We are being asked about the pertussis vaccine. Option 1 is correct, it is the diphtheria-tetanus-pertussis vaccine. Option 4 is also correct, since they are inactivated microorganisms. Now we are left with the doubt between 2 and 3... Option 3 is the one that "is not true among all those proposed to us": immunity lasts about 10 years after the last dose.

We are being asked about the pertussis vaccine. Option 1 is [HIDDEN], it is the diphtheria-tetanus-pertussis vaccine. Option 4 is also [HIDDEN], since they are inactivated microorganisms. Now we are left with the doubt between 2 and 3... Option 3 is the one that "is not true among all those proposed to us": immunity lasts about 10 years after the last dose.

A 3-month-old infant correctly vaccinated for his age, who after two weeks of rhinorrhea, sneezing and coughing, is admitted for intensification of coughing spells, with cyanosis at the end of them, ending with deep inspiration or inspiratory rooster, requiring stimulation, aspiration of secretions and oxygen to recover from them. According to your diagnostic suspicion and with respect to the vaccine for this disease, all are true EXCEPT:

The vaccine in Spain is administered in combination with diphtheria and tetanus.

Adults who will be in contact with infants under 6 months of age should be vaccinated.

Both natural and vaccinal immunity remains for life.

Vaccination is prepared from killed microorganisms.

[Culture-confirmed whooping cough in a tertiary center over a twelve-year period].

To study the characteristics of patients diagnosed with whooping cough at a tertiary center in Barcelona, Spain. We performed a retrospective study of patients aged less than 18 years treated for pertussis-like cough or clinically-suspected whooping cough over a 12-year period (1989-2000). Only patients with isolated Bordetella spp. were included. The variables of age, sex, vaccination status, hospitalization, clinical manifestations, severity, and lethality were analyzed. One hundred sixty-one patients with positive Bordetella spp. culture were identified. Of these, complete information was available in 149 (79 boys and 70 girls) with a median age of 3 months (range: 13 days-17 years); 77.2 % were aged 6 months or less. All the isolated strains corresponded to B. pertussis except three that corresponded to B. parapertussis. Three epidemic cycles (in 1989, 1992 and 2000) were observed during the study period. A total of 72.5 % of cases occurred between May and September. Bordetella spp. was associated with other bacteria in 28.2 % of the patients, viruses in 13.4 % and a bacterium and a virus in 4.7 %. One hundred twenty-one patients required hospitalization, of which 14.9 % were admitted to the intensive care unit. Age was the only factor associated with risk for hospitalization, which was more frequent in younger infants (p < 0.0001). Paroxysmal cough with cyanosis was present in 53.4 % of the patients, leucocytosis with lymphocytosis occurred in 67.5 % and apneas were present in 21.5 %. Chest X-ray revealed atelectasis in 34.1 %. The mean length of hospital stay was 11 days (range: 1-70 days). Three boys aged less than 3 months with malignant pertussis syndrome died (lethality: 2 %). More than half the patients (59.7 %) were not vaccinated (55.4 % for being under the age of 3 months) and only 16 % had received three or more vaccination doses. Whooping cough continues to be a severe disease in infants, with a high admission rate during the first 6 months of life. New preventive strategies are required to protect infants who have not yet developed full immunity to this infection.

[Clinical analysis of 247 children with whooping cough and the risk factors of severe cases].

