Keywords
Vaccine
Booster
Abstract
Available epidemiological data shows that an average number of 59 cases of tetanus per year are still reported in Italy. Most of cases (80.2%) occur in subjects > 64 years-old. Furthermore, the proportion of females among subjects ≥ 65 years-old is significantly higher than males (87.7% vs. 64.4%, p < 0.0001). Seroprevalence data show that the percentage of subjects with protective tetanus antibody levels (> 0.1 IU/ml) decreases with increasing age. Most people aged ≥ 65 years are unprotected. The antibody levels are higher in males than females (p < 0.001) in subjects > 25 years-old.
Conversely, extensive childhood immunization and adequate boosting vaccination of adults led to the near-elimination of diphtheria in Western countries.
The current Italian National Immunization Prevention Plan 2012-2014 recommends the administration of a primary vaccine course in the first year of life and booster at the preschool age, in adolescents and in adults every 10 years. Nevertheless, the need for decennial booster doses is debated by some experts, who state that the best time to offer a single dose of vaccine against tetanus and diphtheria is the age of 50, since low levels of antibody titers are observed.
Considering the availability of combined vaccines against diphtheria, tetanus and pertussis (DTaP or dTaP), and the increasing incidence of pertussis in infants, who are at highest risk of serious complications, in adolescents and in adults, some countries have introduced decennial dTaP in the adults immunization schedule. It is desirable that this recommendation is also introduced in the future Italian Immunization Prevention Plan.
The present review overviews the epidemiological data and the immunization strategies against tetanus, diphtheria and pertussis in Italy, discussing the rationale not only of decennial dT booster but also of the dTaP booster.
References
Centers for Disease Control and Prevention , author. The Pink Book: Course Textbook. Chapter 20. 12th Edition. 2012. May, Epidemiology and Prevention of Vaccine-Preventable Disease. Second Printing. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/index.html (Accessed 28/02/2015).
Mandolini D, Ciofi degli Atti M, Pedalino B, et al. Epidemiology of tetanus in Italy. BEN – Notiziario ISS. 2002;15(3)
Abrutyn E. Tetanus. In: Harrison's Principles of Internal Medicine. Chapter 133, Section 5. 17th ed. Fauci A, Longo DL, Braunwald E, et al., editors. New York: McGraw Hill Professional; 2008. [Google Scholar]
Bishai WR, Murphy JR. Diphtheria and Other Infections Caused by Corynebacteria and Related Species. In: Fauci A, Longo DL, Braunwald E, et al., editors. Harrison's Principles of Internal Medicine. Chapter 131, Section 5. 17th ed. New York: McGraw Hill Professional; 2008. [Google Scholar]
Centers for Disease Control and Prevention , author. The Pink Book: Course Textbook. Chapter 6. 12th Edition. 2012. May, Epidemiology and Prevention of Vaccine-Preventable Disease. Second Printing. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/index.html (Accessed 28/02/2015).
European Centre for Disease Prevention and Control , author . Annual epidemiological report 2014. Stockholm: ECDC; 2014. Available from: http://www.ecdc.europa.eu/en/publications/Publications/AER [Google Scholar]
Centers for Disease Control Prevention (CDC) , author . Tetanus surveillance – UnitedStates, 2001-2008. MMWR Morb Mortal Wkly Rep 2011;60:365. [Google Scholar]
Australian Government Department of Health and Ageing , author . Vaccine preventable diseases in Australia, 2005-2007. Communicable Diseases Intelligence 2010;34(3). Available from: http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda [Google Scholar]
Quinn HE, McIntyre PB. Tetanus in the elderly--An important preventable disease in Australia.. Vaccine 2007;25(7):1304-1309. Available from: http://www.scholaruniverse.com/ncbi-linkout?id=17055128 PubMed PMID: 17055128. doi: 10.1016/j.vaccine.2006.09.084. [Google Scholar]
Filia A, Bella A, von Hunolstein C, Pinto A, Alfarone G, Declich S, et al. Tetanus in Italy 2001-2010: a continuing threat in older adults.. Vaccine 2014;32(6):639-644. Available from: http://www.diseaseinfosearch.org/result/7033 PubMed PMID: 24370712. doi: 10.1016/j.vaccine.2013.12.012. [Google Scholar]
Galazka AM, Robertson SE. Diphtheria: changing patterns in the developing world and the industrialized world.. Eur J Epidemiol 1995;11(1):107-117. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 7489768. doi: 10.1007/BF01719955. [Google Scholar]
Italian National Institute of Statistics (ISTAT) , author. Diphtheria Official Notification Data. Years 1939-1994.
Bergamini M, Comodo N, Gasparini R, Gabutti G, Fabrizi P, Severini R, et al. Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population. Vaccine 1999;17(3):286-290. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 9987165. doi: 10.1016/S0264-410X(98)00053-X. [Google Scholar]
Salisbury D, Ramsay M. Immunization against infectioius disease – the "Green Book". Department of Health; 2013. Available at: https://www.gov.uk/government/publications/immunisation-against-infectious-disease-the-green-book-front-coverand-contents-page (Accessed 28/02/2015).
Gabutti G, Trucchi C, Conversano M, et al. . Booster vaccination: the role of reduced antigen content vaccines as a preschool booster. Biomed Res Int. 2014; 2014. [Google Scholar]
Ministry of Health , author. National Immunization Prevention Plan 2012 - 2014Piano Nazionale Prevenzione Vaccinale (PNPV) 2012-2014. Gazzetta Ufficiale. n. 60. 12 Mar 2012. Italian. Available at: https://www.salute.gov.it/imgs/C_17_pubblicazioni_1721_allegato.pdf (Accessed 25/02/2015).
