ACELLULAR PENTAVALENT: WHAT IT IS FOR, DOSAGE, INDICATIONS, EFFECTS - MEDICINE - 2024

The acellular pentavalent is a vaccine that immunizes the recipient against disease caused by poliovirus, Haemophilus influenzae type B, the Corynebacterium diphtheriae, Clostridium tetani and the Bordetella pertussis.

This vaccine does not contain cells, but rather parts of the bacteria, viruses or toxins that contain the antigens capable of inducing, in the organism in which it is administered, the antibodies against said bacteria, viruses or toxins.

Vaccines (Source: pixabay.com)

According to the WHO, a vaccine is understood as "any preparation intended to generate immunity against a disease by stimulating the production of antibodies." Immunity is defined as a state of natural or acquired resistance against some infectious agent or some toxin.

An antibody is a substance synthesized and secreted by lymphocytes (blood cells) to fight an infection caused by a bacteria or virus, or to neutralize a toxin. These substances are highly specific.

History

The history of vaccines begins in the UK around 200 years ago. There, Edward Jenner observed that some women milking cows who had been infected with a virus that causes cowpox appeared to be protected from human smallpox.

In 1796, Jenner conducted an experiment: He first scraped the arm of an 8-year-old boy with material from a cowpox sore taken from an infected woman.

Then he repeated the same experiment with the same child, but this time he inoculated material from a human pox pustule. He hoped the procedure would immunize the boy against the deadly smallpox infection and, in fact, it did.

Jenner's experiment, while immoral, ushered in the age of vaccines. Almost 100 years later, Dr. Louis Pasteur demonstrated that an infectious disease could be prevented by infecting humans with attenuated or weakened germs.

In 1885, Pasteur successfully used a vaccine to prevent rabies in a child who had been bitten by a rabies dog. Around the middle of the 20th century, Drs. Jonas Salk and Albert Sabin developed the polio vaccine.

The polio vaccine, also called Sabin (oral), has saved countless numbers of children around the world from a disease that often leaves children in wheelchairs or using crutches for life.

What is it for?

The acellular pentavalent vaccine protects against pertussis, diphtheria, polio, tetanus, and diseases caused by Haemophilus influenzae type b such as meningitis, epiglottitis, septic arthritis, pneumonia, and cellulitis.

Diseases caused by Haemophilus influenzae type B

Haemophilus influenzae type B or Hib is a bacterium that was discovered in 1892 in a group of patients during an influenza outbreak, before it was discovered that the flu (influenza) was caused by a virus. Therefore, at the time it was thought to be caused by Hib, hence the confusion of the name.

Haemophilus influenzae type B can cause severe invasive illness in young children. These include meningitis, pneumonia, septic arthritis (joint infections), epiglottitis (infection and inflammation of the epiglottis that can cause closure of the trachea), and cellulitis (skin infection).

This bacteria is transmitted by healthy carriers or by sick people by close contact through drops of saliva that come out with coughing. The bacteria do not survive in the environment.

Diphtheria

Corynebacterium diphtheriae is the bacterium that causes diphtheria, a highly contagious disease that is transmitted through saliva droplets or “flügge” drops that are emitted with the cough or sneeze of an infected person or a healthy carrier.

Diphtheria mainly affects the nose and throat and in these areas generates a grayish or blackish, fibrous and hard pseudomembrane that covers the infected area and that can cause obstruction of the airways.

The bacteria also produce a number of toxins that can cause significant damage to various organs such as cranial nerve palsy and myocarditis (inflammation of the myocardium or heart muscle).

Tetanus

Tetanus is an infectious disease caused by an anaerobic bacteria, Clostridium tetani. This bacterium produces a neurotoxin called tetanus toxin, which alters the function of the central nervous system, generating muscle contractions or painful spasms.

These contractions begin in the jaw with lockjaw and then in the muscles of the neck and dorsal wall in the thoracic and lumbar area. This causes a characteristic arched position. It can also cause problems with breathing and swallowing (swallowing), irritability, fever, among others.

