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There is a complex inter-relationship between nutrition and morbidity in human health. Many diseases reduce nutritional status, but on the other hand, having low nutritional status is also known to make individuals more susceptible to certain diseases and to more serious illness. Modern evidence on these relationships, determined after the introduction of antibiotics and vaccines, may not be applicable to historical settings before these medical technologies were available. This paper uses a historical cohort study based on records from the London Foundling Hospital to determine the causal effect of nutritional status of children, proxied by weight- and height-for-age Z-scores, on the odds of contracting five infectious diseases of childhood (measles, mumps, rubella, chicken pox and whooping cough) and on sickness duration from these diseases. I identify a causal effect by exploiting the randomisation of environmental conditions as foundling children were removed from their original homes, then fostered with families in counties nearby London and later returned to the Foundling Hospital's main site in London. I find no effect of nutritional status on the odds of contracting the five diseases, but I do find a historically important and statistically significant effect of nutritional status on sickness duration for measles and mumps. These findings have three implications. First, historical incidence of these diseases was unrelated to nutritional status, meaning that poor nutritional status during famines or during the Colombian Exchange did not affect the spread of epidemics. However, undernutrition in these events may have exacerbated measles severity. Second, improving nutritional status in the past 150 years would have reduced the severity of measles and mumps infections but not affect the decline in whooping cough mortality. Finally, selective culling effects from measles would be larger than those from whooping cough since whooping cough severity was not correlated with underlying nutritional status. [ABSTRACT FROM AUTHOR]

A retrospective cohort study was conducted to examine trends in the incidence and burden of pertussis among adults ≥50 years in South Korea, with/without pre-existing chronic obstructive pulmonary disease (COPD) or asthma. The nationwide Health Insurance Review and Assessment Service (HIRA) database was used to identify patients ≥50 years diagnosed with pertussis (2009–2018). Mean annual incidence of pertussis per 100 000 persons and overall mean incidence rate ratios (IRR) were calculated for patients with pre-existing COPD or asthma versus those with neither. Incremental healthcare costs (all-cause and pertussis-related) and healthcare utilisation (number of outpatient visits, emergency room visits, and number and length of hospitalisations) up to 12 months after, compared to 3 months before pertussis diagnosis, were also measured for each group (matched on sex, age, and Charlson Comorbidity Index). Of 1011 pertussis cases, 175 had asthma, 96 had COPD (not mutually exclusive), and 796 had neither. Overall mean pertussis incidence was 2.5, 3.4, and 0.5 for adults with pre-existing COPD, asthma, and those with neither. IRR (95% confidence interval) of pertussis for adults with pre-existing COPD and asthma was 4.9 (4.0–‍6.1) and 6.7 (5.7–7.9). Both COPD-pertussis and asthma-pertussis groups had higher mean incremental all-cause costs and length of hospitalisations than the general-pertussis group 3 months following pertussis diagnosis. In conclusion, individuals ≥50 years in South Korea with pre-existing COPD or asthma were at an increased risk of being diagnosed with pertussis and had higher healthcare resource utilisation than those without these conditions. [ABSTRACT FROM AUTHOR]

Despite the vaccination program's great effectiveness, pertussis outbreaks are still reported with substantial spatial heterogeneity. Thus, this study aimed to investigate the spatio-temporal patterns of pertussis to determine the hot spots with the high-risk transmission in Vietnam from 2015 to 2019. This study was designed as a cluster case study from December 2019 to October 2020 in Hanoi, Vietnam. Data on 564 pertussis cases were collected via the pertussis case report form of the national immunization program and disease surveillance system of the Hanoi Centers for Disease Control and Prevention (CDC) from 2015 to 2019. Knox Test was applied to assess the risk of spreading epidemics by space and time via a program running on R software. The pertussis incidence per 100 000 population was the highest in the inner city, with an average of 2.96/100000 in 2015. An area with an extremely high risk of infection was located within 200 meters away from the pertussis case and within 40 days, apart from the detecting time (Relative risk (RR) = 3 to 222). Sixty-two hot spot clusters were defined, mainly distributed in the inner city areas, while only a few risk clusters belonged to suburban districts. By using well-defined spatio-temporal distributions, a geographical area of high pertussis transmission risk was identified. Our findings play a fundamental part in developing the ongoing and comprehensive database to complete the disease surveillance system and design effective intervention measures. [ABSTRACT FROM AUTHOR]