To summarize the clinical characteristics of whooping cough in children and analyze the risk factors for severe whooping cough. A retrospective analysis was made on the clinical data of 247 children with whooping cough in Children's Hospital of Chongqing Medical University between Jan 2013 and Dec 2014. Of these patients, 126 were male, 121 were female, the median age was 3.1 months (23 days-4 years and eight months old). The patients were divided into two groups, group 1 had infants less than 3 months of age (n=120) and group 2 had infants and young children older than 3 months (n=127) according to their age. On the other hand, the patients were also divided into two groups according to vaccination status: vaccinated group (received diphtheria toxoid, tetanus toxoid, and acellular pertussis, DTP) (n=31) and unvaccinated group (n=188). Pure Bordetella pertussis infection was seen in 106 cases, and 141 cases had mixed infection. Severe disease was seen in 13 cases, and the other 234 cases had the modest disease. Clinical data were retrospectively analyzed and compared. (1) Bordetella pertussis was identified in 57/680 cases (8.4%) in 2013, and 190/1 856 cases (10.2%) in 2014. The disease could be seen throughout the year, but 182 cases (73.7%) occurred in summer or autumn; 202 cases (81.8%) were less than 6 months. (2) Paroxysmal cough was seen in 238 cases (96.4%) , 61 cases (24.7%) had inspiratory whoop. Infants in group 1 often had episodes of cyanosis, apnea and suffocation (χ² = 19.999, 12.081, 6.508, P<0.05), persistent cough was often seen in group 2 (χ² = 9.885, P<0.05). Complications such as severe pneumonia, pulmonary consolidation and encephalopathy were more common in the group 1 than in group 2 (χ² = 17.340, 6.080, 11.030, 23.545, P<0.05). (3) The length of stay of group 1, and of unvaccinated group was significantly longer than that of group 2 and of vaccinated group (t=19.331, 26.741, P<0.05). (4) Leukocytosis was found in 224 cases (90.7%), 182 cases (73.7%) had predominant lymphocytosis. White blood cell in group 1, unvaccinated group and severe disease group was higher than the corresponding group (t=11.075,13.739,3.469, P<0.05). (5) Patients who had a history of exposure, fever, leukocytosis and pulmonary consolidation or atelectasis on chest imaging were prone to develop into severe pertussis (OR=4.521, 4.900, 1.085, 4.792, 50.400; P<0.05). A total of 244 cases (98.8%) recovered, 3 cases (1.2%) died, they were less than 3 months old and unvaccinated. The number of cases with whooping cough in Chongqing area tends to be rising. The disease occurred mostly in summer and fall. Infants less than 3 months old, unvaccinated with DTP had high susceptibility to pertussis, often had a severe clinical presentation and severe complications, had a high mortality rate.

DPT vaccine

Infants younger than 12 months of age, specifically less than three months of age, are at highest risk of acquiring pertussis. In U.S, there is no current tetanus-diphtheria-pertussis vaccination (whooping cough) recommended or licensed for new born infants. As a result, in their first few months of life, unprotected infants are at highest risk of life-threatening complications and infections from pertussis. Infants should not receive pertussis vaccination younger than six weeks of age. Ideally, Infants should receive DTaP (name of whooping cough vaccine for children from age 2 months through 6 years) at 2, 4, 6 months of age and they are not protected until the full series is completed. To protect infants younger than twelve months of age not vaccinated with Tdap against pertussis, ACIP also recommends adults (e.g., parents, siblings, grandparents, childcare providers, and healthcare personnel) and children to receive Tdap at least two weeks before being in contact with the infant.

Cocooning (immunization)

Cocooning is especially commonly used for pertussis. It aims to protect newborn infants from becoming infected with pertussis by administering DTaP/Tdap (tetanus, diphtheria and acellular pertussis) booster vaccine to parents, family members and any individuals who would come into regular contact with the newborn infant. By vaccinating these individuals with a pertussis booster, a pool of persons is established around the newborn who are themselves protected from getting pertussis and passing it on to the infant, thereby creating a "cocoon" of protection around the newborn. Young infants have the highest rate of pertussis; in 87-100% of all deaths caused by pertussis, the victim is an infant of less than 6 months of age, too young to have finished acquiring vaccine-induced immunity. Adolescents and young adults whose immunity has just worn off are often infected, but very unlikely to die. They can, however, infect others. 35% to 68% of infants infected with pertussis are infected by a

Pertussis vaccine

Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective. The effectiveness of the vaccines appears to decrease by between 2 and 10% per year after vaccination with a more rapid decrease with the acellular vaccines. The vaccine is only available in combination with tetanus and diphtheria vaccines. Pertussis vaccine is estimated to have saved over 500,000 lives in 2002. Vaccinating the mother during pregnancy may protect the baby. The World Health Organization and Center for Disease Control and Prevention recommend all children be vaccinated for pertussis and that it be included in routine vaccinations. Three doses starting at six weeks of age are typically recommended in young children. Additional doses may be given to older children and adults. This recommendation includes people who have HIV/AIDS.