Advisory Committee on Immunization Practices (ACIP) , author . Notice to Readers Assessing Adult Vaccination Status at Age 50 Years. MMWR Morb Mortal Wkly Rep 1995;44(29):561. [Google Scholar]
Wagner KS, White JM, Andrews NJ, Borrow R, Stanford E, Newton E, et al. Immunity to tetanus and diphtheria in the UK in 2009. Vaccine 2012;30(49):7111-7117. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 23022148. doi: 10.1016/j.vaccine.2012.09.029. [Google Scholar]
Australian Government Department of Health and Ageing , author. Australian immunization handbook. 10th ed. 2013. Available at: http://www.health.gov.au/internet/immunise/publishing.nsf/Content/EE1905BC65D40BCFCA257B26007FC8CA/$File/handbook-Jan2014v2.pdf (Accessed 28/02/2015).
Siegrist C. [New Swiss recommendations for adult boosters against pertussis, tetanus and diphtheria].. Rev Med Suisse 2012 Jan;8(324):125-128. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 23185823. [Google Scholar]
Olander R, Auranen K, Härkänen T, Leino T. High tetanus and diphtheria antitoxin concentrations in Finnish adults--time for new booster recommendations?. Vaccine 2009;27(39):5295-5298. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 19596410. doi: 10.1016/j.vaccine.2009.06.080. [Google Scholar]
Gardner P. Issues related to the decennial tetanus-diphtheria toxoid booster recommendations in adults.. Infect Dis Clin North Am 2001;15(1):143-153. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 11301812. doi: 10.1016/S0891-5520(05)70272-5. [Google Scholar]
Balestra DJ, Littenberg B. Should adult tetanus immunization be given as a single vaccination at age 65? A cost-effectiveness analysis.. J Gen Intern Med 1993;8(8):405-412. Available from: http://www.diseaseinfosearch.org/result/7033 PubMed PMID: 8410405. doi: 10.1007/BF02599616. [Google Scholar]
Mathias RG, Schechter MT. Booster immunisation for diphtheria and tetanus: no evidence of need in adults.. Lancet 1985 May;1(8437):1089-1091. Available from: http://www.diseaseinfosearch.org/result/2292 PubMed PMID: 2860299. [Google Scholar]
Gonçalves G, Santos MA, Frade JG, Cunha JS. Levels of diphtheria and tetanus specific IgG of Portuguese adult women, before and after vaccination with adult type Td. Duration of immunity following vaccination. BMC Public Health 2007;7(1):109. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-109 PubMed PMID: 17565697. doi: 10.1186/1471-2458-7-109. [Google Scholar]
Gardner P, LaForce FM. Protection against tetanus. N Engl J Med 1995;333(9):599-600. Available from: http://www.nejm.org/doi/abs/10.1056/NEJM199508313330916 doi: 10.1056/NEJM199508313330916. [Google Scholar]
Kretsinger K, Broder KR, Cortese MM, Joyce MP, Ortega-Sanchez I, Lee GM, et al. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel.. MMWR Recomm Rep 2006 Dec;55(RR-17):1-37. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm PubMed PMID: 17167397. [Google Scholar]
Gabutti G, Rota MC. Pertussis: a review of disease epidemiology worldwide and in Italy.. Int J Environ Res Public Health 2012;9(12):4626-4638. Available from: http://europepmc.org/abstract/MED/23330226 PubMed PMID: 23330226. doi: 10.3390/ijerph9124626. [Google Scholar]
Elomaa A, He Q, Minh NNT, Mertsola J. Pertussis before and after the introduction of acellular pertussis vaccines in Finland. Vaccine 2009;27(40):5443-5449. Available from: https://www.nlm.nih.gov/medlineplus/whoopingcough.html PubMed PMID: 19628060. doi: 10.1016/j.vaccine.2009.07.010. [Google Scholar]
Clark TA, Messonnier NE, Hadler SC. Pertussis control: time for something new. Trends Microbiol 2012;20(5):211-213. Available from: https://www.nlm.nih.gov/medlineplus/whoopingcough.html PubMed PMID: 22494804. doi: 10.1016/j.tim.2012.03.003. [Google Scholar]
Clark TA. Changing pertussis epidemiology: everything old is new again.. J Infect Dis 2014 Apr;209(7):978-981. Available from: http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=24626532 PubMed PMID: 24626532. doi: 10.1093/infdis/jiu001. [Google Scholar]
Chiappini E, Stival A, Galli L, de Martino M. Pertussis re-emergence in the post-vaccination era. BMC Infect Dis 2013;13(1):151. Available from: http://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-151 PubMed PMID: 23530907. doi: 10.1186/1471-2334-13-151. [Google Scholar]
Gabutti G, Azzari C, Bonanni P, Prato R, Tozzi AE, Zanetti A, et al. Pertussis. Hum Vaccin Immunother 2014 Nov;11(1):108-117. Available from: http://europepmc.org/abstract/MED/25483523 PubMed PMID: 25483523. doi: 10.4161/hv.34364. [Google Scholar]
SItI, FIMP, SIP and SIMMG. Calendario per la vita (Lifetime Vaccination Calendar). 2nd ed. 2014. Available at: http://www.vaccinarsi.org/assets/uploads/files/359/Calendario_per_la_vita_2014_FINALE.pdf (Accessed 28/02/2015).
Centers for Disease Control and Prevention (CDC) , author . Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged < 12 month – Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011;60(41):1424-1426. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm PubMed PMID: 22012116. [Google Scholar]
Committee on Obstetrics Practice , author . Committee Opinion: update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Obstet Gynecol 2012;119:690. [Google Scholar]