The highly contagious whooping cough agent Bordetella pertussis has evolved as a human-restricted pathogen from a progenitor which also gave rise to Bordetella parapertussis and Bordetella bronchiseptica. While the latter colonizes a broad range of mammals and is able to survive in the environment, B. pertussis has lost its ability to survive outside its host through massive genome decay. Instead, it has become a highly successful human pathogen by the acquisition of tightly regulated virulence factors and evolutionary adaptation of its metabolism to its particular niche. By the deployment of an arsenal of highly sophisticated virulence factors it overcomes many of the innate immune defenses. It also interferes with vaccine-induced adaptive immunity by various mechanisms. Here, we review data from invitro, human and animal models to illustrate the mechanisms of adaptation to the human respiratory tract and provide evidence of ongoing evolutionary adaptation as a highly successful human pathogen. [ABSTRACT FROM AUTHOR]

Background: Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization for women during pregnancy (the so-called "maternal immunization") has been introduced in several countries, and recently also in Italy, to protect mother and fetus during pregnancy, infant in his first months of life and mother during postpartum period. However, very low vaccination coverage rates have been reached due to several variables.Methods: A literature search was conducted on PubMed and Embase, including any experimental or observational studies, to assesses existing evidence on the effectiveness, efficacy, safety and optimal timing of administration of Tdap and influenza immunization in pregnancy for mothers and their infants. The search was finalized in August 2019.Results: Reviewing the literature, we identified only a few studies that, among several maternal and infant outcomes, found sporadic significant associations with maternal influenza immunization and even less with Tdap immunization. Moreover, most of the authors of these studies explained these findings as a result of residual confounding effect. The effectiveness of maternal influenza immunization is more complicated to prove than the effectiveness of Tdap immunization because of several reasons. Not all nations recommend and offer vaccines in the same weeks of pregnancy and this one manifests the complexity in defining the best timing for Tdap or influenza immunization.Conclusions: The safety of maternal Tdap or influenza immunization is supported by the evidence so far, however, regular surveillance should be maintained, especially with regard to the influenza vaccine that changes in formulation each year. There is a need to optimize the timing of vaccination in pregnancy and to have a national system of detection of maternal immunization in each country. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) may increase the risk and severity of pertussis infection. Health care resource utilization (HCRU) and direct medical costs (DMC) of treating pertussis among patients with COPD are unknown. Reported incidence of pertussis among individuals aged ≥ 50 years with COPD was assessed in Clinical Practice Research Datalink and Hospital Episode Statistics databases during 2009–2018 using a retrospective cohort design. HCRU and DMC from the National Health Service perspective were compared between patients with COPD and pertussis and propensity score-matched patients with COPD without pertussis. Seventy-eight new pertussis events were identified among 387 086 patients with COPD aged ≥ 50 years (incidence rate: 4.73; 95% confidence interval 3.74–5.91 per 100 000 person-years). HCRU and DMC were assessed among 67 patients with COPD and pertussis and 267 matched controls. During the month before the pertussis diagnosis, the rates of general practitioner (GP)/nurse visits (4289 vs. 1774 per 100 patient-years) and accident and emergency visits (182 vs. 18 per 100 patient-years) were higher in the pertussis cohort; GP/nurse visits (2935 vs. 1705 per 100 patient-years) were also higher during the following 2 months (all p < 0.001). During the month before the pertussis diagnosis, annualized per-patient total DMC were £2012 higher in the pertussis cohort (£3729 vs. £1717; p < 0.001); during the following 2 months, they were £2407 higher (£5498 vs. £3091; p < 0.001). In conclusion, a pertussis episode among individuals with COPD resulted in significant increases in HCRU and DMC around the pertussis event. [ABSTRACT FROM AUTHOR]

