Vaccin coqueluche
La coqueluche est une infection bactérienne des voies respiratoires avec peu ou pas fébrile des voies respiratoires inférieures, mais en changeant de long et très contagieuse. Deux types de Bordetella pertussis bactéries sont responsables des syndromes chez l’homme: Bordetella pertussis et Bordetella parapertussis.
Il s’agit d’une longue maladie (de quatre à huit semaines après une période d’incubation d’une semaine) et difficile (caractérisée par une toux violente qui paroxysme évoque le coq).
Traitements
Cure
Le traitement est avant antibiotiques (macrolides) dans les 3 premières semaines d’évolution. Ils aident à éliminer la présence de bactéries dans les sécrétions et donc de réduire l’infectiosité rapidement.
Dans les exclusions scolaires France qui a été 30 jours depuis le début de la phase clinique, a été réduit à cinq jours après le début des antibiotiques en Novembre 2006.
Administré au début, au début de la phase catarrhale, le traitement peut parfois réduire la maladie ou d’éviter la phase des quintes et de limiter la transmission à l’environnement, en réduisant le réservoir. Cela nécessite le début du traitement de la suspicion de la maladie, sans attendre la confirmation de laboratoire.
Il est également recommandé un traitement préventif aux antibiotiques chez les personnes à risque de l’érythromycine. C’est la même chose pour tout le monde dans l’entourage du patient quel que soit l’âge ou le statut vaccinal.
L’hospitalisation est justifiée pour les enfants de moins de 6 mois lorsque la coqueluche est grave. Elle permet d’établir un système de suivi et des soins infirmiers cardio-respiratoires adaptés durant la phase aiguë.
Une forme particulière et grave: la coqueluche infantile
50% de la coqueluche surviennent avant l’âge d’un an. Il n’ya pas de protection immunitaire de la mère à fetus.From la période néonatale et chez un enfant non vacciné, le risque de contamination de l’environnement, frères et sœurs, ou les parents atteints de coqueluche typique et non identifiés de haut.
Toute la coqueluche chez un nouveau-né ou d’une hospitalisation mandat dans un milieu spécialisé avec une surveillance constante et la surveillance cardio-respiratoire.
Le vaccin contre la coqueluche en France pour la première fois la vaccination est un vaccin appelé ‘cellule entière ou’ comme étant composé de suspensions bactériennes de Bordetella pertussis inactivées par la chaleur. La tolérance clinique est pauvre: réactions inflammatoires locales dans 40% des cas, une forte fièvre pointes, etc.
Un type de vaccin acellulaire purifié a été développé.Il est beaucoup mieux tolérée, mais donne peut-être plus court de l’immunité. Actuellement, il est utilisé en France pour un rappel à 18 mois et 6 ans.
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Dans les populations vaccinées écrasante majorité, la population les plus vulnérables et presque tous les décès se produisent chez les nourrissons de moins d’un an, tandis que chez les populations non vaccinées, la maladie affecte aussi les enfants et les nourrissons plus âgés. La coqueluche est une maladie qui peut entraîner la mort du patient en danger la vie peut se produire dans quelques jours si le traitement approprié n’est pas nécessaire.
Vaccination
Dans les années 2000, la coqueluche a été l’une des maladies pour lesquelles des vaccins existent, les plus difficiles à éliminer. Il peut en outre être particulièrement grave pour les nourrissons non vaccinés, dans laquelle la mère ne transmet ses anticorps.
C’est pourquoi nous recommandons aux parents jeunes pour être vaccinés, ne pas contaminer leurs enfants d’être vaccinés à partir de 2 mois. Le rapport bénéfice / risque a été évalué, il est en faveur de la vaccination.
La vaccination contre la coqueluche a été développée aux États-Unis dans les années 1940.En France, le premier vaccin contre la coqueluche a été introduit en 1959 (Vaxicoq) et la vaccination s’est généralisée à partir de 1966 grâce à la combinaison avec d’autres vaccins contre la diphtérie, le tétanos et la poliomyélite (DTP et Tetracoq) en 1995, le vaccin contre la coqueluche a été combiné avec le composant Haemophilus influenzae ( Pentacoq). [L’association des vaccinations non obligatoires vaccination obligatoire contre la coqueluche n’est pas sans implications juridiques.] Maintien d’une couverture vaccinale élevée a considérablement réduire la morbidité et la mortalité coqueluche.
Les deux types de vaccins sont tous deux largement utilisés dans les pays occidentaux. Le deuxième vaccin a moins d’effets secondaires que la première mais elle donne une immunité plus faible. Certains pays utilisent donc le vaccin à germes entiers pour la primo-vaccination et les doses de vaccin de rappel acellulaire chez les groupes plus âgés. D’autres, comme l’Allemagne et la Suède, utilisent à la fois le vaccin acellulaire pour la primovaccination et pour les rappels.