[Action to be taken when facing one or more cases of whooping-cough].

The evolution of the epidemiology of pertussis, new licensed macrolides and vaccines, new recommendations for vaccination among adolescents and adults need an update of the French guidelines for prevention of the disease around one or grouped cases of the disease. A particular attention should be raised to the diagnosis of whooping cough in adults who are presently the main reservoir of Bordetella pertussis. Whooping cough in adults presents as an unexplained prolonged cough with nocturnal exacerbation witch accounts for most of the contaminations of young infants. A bacteriological confirmation of pertussis should be provided before implementation of preventive measures: culture and PCR are presently the gold standard for the diagnosis of pertussis in infants, children and even adults who have been coughing for less than 20 days. Later on, serology (Elisa, immuno-empreinte) is the only technique available, but cannot be interpreted if the patient has been vaccinated less than one year ago. Infants under three months should be admitted to hospital and every case submitted to respiratory isolation. Eviction from the community should be pronounced within the five first days following the onset of an effective antibiotic treatment. New macrolides should be favoured: clarithromycin for seven days or azithromycin for five days. Household contacts should be given the same prophylactic antibiotic treatment: children and adolescent not correctly immunized, parents of the index case as adults parents of not or not completely immunized infants. The vaccination program of the household should be updated. The same measures should be applied in case of grouped cases (at least two contemporary or consecutive cases in the same area). In that case, the Public Health System doctors should be involved in the investigation and the classification of the cases. The close contacts not or not completely immunized should be prescribed and antibiotic prophylaxis and an update of their vaccination program. Among the occasional contacts, high-risk people only should be treated. In the day care centres an antibiotic prophylaxis should be given to children who have received less than four vaccine shots against pertussis and to the personnel contact to the cases as well. In the schools, the antibiotic prophylaxis should be prescribed to all children of the classroom(s) not completely vaccinated and to the teacher(s) as well. In the boarding schools and institutions with handicapped children, antibiotic prophylaxis could be applied to every member if the pertussis vaccine coverage is at less than 50%. In hospitals, coughing personnel should wear masks and investigations towards pertussis should be performed in people with a more than seven day unexplained cough. Preventive measures should be applied in case of confirmation of pertussis.

Childhood immunizations in the United States

Pertussis (whooping cough) Pertussis is a highly contagious disease that is caused by the bacteria Bordetella pertussis. The bacteria clings to cilia in the lungs and releases a toxin that damages the cilia and causes inflammation in the respiratory tract. Transmission Many infants are infected by older siblings or caregivers that don't even know they have the disease. The bacteria is spread through respiratory secretions, often through coughing or sneezing, or just from breathing in the bacteria while around someone who is infected. Unfortunately, the effectiveness of the Pertussis vaccine is dependent on herd immunity, if pertussis is circulating in the community it is still possible for a vaccinated individual, of any age, to become ill. However, those that are vaccinated may have a less severe infection.

Whooping cough

The multicomponent acellular pertussis vaccine is 71–85% effective, with greater effectiveness against more severe strains. However, despite widespread vaccination, pertussis has persisted in vaccinated populations and is today "one of the most common vaccine-preventable diseases in Western countries". The 21st-century resurgences in pertussis infections is attributed to a combination of waning immunity and bacterial mutations that elude vaccines. Immunization does not confer lifelong immunity; a 2011 CDC study indicated that protection may only last three to six years. This covers childhood, which is the time of greatest exposure and greatest risk of death from pertussis. An effect of widespread immunization on society has been the shift of reported infections from children aged 1–9 years to infants, adolescents, and adults, with adolescents and adults acting as reservoirs for B. pertussis and infecting infants who have had fewer than three doses of vaccine.

Pertussis vaccine

Some studies have suggested that while acellular pertussis vaccines are effective at preventing the disease, they have a limited impact on infection and transmission, meaning that vaccinated people could spread the disease even though they may have only mild symptoms or none at all. Children For children, immunizations are commonly given in combination with immunizations against tetanus, diphtheria, polio, and haemophilus influenzae type B at two, four, six, and 15–18 months of age. Adults In 2006 the CDC recommended adults receive pertussis vaccination along with the tetanus and diphtheria toxoid booster. In 2011 they began recommended boosters during each pregnancy. In the UK vaccination of pregnant women (between 28 and 38 weeks of pregnancy) is also recommended.