The highly contagious whooping cough agent Bordetella pertussis has evolved as a human-restricted pathogen from a progenitor which also gave rise to Bordetella parapertussis and Bordetella bronchiseptica. While the latter colonizes a broad range of mammals and is able to survive in the environment, B. pertussis has lost its ability to survive outside its host through massive genome decay. Instead, it has become a highly successful human pathogen by the acquisition of tightly regulated virulence factors and evolutionary adaptation of its metabolism to its particular niche. By the deployment of an arsenal of highly sophisticated virulence factors it overcomes many of the innate immune defenses. It also interferes with vaccine-induced adaptive immunity by various mechanisms. Here, we review data from in vitro, human and animal models to illustrate the mechanisms of adaptation to the human respiratory tract and provide evidence of ongoing evolutionary adaptation as a highly successful human pathogen. [ABSTRACT FROM AUTHOR]

Globally, the agenda is to end tuberculosis (TB) by 2030. The emic (local) perspective about causes, signs and symptoms, and management of the disease has implications in service utilization and health-seeking. This research paper examines the local beliefs about TB and how this affects case detection and treatment. The analysis triangulates data from eight focus group discussions (N = 72), 15 in-depth interviews (IDIs) with patients with TB, and four traditional healers. TB described locally as Kɔrongkpong, kɔrongpilah (in Dagaare), and Kusibine (in Sissalla) is believed to be caused by curses, bewitchment, breaking local taboos, and a sin against the gods. The ethnosemantics depict TB as a condition of the lungs which presents with severe cough, caused by spiritual factors with fatal health outcome. In that regard, traditional medicine to exorcise the spirit is required before modern medicine can be effective. Initial symptoms such as cough and fever of TB are often self-managed and later traditional remedies sought. Furthermore, some of the signs are misconstrued for conditions such as asthma and whooping cough. The worldview of the community also dictates that these conditions have spiritual aetiologic factors and should be managed as such. This health-seeking pattern results in delays in receiving appropriate treatment. As an infectious disease, the delays in health-seeking will hinder progress towards achieving the end TB global agenda. Incorporating local beliefs into the design of interventions and social and behavioural change communication strategies can help improve case detection and treatment. [ABSTRACT FROM AUTHOR]

Pertussis, commonly known as 'whooping cough', can affect all age groups and occurs at any time during the year. The aim was to estimate the current health and economic burden of pertussis-associated disease in Bulgaria. We also analyzed the cost-benefit and financial consequences of introducing (since 1st January 2020) an acellular pertussis (acP) booster dose at the age of 12 into the immunization schedule of Bulgaria. A combined pharmacoeconomic (cost-benefit and budget impact analysis) and a population-based screening cohort study was performed. It included 202 women in reproductive age (20 to 39 years). Fifty-one percent had only one child and 49% had two or more children. Over 70% of all the 202 women had an average of 3.75 IU/mL IgG-anti-PT (indication for waning pertussis protection) and 1.5% had >100 IU/mL IgG-anti-PT, which indicate a recent infection. Bulgaria has low pertussis morbidity, as the reported cases are limited, compared to the the average in the European Union and there have been no death cases in the last 10 years. However, significant pertussis infections remain unreported but still occur in the adult population. An acP booster dose, at the age of 12, was projected to give significant potential savings from the reduced number of physician and hospitalization visits, ambulatory care and indirect costs. The budget impact of a booster dose was expected to decrease from 4.45 million BGN to 3.9 million BGN. The acP booster dose would lead annually to around 4.2 million BGN and avoid the active cases with seven. [ABSTRACT FROM AUTHOR]

