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Tesi etd-11182018-154002

Type of thesis
Corsi integrativi di II livello
Author
MAZZILLI, SARA
URN
etd-11182018-154002
Title
Bordetella pertussis: new vaccination strategies in the light of disease resurgence
Structure
Cl. Sc. Sperimentali - Agraria
Course
SCIENZE AGRARIE E BIOTECNOLOGIE - Biotecnologie molecolari (LM 8)
Committee
relatore Prof. LICAUSI, FRANCESCO
Presidente Prof. PE', MARIO ENRICO
Membro SEBASTIANI, LUCA
Membro BONARI, ENRICO
Membro ZUCCOLO, ANDREA
Membro Dott.ssa BARTOLINI, SUSANNA
Keywords
  • Immunization
  • Implementation
  • Italy
  • MLVA
  • Pregnancy
  • Prn
  • Ptx
  • Qualitative study
  • Tdap
  • Whooping cough
Exam session start date
;
Availability
parziale
Abstract
Pertussis or whooping cough is a bacterial disease that consists in severe infection of the respiratory tract mainly caused by Bordetella pertussis. The disease is particularly dangerous for young infants and spreads easily from person to person, mainly through droplets produced by coughing or sneezing.<br>For a long time, pertussis has been one of the most common childhood diseases worldwide, but the introduction of infant whole-cell vaccination in the 1950s led to a steep decline in the number of pertussis cases and deaths in children. Due to the presumption that the whole cell vaccine was not completely safe, from the 1980s many countries started to replace it with the acellular vaccine (APV). <br>Despite the fact that the vaccination schedule has little differences beteween countries, either in the timing of administration of the vaccine or in the type of vaccine used, all the developed countries have high childhood primary immunization rates. Because of that, the resurgence of disease observed from the beginning of 1990s was unexpected.<br>As shown in Palazzo et al. studies, the pertussis cases are increasing also in Italy and changes to circulating B. pertussis strains seem to be one of the suggested causes. Indeed, the genome of the current circulating bacteria differ from the isolated ones used in the manufacture of the vaccine component and in particular, it has been shown that modification occurred in ptx and in prn genes whose proteins elicit protective immunity and are two of the used components of the APV. The first aim of this thesis is to investigate on the strain circulating in Italy, in particular in Apulia.<br>Nowadays, whooping cough represents one of the most prevalent vaccine-preventable diseases in Western countries and to prevent the occurrence of infectious pertussis in new-borns, many European countries have introduced the acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids (Tdap) for women in the third trimester of pregnancy. Thanks to the approval of the new National Immunization Prevention Plan (PNPV) 2017–19: Italy is among those countries. The Italian health-care system is a regionally based National Health Service (NHS), therefore, regions are in charge of organizing and implementing new vaccination strategy their own. The second aim of this study is to explore how new vaccine policies have been adopted by regions, focusing on Tuscany’s experience in implementing the pertussis vaccine for expectant mothers and to identify lessons learnt that may be relevant to facilitate the implementation of future policies.
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