Extensive swelling reactions occurring after booster doses of diphtheria-tetanus-acellular pertussis vaccines

Rennels, Margaret B.

doi:10.1016/s1045-1870(03)00033-5

Cited by 81 publications

(49 citation statements)

References 19 publications

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“…Firstly, the overall results of this study are consistent with a series of previous reports (2,14,19,26) indicating relatively frequent local reactions to the preschool booster in children primed in infancy exclusively with the DTaP vaccine. Moreover, the findings are consistent with earlier reports suggesting that the preschool DTaP booster selectively increases levels of Th2-associated responsiveness to vaccine antigen, including both humoral (specific IgE antibody) and cellular immunity (24), and also with data suggesting that susceptibility to the Th2-trophic effects of DTaP is highest among children who are intrinsically "high Th2 responders" (4).…”

Section: Discussionsupporting

confidence: 91%

“…Notably, the occurrence of febrile reactions in a small proportion of DTwPvaccinated children (6,8,13) which are likely to be associated with cell-mediated responses to the vaccine has provided the impetus for development of the second-generation DTaP, and large-scale international trials have demonstrated efficacy with a significantly improved safety profile with this vaccine in infants (7, 16). However, more recent studies in older children suggest that the DTaP booster dose given at the end of the preschool years, given alone or in combination with inactivated polio vaccine, is relatively frequently associated with local side effects of redness and swelling at the injection site (2,14,19,26). The mechanism(s) underlying these local reactions is incompletely understood and has been variously suggested to result from the large amount of diphtheria toxoid in the vaccine (27) or a combination of vaccine antigenspecific immunoglobulin E (IgE) antibody (20, 24) and T helper 2 (Th2) cytokine production (24).…”

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confidence: 99%

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Th2-Associated Local Reactions to the Acellular Diphtheria-Tetanus-Pertussis Vaccine in 4- to 6-Year-Old Children

et al. 2005

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Acellular vaccines against diphtheria-tetanus-pertussis (acellular pertussis) (DTaP) are being progressively introduced into vaccination programs worldwide, with the aim of reducing T-helper 1 (Th1)-associated reactogenicity associated with the cellular diphtheria-tetanus-pertussis (whole-cell pertussis) (DTwP) vaccine. The DTaP vaccine has an improved safety profile in infants, but little information is available concerning the nature of the ensuing immunological memory in older children and how this may affect the reactogenicity of DTaP booster doses. We have addressed this question in the present study by assessing polyclonal and vaccine antigen-specific humoral and cellular immune responses to boosting with DTaP in 4-to 6-year-old children primed during infancy with DTaP (n ‫؍‬ 30) or DTwP (n ‫؍‬ 16) and by correlating these parameters, in particular cytokine responses, with expression of local side effects at the injection site. Large local reactions (>50-mm diameter) 24 to 72 h after receiving the DTaP booster occurred in 43% of exclusively DTaP-primed children, in contrast to 6% of children primed with DTwP. These reactions were associated with vigorous T helper 2 (Th2)-polarized memory responses to vaccine antigen exemplified by interleukin 5 (IL-5), IL-6, and IL-13 production and log-scale boosting of tetanus-specific immunoglobulin E and occurred most frequently among children who are intrinsically "high Th2 responders" as detected by in vitro responsiveness to polyclonal mitogen. Our findings suggest that priming during infancy with DTaP promotes stable, boostable Th2-polarized immunity against vaccine antigens, which in a significant subset of children is subsequently associated with local reactions at the booster site. The time course of these reactions suggests that the underlying mechanism involves reactivation of Th2-polarized cellular immune memory.Morbidity and mortality to infectious diseases are maximal during early infancy, and as a consequence, the pressure to develop an increasingly broad range of vaccines in progressively younger age groups is increasing. An archetypal example is the diphtheria-tetanus-pertussis (DTP) vaccine, which provides protection against pathogens responsible for severe illness and death in millions of children worldwide, and initiatives to introduce versions of this and other vaccines for use in neonates to provide protection during the crucial first months of life are well advanced in many centers (3,11,17,29).The primary consideration underpinning research and development in this area continues to be that of safety, and the first major shift in formulation of the DTP vaccine from the original combination of whole-cell pertussis combined with tetanus and diphtheria toxoids (DTwP) to the new-generation acellular version (DTaP) was driven precisely by this imperative. Notably, the occurrence of febrile reactions in a small proportion of DTwPvaccinated children (6,8,13) which are likely to be associated with cell-mediated responses to the vaccine has provided the imp...