Background: Recently, a resurgence of pertussis has been observed worldwide despite broad vaccination coverage. The purpose of this study was to identify the clinical characteristics and the aetiological agent of pertussis-like syndrome (PLS) in Eastern China. Methods: 1168 patients who were diagnosed with a suspected Bordetella pertussis in Shanghai Children's Hospital from 2013 to 2017 were included in the study. Clinical features and aetiologies were analysed. Aetiological analyses in sub-cohorts of age, seasons and years were also investigated. Results: 96.0% (1121) of the patients were less than 12 months old. 59.0% (689) of the patients were male. The Top 5 pathogens were respiratory syncytial virus (RSV; n = 125; 10.7%), Streptococcus pneumonia (SP; n = 109; 9.3%), Haemophilus influenzae type b (HIB; n = 86; 7.4%), Bordetella pertussis (B. pertussis; n = 84; 7.2%), and Mycoplasma pneumonia (MP; n = 80; 6.9%), respectively. The percentage of SP in the age group of 0–3 months was significantly lower than that in other age groups. The percentage of B. pertussis in the age group of 3–6 months was significantly lower than that in the group of 6-12 months. The percentage of MP in 0-3 months' group was significantly lower than that in >12 months group. RSV peaked in winter (n = 52), while HIB peaked in spring (n = 38). Conclusion: PLS occurred most often in infants. RSV, SP, HIB, B. pertussis, and MP were the most prevalent pathogens. Since patients with B. pertussis and other pathogens have similar clinical manifestations, diagnosis of pertussis should be based on both clinical symptoms and laboratory confirmation. [ABSTRACT FROM AUTHOR]

Background: Pertussis incidence has increased in recent decades despite childhood vaccination programs and high vaccination rates. To quantify the burden of pertussis, incidence, healthcare resource utilization, and costs among pertussis patients were estimated in a US managed care setting. Methods: Patients aged 0–64 years with evidence of pertussis (ICD-9-CM codes 033.0, 033.9, 484.3, ICD-10-CM codes A37.0, A37.9) and commercial insurance from 1 January 2006–12 December 2015 were identified. Incidence rates were calculated and standardized to the 2010 US Census on age, sex, and geographic region. Healthcare costs and resource utilization were compared between patients and matched comparators (health plan members without pertussis). Results: From 2006 to 2015, 11,378 pertussis cases were identified. Adjusted pertussis incidence was 15.55 cases per 100,000 person-years. Incidence was highest among infants and children; however, 59.0% of total cases were among adolescents or adults. Average adjusted healthcare costs per episode were 3.17 times higher among pertussis patients versus comparators ($5195 versus $1637, p <.001). Stratifying by age group, adjusted incremental healthcare costs per episode were $5581, $827, $700, $1429, $2530, and $4849 for patients aged <1 year, 1–6 years, 7–10 years, 11–19 years, 20–49 years, and 50–64 years, respectively. Conclusions: Managing pertussis is associated with substantial economic burden. Incidence rate estimates from this study were higher than CDC-reported rates; however, similar overall trends were observed. Although pertussis incidence has been declining since CDC-recommended vaccination for all adults in 2012, this study highlights the importance of continued management and prevention strategies, especially among adolescents and adults as they represent an important source of transmission to infants. [ABSTRACT FROM AUTHOR]

The mucosal immune system serves as the first line of defense against Bordetella pertussis. Intranasal vaccination, due to its potential to induce systemic and mucosal immune responses, appears to prevent the initial adherence and colonization of the bacteria at the first point of contact. In the present study, two B. pertussis antigens, pertussis Toxoid (PTd) and Filamentous hemagglutinin (FHA), which play a very significant role in virulence and protection against pertussis, were encapsulate into N-trimethyl chitosan (TMC) nanoparticulate systems. After preparation of TMC nanoparticles (NPs), the NPs were characterized and their ability to induce efficient immune responses against B. pertussis was studied in a mouse model. Our findings showed that PTd + FHA-loaded TMC NPs have strong ability to induce IL-4, IL-17, IFN-γ, IgG, and IgA in the mouse model. Results from this study suggest that nasal administration of the PTd + FHA-loaded TMC NPs induced not only a systemic immune response but also a local mucosal response, which may improve the efficacy of pertussis prevention through respiratory tract transmission. [ABSTRACT FROM AUTHOR]

