EFFICACY OF AN ACELLULAR PERTUSSIS VACCINE AMONG ADOLESCENTS AND ADULTS
After careful reading of the following abstracts obtained from a literature search of disease topic answer the questions provided.
3. EFFICACY OF AN ACELLULAR PERTUSSIS VACCINE AMONG ADOLESCENTS AND ADULTS
Ward JI, Cherry JD, Chang S-J, et al.
Background: Pertussis immunization of adults may be necessary to improve the control
of a rising burden of disease and infection. This trial of an acellular pertussis vaccine
among adolescents and adults evaluated the incidence of pertussis, vaccine safety,
immunogenicity, and protective efficacy.
Methods: Bordetella pertussis infections and illnesses were prospectively
assessed in 2,781 healthy subjects between the ages of 15 and 65 years who were
enrolled in a national multicenter, [ ] of an acellular pertussis vaccine or a hepatitis A
vaccine (control) and were monitored for 2.5 years for illnesses with cough that lasted
for more than 5 days. Each illness was evaluated with use of a nasopharyngeal aspirate
for culture and polymerase chain reaction assay, and serum samples from patients in
both acute and convalescent stages of illness were analyzed for changes in antibodies to
nine B. pertussis antigens.
Results: Of the 2,781 subjects, 1,391 received the acellular pertussis vaccine and
1,390 received the control vaccine. The groups had similar ages and demographic
characteristics, and the median duration of follow-up was 22 months. The acellular
pertussis vaccine was safe and immunogenic. There were 2,672 prolonged illnesses with
cough, but the incidence of this nonspecific outcome did not vary between the groups,
even when stratified according to age, season, and duration of cough. On the basis of
the primary pertussis case definition, vaccine protection was 92% (95% CI 32 to 99%).
Among unimmunized controls with illness, 0.7% to 5.7% had B. pertussis infection, and
the percentage increased with the duration of cough. On the basis of other case
definitions, the incidence of pertussis in the controls ranged from 370 to 450 cases per
100,000 person-years.
Conclusions: The acellular pertussis vaccine was protective among adolescents
and adults, and its routine use might reduce the overall disease burden and
transmission to children.
N Engl J Med 2005;353:1555-63.
1. What is the epidemiologic study design?
2. (a) Identify the exposure(s) of interest (independent variables) and (b) the
outcome(s) (dependent variables) of interest in the study.
3. (a) Suggest at least one possible bias (systematic error) that might be present in
each study. Pay particular attention to how subjects were selected, and what
information was gathered from them and how it was collected. (b) Explain
specifically how this could introduce bias into the study.
4. (a) Suggest one or more possible confounding factors related to the data
collected and analyzed in the study, and (b) explain how it/they might confound
interpretation of the authors’ findings.
5. (a) Suggest at least one other epidemiologic study design that could address the
same question(s), and (b) discuss the relative strengths and limitations of the
other study design compared to the one actually used.
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