RESUMEN
PURPOSE: To examine recent evidence concerning the health benefits and cost effectiveness of replacing a single dose of adult tetanus/diphtheria vaccine with a single dose of tetanus/diphtheria/pertussis (TDaP). METHODS: A review of the literature was conducted utilizing the databases CINAHL and Medline with the keywords pertussis, adult immunization, vaccination, TDaP, DTaP, and healthcare workers. CONCLUSIONS: Recent outbreaks of pertussis have shown that preventing such outbreaks through immunization of adults with a single TDaP vaccine is a cost-effective measure. These studies focused on hospitals and universities where air-borne diseases are easily spread. Four hospital studies that examined the financial cost of investigating and treating a pertussis outbreak were reviewed. Results presented offer strong evidence to support vaccinating adults with TDaP at their next scheduled immunization or sooner if they are frequently exposed to populations vulnerable to pertussis. IMPLICATIONS FOR PRACTICE: Financially, investigating a single case of pertussis can cost hospitals hundreds of thousands of dollars. This is related to the time and expense of determining who was exposed and the provision of preventive treatment for those exposed. Preventing unnecessary illness and potential mortality, especially among not yet immunized infants, provides a strong argument for administration of the TDaP vaccine. Healthcare providers should educate adults about the availability and advantages of TDaP immunization and encourage them to be immunized with TDaP.
Asunto(s)
Toma de Decisiones , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Programas de Inmunización , Tos Ferina/prevención & control , Adulto , Factores de Edad , Brotes de Enfermedades , Humanos , Esquemas de Inmunización , Salud Pública , Factores de Riesgo , Estados Unidos/epidemiología , Tos Ferina/epidemiologíaRESUMEN
Information concerning the impact of environmental factors on cystic fibrosis (CF) is limited. We conducted a cohort study to assess the impact of air pollutants in CF. The study included patients over the age of 6 years enrolled in the Cystic Fibrosis Foundation National Patient Registry in 1999 and 2000. Exposure was assessed by linking air pollution values from the Aerometric Information Retrieval System with the patients' home zip code. After adjusting for confounders, a 10 microg/m(3) rise in particulate matter (both with a median aerodynamic diameter of 10 microm (PM(10)) or less and with an aerodynamic diameter of 2.5 microm or less (PM(2.5)) was associated with an 8% (95% confidence interval [CI], 2-15%) and 21% (95% CI, 7-33%) increase in the odds of two or more exacerbations, respectively; a 10-ppb rise in ozone was associated with a 10% (95% CI, 3-17%) increase in odds of two or more exacerbations. For every increase in PM(2.5) of 10 microg/m(3), there was an associated fall in FEV(1) of 24 ml (7-40) (95% CI) after adjusting for confounders. PM(2.5)'s association with mortality did not achieve statistical significance (adjusted RR = 1.32 per 10 microg/m(3) 0.91-1.93; 95% CI). Annual average exposures to particulate air pollution was associated with an increased risk of pulmonary exacerbations and a decline in lung function, suggesting a role of environmental exposures on prognosis in CF.