Ces vaccins sont administrés en trois injections à 2, 3 et 4 old.However mois, compte tenu de l’immaturité du système immunitaire des nourrissons, il ne confère pas d’immunité pour corriger seulement 4-6 mois. Cette population des nourrissons trop jeunes pour être complètement vaccinés pose de sérieux problèmes.Ils sont contaminés 3-5 fois sur 10 par leur famille, qui recherche un nouveau vaccin. Les rappels sont ensuite recommandé à 18 mois et d’autres à quatre ans.
En France, un vaccin tétravalent contenant une dose de vaccin anticoquelucheux acellulaire est destiné aux adolescents et aux adultes pour les rappels. En effet, suite à la résurgence de la coqueluche, la fin d’un rappel est recommandé à 11-13 ans depuis 1998. De même, depuis 2004, ce rappel est également recommandé pour les jeunes parents, les personnes à risque et le personnel de santé en contact avec des nouveau-nés.
Contre-indications
New vaccination schedule for 2005 young and old.The purpose of vaccination is to protect the person vaccinated against the disease which it has been vaccinated, through its immune system, that is to say by increasing its specific antibodies. The duration of immunity gained varies from one person to another. Vaccine is preferably against diseases for which there is no satisfactory treatment and because of which, in some cases, the condition can be fatal or cause serious sequelae. As you probably noticed, a generation of children to another, from one doctor to another, data and recommendations made vaccines are not the same. This does not mean that both are right and others wrong. Many studies are done, that bring objective benchmarks and progressively changing our habits. We will rely on his studies to explain the new calendar vaccinal.La vaccination against tuberculosis. Vaccination against tuberculosis (BCG) is compulsory for children under 6 years and before the entry into community (school nurse).It must be made within the first month of life in children exposed to increased risk of tuberculosis (context precarious living relative or family member affected by this disease). The tuberculin skin test involves injecting product under the skin, to verify the quality of immunization can be done once, but has no reason to be répété.Seules occupations at risk should undergo a tuberculin test prior to any hiring. To understand these new provisions and in particular the disappearance of tuberculin tests in the context of assessing the quality of immunization against, you should know that a portion of the population does not respond to these tests: Studies have shown that regardless of the outcome of these tests, 15% of recipients do not mount their antibodies against tuberculosis, irrespective of the number of vaccinations that they fasse.La immunization against tetanus. It is made at the 2nd month of life, by 3 successive vaccinations spaced 1 month.Follow revaccinated one year later and then revaccination every 5 years to adolescence, from 18 years, revaccination is done every 10 years.In the case of delay in infants or young subjects, he n is not necessary to repeat all immunizations, they simply resumed where they were arrested. Example: a baby who has been at the age of 1 year as the first vaccine to undergo the second as soon as possible, then the third a month later, then the official of the year at 16-18 months. The following will be at the age of 6-7 ans.Après 18 years, the vaccine will be every 10 years. In case of major delays, there is no vaccination total redo as if the last date of vaccine over 15 years. These protocols and tolerance around the delays stem from the fact that vaccination antibody levels resulting in these situations are sufficient to ensure immunity. Tetanus vaccine may be commonly associated in the same syringe to vaccines for pertussis, diphtheria, haemophilus influenzae B’s, hepatitis B. Associations will vary by age.Vaccination against whooping cough. Vaccination against whooping cough accompanies that of tetanus in infant. Given the duration of acquired immunity, it is no longer appropriate to recall the 6 ans.Il is then recommended that a booster every 10 years from the tetanus booster of 11-13 years. A pregnancy test will be done in women because the vaccine must be made in case of pregnancy. Pertussis is a serious disease especially in infants, father, brothers and sisters should, if they are not up to date on their vaccine be vaccinated during pregnancy of the mother. The mother will be vaccinated at the end of pregnancy. Even in case of delay important vaccine, one dose is enough to immuniser.La vaccination against diphtheria. Throughout life, this vaccination protocol follows exactly the same as immunization against tetanus. There is associated in the same seringue.La vaccination against Haemophilus influenzae B. This follows exactly the same immunization protocol as the tetanus vaccination up to age 16-18 months included, then there is no need to do.There is associated in the same seringue.La vaccination against hepatitis B. Although no study has demonstrated his dangerousness in absolute terms, it is still very controversial in adults. By cons in children, there has never been a case of neurological disease described secondairement.Actuellement United States, there has been an upsurge in hepatitis B, cirrhosis and cancer associated therewith. Immunity is acquired after 3 injections. We respect a delay of 1 month between the first two, then 6 to 12 months between the second and third. There is no need to make other points. For people at high occupational risk control immunity every 10 years by determining HBs antibodies specific to the vaccine. We do revaccination if the antibody level is insufficient. For infants, it can combine in one syringe vaccinations