Pertussis remains a serious global health issue in infants aged less than 6 months. Neonates and young infants have the highest risk of developing pertussis as they are too young to be vaccinated and thus are more likely to develop more severe pertussis-related complications, including death. Protecting this vulnerable age population from pertussis is considered a main priority in many national health programs. Two vaccine strategies exist to protect infants from pertussis: "cocooning" and maternal vaccination during pregnancy. The latter is the more recent and preferred strategy, which protects newborns by passive transplacental transfer of pertussis antibodies. We review the reported evidence on the safety, effectiveness, timing and implementation of this antenatal immunization strategy. [ABSTRACT FROM AUTHOR]

Background: Pertussis has caused several outbreaks and concern worldwide. Despite high vaccination coverage, people of all ages are still affected with significant morbidity and mortality. We aimed to analyse all pertussis hospitalizations in Portugal to help to delineate preventive policies. Methods: Data were collected from a Portuguese administrative database, which contains all registered hospitalizations in mainland Portugal. Cases were identified using the ICD-9-CM code 033.x (whooping cough) as principal or secondary diagnosis, with hospital discharges between 2000 and 2015. Data were analysed by age groups. Results: Of 2281 hospitalizations, 94% occurred in infants (<1 year). The mean and median ages were 20 and 2 months, respectively. A seasonal pattern was observed, with higher number of hospitalizations during the winter for infants, and during the summer for other age groups. Higher hospitalization rates were registered in the Southern regions. The mean and median lengths of hospital stay were 8 and 6 days, respectively. The main complications were acute respiratory failure and pneumonia. Invasive or non-invasive ventilation, or both, was required in 2.4, 1.8 and 0.6% of hospitalized cases, respectively. The overall inpatient case fatality rate was 0.7%; 0.8, 11.5 and 17.4% for the age groups 0-1 months, 18-64 years and ≥65 years, respectively. Total hospitalization costs were estimated to be 2,698,995€. Conclusion: Our study emphasizes the need to adopt new preventive strategies mainly focused on infants, to reduce morbidity and costs of hospitalizations related to pertussis. [ABSTRACT FROM AUTHOR]

Currently, in Morocco, the vaccination strategy includes a primary vaccination at 2, 3 and 4 months of age, completed by booster doses at 18 months and 5 years of age. Human rhinovirus (HRV)/human enterovirus (HEV), human metapneumovirus, human bocavirus, human coronavirus types OC43, 229E, NL63 and HKU1, I Bordetella pertussis, Chlamydia pneumoniae and Mycoplasma pneumoniae. i In our study, among children with I B. pertussis, i we found that 8 mothers were carriers of I B. pertussis. i Epidemiology of pertussis in Casablanca (Morocco): contribution of conventional and molecular diagnosis tools. [Extracted from the article]

Maternal antibodies induced by vaccination during pregnancy cross the placental barrier and can close the susceptibility gap to pertussis in young infants up to the start of primary immunization. As not only the quantity but also the quality of circulating antibodies is important for protection, we assessed whether maternal immunization affects the avidity of infant vaccine-induced IgG antibodies, in the frame of a prospective clinical trial on pregnancy vaccination in Belgium. Infants born from Tdap (Boostrix®) vaccinated (N = 55) and unvaccinated (N = 26) mothers were immunized with a hexavalent pertussis containing vaccine (Infanrix Hexa®) at 8, 12 and 16 weeks, followed by a fourth dose at 15 months of age. Right before and one month after this fourth vaccine dose, the avidity of IgG antibodies against diphtheria toxin (DT), tetanus toxin (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (Prn) was determined using 1.5 M ammonium thiocyanate as dissociating agent. In both groups, antibody avidity was moderate for TT, PT, FHA and Prn and low for DT after priming. After a fourth dose, antibody avidity increased significantly to high avidity for TT and PT, whereas it remained moderate for FHA and Prn and low for DT. The avidity correlated positively with antibody level in both study groups, yet not significantly for PT. When comparing both study groups, only PT-specific antibodies showed significantly lower avidity in infants born from vaccinated than from unvaccinated mothers after the fourth vaccine dose. The clinical significance of lower avidity of vaccine induced infant antibodies after maternal vaccination, if any, needs further investigation. [ABSTRACT FROM AUTHOR]

