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Delaying DPT Vaccination May Reduce Incidence of Childhood Asthma



 
 
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Old June 3rd 08, 02:37 AM posted to misc.health.alternative,sci.med,misc.kids.health,misc.kids,alt.parenting.solutions
Jan Drew
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Default Delaying DPT Vaccination May Reduce Incidence of Childhood Asthma


"J" xnswex@nalid;"no wrote in message
...
Please pass this along to kid's health newsgroups


Done. FYI try www.googlegroups.com
Type in kids newsgroups, or kids health newsgroups


http://www.medscape.com/viewarticle/572891
Delaying DPT Vaccination May Reduce Incidence of Childhood Asthma

elease Date: April 14, 2008; Valid for credit through April 14, 2009
Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)T for physicians;

Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians

To participate in this internet activity: (1) review the target audience,
learning objectives, and author disclosures; (2) study the education
content; (3) take the post-test and/or complete the evaluation; (4)
view/print certificate View details.

Learning Objectives

Upon completion of this activity, participants will be able to:

1. Describe the relation between risk for asthma and delay in the
administration of the first dose of diphtheria, pertussis, and tetanus
vaccine by more than 2 months.
2. Describe the relation between risk for asthma and delays in
administration of all 3 doses.

Authors and Disclosures

Laurie Barclay, MD
Disclosu Laurie Barclay, MD, has disclosed no relevant financial
relationships.

Brande Nicole Martin
Disclosu Brande Nicole Martin has disclosed no relevant financial
information.


April 14, 2008 - Childhood asthma is reduced by half when the first dose
of diphtheria, pertussis, and tetanus (DPT) is delayed by more than 2
months vs given during the recommended period, according to the results of
a retrospective longitudinal study reported in the March issue of the
Journal of Allergy & Clinical Immunology.

"Early childhood immunizations have been viewed as promoters of asthma
development by stimulating a TH2-type immune response or decreasing
microbial pressure, which shifts the balance between TH1 and TH2
immunity," write Kara L. McDonald, MSc, from the University of Manitoba in
Winnipeg, Manitoba, Canada, and colleagues. "Differing time schedules for
childhood immunizations may explain the discrepant findings of an
association with asthma reported in observational studies. This research
was undertaken to determine whether timing of diphtheria, pertussis,
tetanus (DPT) immunization has an effect on the development of childhood
asthma by age 7 years."

The investigators analyzed data from the complete immunization and
healthcare records of a cohort of children born in Manitoba in 1995, from
birth until age 7 years. Using multivariable logistic regression, they
computed the adjusted odds ratio for asthma at age 7 years according to
the timing of DPT immunization.

Among 11,531 children who received at least 4 doses of DPT, the risk for
asthma was halved in children in whom administration of the first dose of
DPT was delayed by more than 2 months. For children with delays in
administration of all 3 doses, the likelihood of asthma was 0.39 (95%
confidence interval [CI], 0.18 - 0.86).

"We found a negative association between delay in administration of the
first dose of whole-cell DPT immunization in childhood and the development
of asthma; the association was greater with delays in all of the first 3
doses," the study authors write. "The mechanism for this phenomenon
requires further research."

Limitations of this study include possible ascertainment bias; findings
not yet confirmed with the diphtheria, acellular pertussis, tetanus (DaPT)
vaccine; and inability to refute the issue of early-life infections as an
explanation for the association between delayed immunization and
protection against the development of asthma.

"Further study is vital to gain a detailed understanding of the
relationship between vaccination and allergic disease, because a
perception that vaccination is harmful may have an adverse effect on the
effectiveness of immunization programs," the study authors conclude.

The Canadian Institutes of Health Research supported this study. Some of
the authors have disclosed various financial relationships with the
Western Regional Training Center for Health Services Research, the
National Training Program in Allergy and Asthma, the Canadian Institutes
of Health Research, Allergen, and/or Novartis.

J Allergy Clin Immunol. 2008;121:626-631.
Clinical Context

Early childhood vaccinations may promote development of asthma, directly
by stimulating a TH2-type immune response or indirectly by decreasing
microbial pressure. In support of this hypothesis, an IgE response to
vaccine antigens often occurs in children vaccinated with
diphtheria/tetanus, and this response is more pronounced among individuals
with atopy.

Epidemiologic evidence linking DPT immunizations to childhood asthma is
inconsistent. Some studies show an increased or decreased risk of
developing asthma, whereas others show no association. This study assessed
whether timing of DPT vaccination affects the risk of developing childhood
asthma by age 7 years.
Study Highlights

* Of children born in Manitoba in 1995, 11,531 children (82.6%) had
received at least 4 doses of DPT and were included in this study.
* These children were primarily immunized with whole-cell pertussis
DPT, because the DaPT vaccine was phased in throughout Manitoba beginning
in November 1997.
* The investigators analyzed data from the complete immunization and
healthcare records of these children from birth until age 7 years.
* The investigators used multivariable logistic regression to compute
the adjusted odds ratio (OR) for asthma at age 7 years, based on the
timing of whole-cell DPT immunization.
* Prevalence of asthma was 11.7%.
* Children with asthma were predominantly boys (3:2) and lived in
urban areas (70.3%); 25% were from low-income homes; and 10.1% had mothers
with a history of asthma.
* The risk for asthma was decreased by 50% in children in whom
administration of the first dose of DPT was delayed by more than 2 months
(OR, 0.50; 95% CI, 0.25 - 0.97).
* Sensitivity analyses that varied the interval for DPT immunization
showed that these findings were robust.
* Asthma prevalence rates decreased successively from 13.8% to 5.9%
with each month delay in DPT administration.
* Likelihood of childhood asthma was also decreased after delays in
the administration of the second and third doses of DPT. Most of these
delays were in children with delays in their first dose.
* The reduction in asthma risk for the second and third doses mainly
resulted from the delay in the first dose because there were no
statistically significant differences in asthma risk with delays in the
second and third doses in the absence of delays in the first dose.
* However, for children with delays in administration of all 3 doses,
the likelihood of asthma was further reduced by 60% (likelihood ratio,
0.39; 95% CI, 0.18 - 0.86).
* Based on these findings, the investigators conclude that there was a
negative association between delay in administration of the first dose of
DPT immunization in childhood and the development of asthma; that the
association was greater with delays in all of the first 3 doses; and that
the underlying mechanism requires further research.
* Limitations of this study include possible ascertainment bias;
findings not yet confirmed with the DaPT vaccine; and inability to refute
the issue of early-life infections as an explanation for the association
between delayed immunization and protection against the development of
asthma.

Pearls for Practice

* Among children who received at least 4 doses of DPT, the risk for
asthma was reduced by 50% in children in whom administration of the first
dose of DPT was delayed by more than 2 months from the recommended period.

* For children with delays in administration of all 3 doses of DPT,
the risk of developing asthma was decreased by 60%. The reduction in
asthma risk for the second and third doses mainly resulted from the delay
in the first dose.



 




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