Symptoms Symptoms usually develop 7–10 days after being exposed, but sometimes they don't appear for as long as 6 weeks after infection. The disease begins with cold-like symptoms and after a week or two, severe coughing begins that can continue for 10 weeks or more. Infants may develop "apnea" rather than a cough. Apnea is when the child stops breathing momentarily. Approximately half of the infants, younger than one year of age, who get the disease are hospitalized. 1 in 4 get pneumonia 1 or 2 in 100 will have convulsions (violent, uncontrolled shaking) 2/3 will have apnea 1 in 300 will have encephalopathy (disease of the brain) 1 or 2 in 100 will die In teens and adults symptoms include weight loss loss of bladder control passing out rib fractures from severe coughing exhaustion If someone with the vaccine becomes infected, in most cases the cough won't last for many days, symptoms occur less often and the percent of children with severe symptoms is less.

World Immunization Week

Immunization can protect against 25 different infectious agents or diseases, from infancy to old age, including diphtheria, measles, pertussis, polio, tetanus and COVID-19. The World Health Organization (WHO) estimates active immunization currently averts 2 to 3 million deaths every year. However 22.6 million infants worldwide are still missing out on basic vaccines, mostly in developing countries. Inadequate immunization coverage rates often result from limited resources, competing health priorities, poor management of health systems and inadequate surveillance. The goal of World Immunization Week is to raise public awareness of how immunization saves lives, and support people everywhere to get the vaccinations needed against deadly diseases for themselves and their children.

Is the vaccination coverage established enough to control pertussis, or it is a re-emerging disease?

Although vaccination coverage is high in Catalonia, Spain, pertussis is still a significant cause of morbidity and mortality among infants, overall due to adolescent and adult contacts. An epidemiological study from voluntary health care centres to detect confirmed pertussis cases was carried out in Catalonia. From 465 pertussis-suspect-cases, we identified 126 confirmed events, 73 of them confirmed by laboratory tests. Most of cases were infants less than 4 months old 23 (18.3%), adolescents 22 (17.4%) and adults 46 (36.5%). Sixty-one cases (49.6%) presented paroxysmal cough, 33 (26.8%) post-tussive vomiting and inspiratory whoop, and 27 (22%) apnoea. The vaccination status was not known for 46 (36.5%) patients. Of the total vaccine status documented, 59 (73.8%) patients had received at least one dose. Sixty patients (47.6%) were considered index cases, 32 of them (53.3%) were children under 1-year old. Among contacts identified as pertussis cases, 63.6% (42/66) were older than 14 years of age. These contacts were parents (30), siblings (19), grandmother (4), and others (13). These results confirm protective efficacy of pertussis vaccine only during few time. Regular pertussis boosters in teenagers, and/or in adults who take care of young children, could decrease the incidence of the infection.

Healthcare in Denmark

Vaccinations The National Childhood Vaccination Program in Denmark provides vaccinations to children for many diseases, including diphtheria, tetanus, and whooping Cough. From 1980 to 2015, vaccination coverage for those diseases increased from 88% to 93% of the children in Denmark, and the nation has consistently maintained 90% coverage or more since 2010. Those aged 65+ also receive the influenza vaccine. Denmark vaccinated 41.9% of the population aged 65 or above in 2015, a drastic increase from 6.2% in 2002. The cost of vaccinations is covered by the regions, with the exception of vaccinations required for vacation travel. References External links "Health care systems in transition - Denmark, HiT Summary" - World Health Organization Denmark

[Pertussis in young infants].