Background: The goal of our study was to compare the following two methods of assessment of pertussis post-vaccination immunity: bacterial agglutination test and pertussis toxin enzyme-linked immunosorbent assay (ELISA). Methods: The study was carried out in Perm Region, Russia. We measured pertussis immunity using two serological methods: ELISA of IgG to pertussis toxin (PT) and the agglutination test (AT) among 135 children, in the age range from 2 months to 17 years old. The immunization schedule included four doses of DTwP: at 3, 4.5 and 6 months of age and a booster at 18 months. All participants were divided into six age groups. Results: The percentage of samples with IgG level less than the detection limit in vaccinated children was 52.2%. The total seropositivity rate (the percent of children with agglutinin titres ≥1:160) in vaccinated children was 47.8%. Only a weak association was observed between agglutinin and anti-PT IgG titres (R =.3). Neither the primary nor the booster vaccination with DTwP influenced the IgG levels in children. Agglutinin titres significantly increased after vaccination and declined 5 years after the booster dose. Significant growth of IgG concentration was observed in 11-year-olds, indicating the presence of B. pertussis circulation in the childhood population. Conclusions: Based on the obtained results and the results of other authors, we summarize that anti-PT ELISA should be carefully used to assess the population immunity to pertussis. Currently, there is neither a serological test that accurately determines the protection against pertussis nor a distinctive criterion of protection that can be applied in seroepidemiological studies. [ABSTRACT FROM AUTHOR]

ContextThe roots ofIlex asprella(Hook. et Arn.) Champ. ex Benth. (Aquifoliaceae) are widely used in Chinese medicine to treat influenza, amygdalitis, pertussis, etc. Their mechanism of action is still unknown, which raises the need to identify new bioactive compounds in this plant. ObjectiveIn this study, we isolated a novel saponin containing sulphonic groups, namely, asprellcoside A (1) and a known phenolic glycoside compound (2) from the roots ofIlex asprellaand evaluated their bioactivities. Materials and methodsMolecular structures were elucidated by analysing their spectral and chemical properties. The viability of A549 cells was tested using a MTT assay. Ability of the compounds to inhibit viruses was determined using the neuraminidase activity assay. Their anti-inflammatory effects were tested using the IP-10 activity assay using various concentrations (compound1: 0.6, 0.2, 0.6, 1.70, 5.00 and 15.00 μM; compound2: 0.4, 1.2, 3.6, 11.0, 33.0 and 100 μM). Their inhibitory effect on platelet aggregation induced by adenosine diphosphate (ADP) in rabbit plasma was determined at 60 and 80 μM. ResultsBoth compounds inhibit influenza virus strain A/PuertoRico/8/1934 (H1N1) strongly with EC50values of 4.1 and 1.7 μM, respectively. Both compounds inhibit the secretion of IP-10 with EC50values of 6.6 and 2.5 μM, respectively. Compound1alone inhibited platelet aggregation significantly, with the rate of suppression being 47 ± 8 and 38 ± 3%, at 60 and 80 μM, respectively. ConclusionsThe results suggest that both compounds may be valid therapeutics against influenza virus infection and that compound1may be a novel agent for treating thrombosis. [ABSTRACT FROM PUBLISHER]