The bacteria live in the soil, in feces, and in the mouths of animals. It can remain inactive for decades in the form of spores that can become activated by contact with open wounds and thus cause infection.

It was a frequent cause of death for the mother and her newborn because it was transmitted in childbirth without hygienic conditions.

Bordetella pertussis

Bordetella pertussis bacteria is the causative agent of whooping cough. The Chinese call it "100-day cough." It is a highly contagious bacterial infectious disease that causes severe coughing attacks that can cause respiratory distress.

Coughing spells may be accompanied by vomiting and a red or bluish discoloration of the face. The illness lasts between 6 and 10 weeks.

Poliomyelitis

Polio or infantile paralysis is a contagious disease caused by a virus. Three polio viruses have been identified and are called viruses I, II and III. It is a disease that begins with general malaise, headache, and cervical and back stiffness.

In severe cases, it produces paralysis of the voluntary muscles, preferably of the lower limbs. When poliomyelitis affects the medulla oblongata, its mortality reaches up to 60% of infected patients.

This disease occurs all over the world, but mass vaccination has considerably reduced the casuistry. Many countries have not registered cases for at least a decade. Pentavalent includes antigens from all three types of viruses.

Dose

Normally, the basic vaccination schedule in children consists of four doses administered intramuscularly in the right thigh (for those under 18 months) or the left deltoid (for those over 18 months), provided there is sufficient muscle development.

The first dose is given at 2 months, then the third dose at 4 and 6 months. At 18 months another dose is placed and at 6 years a booster is placed. In adults who have not been vaccinated, three doses are given.

Indications

It is used for the prevention of tetanus, poliomyelitis, diphtheria, pertussis and severe diseases caused by Haemophilus influenzae type B. As a pentavalent vaccine it is indicated for children under 7 years of age.

Adverse effects

Vaccines can cause side effects just like any medicine. An adverse reaction to a vaccine is a side effect that results from the placement of the vaccine.

Most of the side effects of vaccination are mild. Discomfort, swelling, or redness may appear at the injection site. Fever, skin rash, and local pain sometimes occur.

Serious side effects are rare, but can include severe allergic reactions or life-threatening seizures.

Contraindications

They should not be vaccinated:

- Patients who have had allergic reactions to the vaccine.

- Cases of patients with active neurological disease.

- Fever at the time the vaccine is to be administered or an infectious process with fever around 40 degrees in the days prior to vaccination.

- Patients with congenital or acquired immunodeficiency or who are receiving immunosuppressive treatment such as steroids or radiotherapy. This can decrease the immune response to the vaccine. In the case of short-term treatments, the administration of the vaccine should be postponed to ensure a good immune response.

References

1. Cochrane, C. (2001). Acellular vaccines for the prevention of pertussis in children. Journal of Primary Care Pediatrics, 3 (12), 617-625.
2. Figueroa, JR, Vázquez, PV, & López-Collada, VR (2013). Epidemiology of preventable diseases with acellular pentavalent vaccine in Mexico. Vaccines, 14 (2), 62-68.
3. Hammond, B., Sipics, M., & Youngdahl, K. (2013). The History of Vaccines: The College of Physicians of Philadelphia. College of Physicians of Philadelphia.
4. James, C. (2001). Control of communicable diseases. Seventeenth edition. Washington DC, USA. OPS.
5. Kliegman, RM, Behrman, RE, Jenson, HB, & Stanton, BM (2007). Nelson textbook of pediatrics e-book. Elsevier Health Sciences.
6. Lagos, R., Kotloff, K., Hoffenbach, A., SAN MARTIN, ORIANA, Abrego, P., Ureta, AM,… & Levine, MM (1998). Clinical acceptability and immunogenicity of a pentavalent parenteral combination vaccine containing diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis and Haemophilus influenzae type b conjugate antigens in two-, four-and six-month-old Chilean infants. The Pediatric infectious disease journal, 17 (4), 294-304.