cellular pertussis vaccines are the lipopolysaccharide of bacterial cell wall and pertussis toxin. The removal of part of lipopolysaccharide layer has allowed the creation of a safer cellular pertussis vaccine, with costs comparable to the traditional cellular vaccine, and which may be a substitute for the acellular vaccine.\ud Conclusion: The new methodology introduced by Instituto Butantan allows for the development of a new safer pertussis vaccine with low LPS content (Plow), and the use of the lipopolysaccharide obtained in the process in the production of monophosphoryl lipid A. This component has shown potent adjuvant effect when administered together with influenza inactivated vaccine, making possible to reduce the antigen dose, enhancing the production capacity and lowering costs.Objetivo: Discutir as recomendações da WHO-OPAS que não consideram indicada a substituição da vacina DTP celular clássica pela DTP acelular e o papel de mutações, em humanos, como principal causa dos raros eventos de convulsões epileptiformes desencadeadas pela vacina pertussis.\ud Revisão dos dados: Os principais componentes relacionados aos efeitos tóxicos da vacina pertussis celular são o lipopolissacarídio da parede celular da bactéria e a toxina pertussis. A remoção de parte da camada lipopolissacarídica permitiu a criação de uma vacina pertussis celular, mais segura e de custo comparável ao da vacina celular tradicional, podendo substituir a vacina pertussis acelular.\ud Conclusão: A nova vacina pertussis, com baixo teor de LPS (Plow) desenvolvida pelo Instituto Butantan, além de oferecer uma vacina mais segura, permite o aproveitamento do lipopolissacarídeo para a produção de monofosforil lipídeo A. Esse componente mostrou-se potente como adjuvante e altamente eficiente quando administrado com a vacina de influenza, levando à possibilidade de se reduzir a dose de antígeno, aumentando a capacidade de produção e redução dos custos