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Th2-Associated Local Reactions to the Acellular Diphtheria-Tetanus-Pertussis Vaccine in 4- to 6-Year-Old Children

et al. 2005

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“…In countries with a recommendation for a pre-school booster against pertussis, the pre-school booster vaccination often represents a fifth dose of 'full-strength' diphtheriatetanus-pertussis (DTP) vaccine and is associated with increasing local reactogenicity [15,16,20]. Although the morbidity associated with local reactogenicity is very low [4,17], the potential exists to reduce reactogenicity by using reduced-antigen-content vaccines.…”

Section: Introductionmentioning

confidence: 99%

Booster vaccination and 1-year follow-up of 4–8-year-old children with a reduced-antigen-content dTpa-IPV vaccine

Sänger

Behre

Krause³

et al. 2007

Eur J Pediatr

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Reduced-antigen-content pertussis vaccines designed initially for booster vaccination of adolescents and adults can also be used to vaccinate pre-school age children. Combination vaccines, which reduce the number of administered injections, combine multiple antigens including inactivated poliovirus (IPV), which is recommended in this age group in some countries. This randomised, controlled study compared a combined diphtheria-tetanus-acellular pertussis-inactivated polio-containing booster vaccine, dTpa-IPV (Boostrix Polio, n=822), to separately administered dTpa (Boostrix) and IPV (IPV Mérieux, n=136) in 4-8-year-old children who had previously received four doses of DTPa. Additional serological assessment was performed 1 year after the booster dose. One month after vaccination, seroprotection/vaccine response rates were similar for both groups. At least 99.9% of the subjects had protective antibodies against diphtheria, tetanus and polio, and at least 90.1% had a vaccine response to pertussis antigens after dTpa-IPV. Reactogenicity of dTpa-IPV was comparable to dTpa + IPV. Fever and grade 3 loss of appetite occurred more commonly after dTpa-IPV, whereas swelling and grade 3 pain occurred more frequently after separately administered dTpa + IPV (P<0.05 for all). However, 95% CIs overlapped in all cases. Large swelling reactions after dTpa-IPV occurred less commonly than have been reported after a fifth dose of DTPa. One year after the booster, 98.6% of the subjects tested continued to have protective antibodies against diphtheria, tetanus and polio, and at least 81.2% were seropositive for pertussis components. The reduced-antigen-content dTpa-IPV vaccine was immunogenic, well tolerated and safe in pre-school age children. It provides immunity against four diseases in a single injection, with the potential reactogenicity benefit of a reduced-antigen dose.

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“…Indeed, swelling and redness >50 mm and fever of all intensity were reported significantly less frequently at the older age. These results are important as increasing reactogenicity with successive acellular pertussis booster doses that has been demonstrated during childhood [20][21][22] has been a concern for the feasibility of repeated acellular pertussis booster doses in older age groups. The results of the present study are in line with those observed in another study in which 10-12 year old children received a sixth acellular pertussis vaccine dose…”

Section: Resultsmentioning

confidence: 99%

Repeated administration of a reduced-antigen-content diphtheria-tetanus-acellular pertussis and poliomyelitis vaccine (dTpa-IPV;Boostrix™IPV)

Knuf¹,

Vetter²,

Celzo³

et al. 2010

Human Vaccines

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Extensive swelling reactions occurring after booster doses of diphtheria-tetanus-acellular pertussis vaccines

Cited by 81 publications

References 19 publications

Th2-Associated Local Reactions to the Acellular Diphtheria-Tetanus-Pertussis Vaccine in 4- to 6-Year-Old Children

Th2-Associated Local Reactions to the Acellular Diphtheria-Tetanus-Pertussis Vaccine in 4- to 6-Year-Old Children

Booster vaccination and 1-year follow-up of 4–8-year-old children with a reduced-antigen-content dTpa-IPV vaccine

Repeated administration of a reduced-antigen-content diphtheria-tetanus-acellular pertussis and poliomyelitis vaccine (dTpa-IPV;Boostrix™IPV)

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