Four infants, three girls aged 4 weeks, 2.5 months and 3 months, and a boy aged 2 months, were hospitalized because of severe respiratory distress. Apnoea spells with bradycardia and hypoxia were seen in two of the patients, one showing convulsions as well, and bronchopneumonia in the other two, of whom one eventually died. All suffered from pertussis. During outbreaks of pertussis, infants less than 6 months of age are at highest risk for severe disease. In this age group, however, the clinical signs of pertussis are often atypical. Classical symptoms such as paroxysms of cough and loud whoops may be absent while feeding problems, apnoea, cyanosis and bradycardia may be present. For infants younger than 6 months with signs indicating pertussis hospitalization is indicated. In the current vaccination schedule in the Netherlands infants are vaccinated at 3, 4, 5 and 11 months of age. Starting in 1999 the first vaccination will be administered at the age of 2 months.

Whooping cough

Prevention is mainly by vaccination with the pertussis vaccine. Initial immunization is recommended between six and eight weeks of age, with four doses to be given in the first two years of life. Protection from pertussis decreases over time, so additional doses of vaccine are often recommended for older children and adults. Antibiotics may be used to prevent the disease in those who have been exposed and are at risk of severe disease. In those with the disease, antibiotics are useful if started within three weeks of the initial symptoms, but otherwise have little effect in most people. In pregnant women and children less than one year old, antibiotics are recommended within six weeks of symptom onset. Antibiotics used include erythromycin, azithromycin, clarithromycin, or trimethoprim/sulfamethoxazole. Evidence to support interventions for the cough, other than antibiotics, is poor. About 50% of infected children less than a year old require hospitalization and nearly 0.5% (1 in 200)

[Whooping cough necessitating hospitalization in Denmark, 1980-1986].

Information from the Danish National Patient Register revealed that 817 patients had been hospitalized with verified whooping cough during the period 1980-1986. The letters of discharge or the case records were obtained for all patients under one year for the entire period and for all patients over one year for the period 1984-1986, a total of 627 persons. These were supplemented by information from forms with information about positive cultures for whooping cough in nasopharyngeal swabs and from individual notifications about children under one year. 65% of the hospitalized patients were under one year and only 2% over 15 years. The severity of the disease measured by the duration of hospitalization and the presence of serious complications and symptoms decreased with age. The average duration of hospitalization was 15 days for children under one year and seven days for children over one year. Five children died. One child developed epilepsy, nine of the remainder required assisted respiration and recovered apparently without permanent damage. Out of the 627 patients who were hospitalized, pneumonia developed in 12%, seizures in 2% under one year and 5% over one year, apnoea occurred in 10% under one year and 2% over one year and cyanosis occurred in 61% under one year and 30% over one year. None of the vaccinated children developed seizures, required assisted ventilation or died and only 2% had apnoea as compared with 7% in the unvaccinated children. Children under two months and children in whom vaccination was contraindicated were responsible for 56% of the hospitalizations among children under one year and for 79% of the most severe cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Breastfeeding

Maternal vaccinations while breastfeeding is safe for almost all vaccines. Additionally, the mother's immunity obtained by vaccination against tetanus, diphtheria, whooping cough and influenza can protect the baby from these diseases, and breastfeeding can reduce fever rate after infant immunization. However, smallpox and yellow fever vaccines increase the risk of infants developing vaccinia and encephalitis. Mortality Babies who receive no breast milk are almost six times more likely to die by the age of one month than those who are partially or fully breastfed. Childhood obesity The protective effect of breastfeeding against obesity is consistent, though small, across many studies. A 2013 longitudinal study reported less obesity at ages two and four years among infants who were breastfed for at least four months. Allergic diseases

[Whooping cough in Denmark among children under 1 year of age during 1980-1986].

On the basis of individual notifications, reports of cases verified by culture and letters of discharge or case reports of infants under one year with whooping cough during the period 1980-1986, the distribution of the disease is described together with vaccine efficacy and the presumed sources of infection for infants in this age group. The incidence of whooping cough in infants under one year is estimated to be approximately three cases per 1,000 per annum as compared with 150 per 1,000 at the beginning of this century and 60 per 1,000 in the nineteen fifties before routine vaccination was introduced in 1961. The first vaccination is calculated to provide a vaccine efficacy of 39%, after the second vaccination the vaccine efficacy rises to 86% and after the third vaccination the vaccine efficacy is about 98% during the remainder of the first year of life. Even although the times of vaccination were advanced in 1970, this has not reduced the frequency of whooping cough in infants as the vaccination programme has simultaneously been weakened because children are now vaccinated only three times with a weaker vaccine and the immunity is of briefer duration. The commonest sources of infection for infants are siblings. A lower infective risk is desirable and this could be obtained by vaccinating infants an extra time. Alterations in the system of notification in 1980 have resulted in increased under-notification of whooping cough in children under one year while, simultaneously, the notified cases have been described better.