for hepatitis, tetanus, pertussis, diphtheria, haemophilus influenzae B’s It is advisable to have this vaccination in infancy, immunity is final and no vaccine risk.In adults, it can not vaccinate people with relatives suffering from neurological disease multiple sclerosis type. Vaccinations against measles, mumps, rubella. These vaccinations are associated in the same syringe. The first injection will be around the age of 9 months. The second will be at 24 months. Whatever their age, these vaccines must be made at least 2 times, with a reservation about the pregnancy: rubella vaccine may be dangerous to the fetus. A preliminary test of pregnancy should be done before any vaccination. It should avoid becoming pregnant during the 2 months after the vaccination (birth control). Vaccination against chickenpox. This vaccination is recommended for persons in contact with immunocompromised people (AIDS, chemotherapy, bone marrow X). The interest is to avoid exposure of immunocompromised persons to varicella virus. Vaccination is also recommended for adults who have never had chickenpox and come into contact with infected individuals.Any vaccination in women of childbearing age must be preceded by a test grossesse.Les vaccinations against pneumococcus. In young children: The objectives of anti-pneumococcal vaccination in children, are to reduce the resistance of pneumococci to antibiotics, and especially to reduce the risk of meningitis associated with these bacteria. In very young child under 2 years, the indication is a bit ambiguous: it concerns children with an illness putting them at high risk of pneumococcal infection (AIDS, aplastic anemia, renal failure, sickle cell homozygous etc. ..), but also children in contact with other children of different sibling, child with 3 brothers or sisters of preschool children who were breastfed less than two months by the mother. Thus formulated, the indication returns to vaccinate everyone or almost. This vaccination is optional. It is by 3 injections spaced at least 4 weeks. The duration of immunity is not known.We do not vaccinate older children because the number of cases of diseases controlled by this vaccine is much lower with these children, good health, were much less likely to be affected by pneumocoques.Chez adults: The pneumococcal vaccination is recommended every 5 years in patients at increased risk of infection: respiratory insufficiency, sickle cell homozygous, splenectomized,
and alcoholic liver disease, inadequate cardiaques.A noted that the vaccine for children is not the same as the vaccine for adults (seven different pneumococcal cons in the first 23 in the second, the second immunizing vaccine is less in duration). Vaccination against meningococcal group C. This vaccination only for persons with cases infected with this germ, people with more or no spleen (splenectomy), or with complement deficiencies or serum properdine.La vaccination can be generalized on authorities’ decision, in limited areas where the number of cases Meningococcal infection is abnormally high.
This infectious disease is caused by Bordetella pertussis (Bordet and Gengou bacillus), Gram-negative aerobic cultivation.
The World Health Organization estimates that each year 600,000 children die from the disease over 60 million are affected.
The organism multiplies in the respiratory ciliated epithelium of the trachea and bronchi. It broadcasts several specific toxins that cause disease: pertussis toxin is a disease
Contamination occurs from person to person by air (droplets of saliva during coughing), mainly in the catarrhal stage of the disease when clinical signs are not characteristic.
Contagiousness decreases rapidly with the paroxysmal phase, but may continue for 3 weeks. The source of contamination is mainly formed by the preschool or school, and also by adults and elderly patients whose symptoms are often misidentified. The attack rate is 70-80% if the contact is near.
The immunity is final after illness.The incidence of whooping cough in infancy was significantly decreased with the routine vaccination, not mandatory, infants. The pressure remains endemic: thanks to the phasing of vaccine immunity, older children and adults are often the darlings unidentified atypical and may be the source of contamination of newborns and infants unvaccinated.
Catarrhal stage, there are signs of nonspecific upper respiratory tract infection: rhinitis, sneezing, coughing, fever. This phase lasts 1-2 weeks. Cough, rebel, becomes progressively spasmodic, emetic (nausea giving) up to at night.
Typically, the fifth is defined as the succession of shocks of cough expiratory (5 to 20, closer and closer together), resulting in apnea of a few seconds in forced expiration (cyanosis), followed by a long inspiration – the ‘recovery ‘- and noisy (the’ whoop ‘) prelude to a new series of shocks expiratory … The cycle is repeated 5-15time and ends with mucous expectoration causing vomiting. There 15 to 30 fits in 24 hours. During the fifth, the face of the child is cyanotic, swollen, dilated veins of the face and neck. Followed by a phase of pallor with petechial purpura.
Then begins the phase of decline and recovery: the fits are less frequent and less intense. ‘Taking’ by cons, lasts longer. The sputum becomes mucopurulent and easier. This phase lasts 3 to 4 weeks. There is often several months the recurrence of transient recovery hacking cough with noisy ‘tic pertussis’ on behalf of non-specific respiratory infection.
Blood count: the paroxysmal phase: leukocytosis, which can reach 30 000 cells with high lymphocytosis blancs/mm3 60-90% (small mature B cells and T). Lymphocytosis may be absent in young children. No anemia. Sedimentation rate normal or moderately elevated. Hyper-plaquettose.