Lmergence et la diffusion de la rsistance aux antibiotiques a conduit, en France, comme dans dautres pays, la mise en place de plans antibiotiques sappuyant notamment sur des recommandations de bon usage. Lobjectif de cette tude est de dterminer la structure de la prescription des antibiotiques par des pdiatres ambulatoires sensibiliss au bon usage des antibiotiques et de vrifier leur conformit aux recommandations.

AUGMENTATION DE LINCIDENCE DE LA COQUELUCHE DANS LE MONDE ?Diagnostic biologique plus performantCouverture vaccinale insuffisanteAdoption des acellulaires dans de nombreux paysMoins efficace ?Dure de protection moins longue ?Modification des souchesvaccins moins efficaces1

Pourquoi vacciner contre la coqueluche ?Eradiquer la maladie : NonProtger dune maladie grave chez le petit nourrisson +++Protger dune maladie gnante chez le grand enfant et ladulte +Assurer une immunit de groupe protgeant contre les grandes pidmies +

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Pourquoi vacciner les adultes contre la coqueluche ?Eradiquer la maladie Les protger dune maladie gnante, exceptionnellement grave Les empcher de contaminer les petits enfantsAssurer une immunit de groupe protgeant contre les grandes pidmies

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Review of Randomized TrialsConclusions aP vaccines effective in preventing confirmed pertussisMarginally less effective than the best wP vaccines1,2,3, and 5 component vaccines all effectiveNotably, no resurgence in Denmark despite monocomoponent vaccineNo simple relationship between immunogenicity and efficacy

World Health Organization2 May, 20144Animal ModelBaboon Study

Attribution: Tod J. Merkel et alLaboratory of Respiratory and Special Pathogens CBER/FDA

Name of groupWorld Health Organization2 May, 20145Animal Model (Baboon Study)

wP and aP both protective against diseaseAttribution: Tod J. Merkel et alLaboratory of Respiratory and Special Pathogens CBER/FDA

World Health Organization2 May, 20146Animal Model (Baboon Study)

aP did not prevent infectionAttribution: Tod J. Merkel et alLaboratory of Respiratory and Special Pathogens CBER/FDA

World Health Organization2 May, 20147Animal Model (Baboon Study)aP did not prevent transmission

Attribution: Tod J. Merkel et alLaboratory of Respiratory and Special Pathogens CBER/FDA

World Health Organization2 May, 20148Animal Model (Baboon Study)ConclusionsInfection, wP, aP all protected against symptomatic diseasewP provided some sterilizing immunityLess than natural infectionInduces Th1 and Th17 memoryaP did not prevent infection and transmissionHigher Th2 but lower Th1 and Th17 responsesLack of mucosal immunity induction likely has role in pertussis resurgenceReferencesWarfel JM, Beren J, Kelly VK, Lee G, Merkel TJ. Nonhuman primate model of pertussis. Infect Immun 2012;80(4):1530-1536.Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci 2014;111(2):787-792.Warfel JM, Papin JF, Wolf RF, Zimmerman LI, Merkel TJ. Maternal and neonatal vaccination protects newborn baboons from pertussis infection. J Infect Dis 2014.

Warfel JM, Beren J, Kelly VK, Lee G, Merkel TJ. Nonhuman primate model of pertussis. Infect Immun 2012;80(4):1530-1536.Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci 2014;111(2):787-792.Warfel JM, Papin JF, Wolf RF, Zimmerman LI, Merkel TJ. Maternal and Neonatal Vaccination Protects Newborn Baboons From Pertussis Infection. J Infect Dis 2014.

World Health Organization2 May, 20149SummaryPertussis vaccination very effective in reducing diseasewP and aP both effective in reducing infant mortalityNo evidence of broad resurgence at global levelCyclic recurrent patterns of pertussis still observedaP disease preventionLower initial efficacy and faster waning of immunity Reduced impact on infection and transmissionModelling and baboon data support hypothesis that wP to aP transition is associated with localized disease resurgence

Summarize big key message

Role of aP

Get rid of sub bullet points

Modelling and babbon data support conclusion shorter duration of wP to aP transition has role in disease resurgence

Remove 3rd bullet only comes from next slide deck (timely vaccination)

UK SLIDE ON LONG TERMWorld Health Organization2 May, 201410Si on veut protger les petits enfantsVaccination prcoce +++ 6 semaines (moins)Vaccination des femmes enceintes +++Cocooning +

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