Study on the establishment of the early diagnosis of Pertussis and the efficacy of vaccination

(1)细菌分离和早期诊断。作为百日咳的早期诊断方法，对细菌进行了分离。据报道，孤立者的阳性率很低。然而，在我们目前的研究中，分离率高达51.8%。此外，34.2%的分离病例是在分离前使用过抗生素的病例。说明细菌分离是早期诊断百日咳的有效方法。对疑似百日咳的病例，无论是否使用抗生素，均应尝试隔离。另一方面，对分离失败的病例进行了血清学检测作为早期诊断的方法的评价，建立了百日咳毒素IgM抗体的检测体系。(2)家族性感染和成人百日咳调查对隔离病例进行了家庭调查。…更多的结果是，从接种过疫苗的兄弟姐妹和父母身上也分离出了细菌。所有病例均无典型百日咳临床表现，仅有长期慢性咳嗽，无严重发作。一些母亲甚至没有表现出任何咳嗽。实验室数据也未显示明显的白细胞增多或相对淋巴细胞增多(平均白细胞计数为7040，淋巴细胞百分比为36%)。据估计，婴儿的感染源是兄弟姐妹和父母。因此，在百日咳病例近年来呈下降趋势的情况下，调查家庭感染状况是评价百白破疫苗效果的有效途径。虽然受试者人数较少，但DTP疫苗的效力为82%。(3)疫苗效力的评价研究了抗体水平的持久性作为评价疫苗效力的一种方法。对日本1981年改进的无细胞百日咳疫苗(DTaP)和全细胞百日咳疫苗(DTwP)接种儿童进行了比较研究。结果表明，接种DTaP疫苗的儿童白喉、破伤风抗体和FHA抗体水平均高于DTIP疫苗接种儿童，可能还受既往百日咳流行的影响，DTaP疫苗免疫儿童的抗体持久性较好。较少

(1) Isolation of bacteria and establishment of the early diagnosis.As an early diagnostic method of pertussis isolation of the bacteria was performed. It has been reported that the positivity of the isolated was low. However, in our current study, the isolation rate was high as 51.8%. Furthermore, 34.2% of our isolated cases were cases who had been treated with antibiotics before the isolation. This shows that isolation of the bacteria is an useful method on the early diagnosis of pertussis. And it is necessary to attempt the isolation on cases suspective of pertussis disregard the medication of antibiotics or not. On the other hand, if case who had been failed in the isolation, evaluation on a method to detect the IgM antibodies serologically as an early diagnosis has been performed, and a system of detection of the PT (pertussis toxin) IgM antibody has been established.(2) Investigation on familial infection and adult pertussisFamilial investigation to isolated cases were performed. … More As a result, bacteria were also isolated from siblings and parents who had been vaccinated. All these cases showed no typical clinical manifestation of pertussis, but only showing long term chronic coughing without serious attacks. And some mothers even did not show any coughing. Laboratory data also showed no obvious leukocytosis or relative lymphocytosis (mean white blood cell count 7040, %lymphocyte 36%). Source of infection to infants was estimated to be siblings and parents. Therefore, investigation on the familial infective status is an effective way to evaluate the efficacy of DTP vaccine, as the number of pertussis cases are decreasing in the recent years. Although the number of subject is small, the efficacy of DTP vaccine was 82%.(3) Evaluation of the efficacy of vaccineThe persistence of antibody level is studied as a method on the evaluations of the efficacy of the vaccine. A comparative study between children vaccinated with the acellular pertussis vaccine (DTaP) improved in 1981 in Japan and children vaccinated with the whole cell pertussis vaccine (DTwP) was performed. As a result, children vaccinated with the DTaP showed higher levels of diphtheria, tetanus antibody and FHA (filmentous hemagglutinin) antibody than those vaccinated with DTwP.It might also be influenced by epidemics of pertussis in the past, the persistence of antibody was better in the DTaP vaccinees. Less