Context: Funtumia elastica (Preuss) Stapf. (Apocynaceae) has a long ethnopharmacological history for uses such as treatment of whooping cough, asthma, blennorhea, painful menstruation, fungal infections, and wounds. Objective: To investigate the antimicrobial and anti-inflammatory properties of ethanol extracts from the leaves and stem bark of Funtumia elastica based on its ethnopharmacological uses and also determine the secondary metabolites present in the extracts. Materials and methods: The antimicrobial activities of ethanol leaf and bark extracts of F. elastica were determined using the microdilution technique (MIC determination) and agar diffusion method using 10, 25, and 50 mg/mL concentrations against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis, Candida albicans, Aspergillus flavus and Aspergillus niger as test organisms. Anti-inflammatory activities of the doses of extracts at 30, 100, and 300 mg/kg per body weight were determined by carrageenan-induced edema in the footpad of 7-day-old chicks and the foot volumes measured at hourly interval post-treatment for 5 h. Results: The MIC ranges of both ethanol leaf and bark extracts against the test organisms were 125 (lowest MIC) to1550 µg/mL (highest MIC) and 125 (lowest MIC) to 1750 µg/mL (highest MIC), respectively. The ethanol leaf and bark extract of F. elastica showed significant anti-inflammatory activity (p ≤ 0.001) at 30, 100 and 300 mg/kg. Preliminary phytochemical screening revealed that F. elastica bark contains hydrolysable tannins, sapogenetic glycosides, steroids and saponins while the leaves contain hydrolysable tannins, flavonoids, starch and alkaloids. Tannin contents of the leaf and stem bark were 2.4 and 1.3% w/w (related to the dried material), respectively. Discussion and conclusion: Both ethanol leaf and bark extracts of F. elastica showed antimicrobial and anti-inflammatory activities and these pharmacological properties may be responsible for the ethnomedicinal uses of the leaves and stem bark of the plant. [ABSTRACT FROM AUTHOR]

The need for the poor, the marginalised and socially excluded to live healthier and longer lives has in recent times become paramount in the development literature and policy discussions seeking to achieve the Millennium Development Goals (MDGs). In response to this, attempts are being made to redirect the research focus to examine socio-economic factors underpinning disease occurrence and ill health for health planning policies and practices to benefit the poor and vulnerable in society. Tliis paper explores the relationship between socio-economic conditions and health outcomes. It identifies and examines through participatory rural assessment techniques, basic socio- economic factors acting as significant pathways through which poverty increases the susceptibility of rural households to diseases. It seeks to address the reasons why the poor are poorer in health in rural communities of the Amansie West district of Ghana. This paper thus emphasises how social stratification and inequalities could affect quality of life of people in any given society, hence supporting the theory of social suffering and its implications on societal health. [ABSTRACT FROM AUTHOR]

Despite the introduction of routine vaccination against pertussis for more than a half century, leading to a drastic decline in the number of reported cases, pertussis continues to be an important respiratory disease afflicting unvaccinated infants and previously vaccinated children as well as adults in whom immunity has waned. The diagnosis of pertussis is challenging and accurate laboratory identification of Bordetella infections remains problematic. Common laboratory diagnostic methods used for pertussis diagnosis include culture, direct-fluorescent-antibody testing (DFA), serology and polymerase chain reaction (PCR). Culture of Bordetella pertussis is highly specific but fastidious and has limited sensitivity. DFA provides a much more rapid result, but has the disadvantage of poor sensitivity and specificity. Serology is not useful in infants. In older persons, it is hampered by the limitations of paired sera and it provides mainly a retrospective diagnosis. Such limitations of conventional diagnosis testing have led to the development of PCR assays. Notwithstanding its lack of standardization, PCR has been found to be more sensitive and more specific than other methods. In this report, we aimed to review current knowledge about the available diagnostic methods and tests that accurately diagnose pertussis. [ABSTRACT FROM AUTHOR]

Vaccination ideally protects susceptible populations at high risk for complications of the infection. However, vaccines for these subgroups do not always provide sufficient effectiveness. The herd effect or herd immunity is an attractive way to extend vaccine benefits beyond the directly targeted population. It refers to the indirect protection of unvaccinated persons, whereby an increase in the prevalence of immunity by the vaccine prevents circulation of infectious agents in susceptible populations. The herd effect has had a major impact in the eradication of smallpox, has reduced transmission of pertussis, and protects against influenza and pneumococcal disease. A high uptake of vaccines is generally needed for success. In this paper we aim to provide an update review on the herd effect, focusing on the clinical benefit, by reviewing data for specific vaccines. [ABSTRACT FROM AUTHOR]