National Immunisation Program Schedule

The national coverage rate has increased over the last 10 years, as of 2019. National Immunisation Program Schedule Childhood vaccinations Birth Hepatitis B 2 weeks (Can be given from 6 weeks of age) Diphtheria Tetanus Pertussis (whooping cough) Hepatitis B Polio Haemophilus influenzae type b Pneumococcal Rotavirus ("First dose must be given by 14 weeks of age, and the second dose by 24 weeks of age") 4 months Diphtheria Tetanus Pertussis (whooping cough) Hepatitis B, polio Haemophilus influenzae type b Pneumococcal Rotavirus 6 months Diphtheria Tetanus Pertussis (whooping cough) Hepatitis B, polio Haemophilus influenzae type b 12 months Meningococcal ACWY Measles, mumps, rubella (MMR Vaccine) Pneumococcal 18 months Haemophilus influenzae type b Measles, mumps, rubella (MMR Vaccine) Varicella (chickenpox) Diphtheria Tetanus Pertussis (whooping cough) 4 years Diphtheria Tetanus Pertussis (whooping cough) Polio

[Pertussis: a reemerging infection?].

To analyze the incidence of pertussis in the Czech Republic, influencing factors and, in particular, the effect of vaccination on pertussis morbidity, clinical seriousness of the disease and circulation of Bordetella pertussis in the population. To study the causes of defective diagnosis and reporting and to propose remedial measures. Data on pertussis morbidity were obtained from the archives of the National Institute of Public Health and the public health information systems ISPO and EPIDAT. Mortality data were taken from the above sources and literature. The case definition was used as specified in the Methodical Guidance for Pertussis Surveillance and the EC Directive. Laboratory diagnosis was based on culture and serology. An at least fourfold increase in the serum antibody titer found within an experiment was considered as a positive result. Pertussis together with diphteria and measles used to be among the most dangerous infections in childhood. The oldest mortality data date back to 1890 when 62 deaths per 100,000 population were reported. In 1951, the death rate still reached 3.6/100,000. The pertussis morbidity peaked in 1955 with 540 cases per 100,000 population. Vaccination against pertussis since the early 1950's led to a rapid reduction of morbidity in children. Nevertheless, higher pertussis morbidity rates were observed at 2-4-year intervals (in the so- called epidemic years). The lowest morbidity rates were reported during the 1980's. However, a stable upward trend has been observed over the following years. In 2006, a neonate died from pertussis. The age specific morbidity rates in 1980 through 2000 were highest in children under one year of age. This fact together with the regularly increased morbidity rates observed at 2-3-year intervals indicate that Bordetella pertussis still circulates in the population. While in the 1980's, the cases of pertussis were reported almost exclusively in children under one year of age, in the 1990's, they became more common also among children 1-4 years of age and started to be prevalent in children 10-14 years of age since 2001. A high immunisation coverage (97%) with five doses of high quality whole-cell vaccine of Czech origin introduced into practice in 1958 played a crucial role in the reduction of pertussis morbidity from more than 500/100,000 in the mid-1950's to less than 0.5/100,000 in the 1980's. Nevertheless, this strategy did not lead to elimination of the causative agent in the population. It is evident that the current immunization scheme with the use of the available vaccines cannot solve the epidemiological situation. Since the efficacy of the currently available acellular pertussis vaccines is, at the best, the same as that of the whole-cell vaccines, any improvement of the current status cannot be expected. Only effective active surveillance, the use of new more immunogenic pertussis vaccines and revaccination of older age groups can result in desirable outcomes.

Louis W. Sauer

Louis Wendlin Sauer (born August 13, 1885 in Cincinnati; d. February 10, 1980 in Miami) was an American pediatrician who became known for perfecting the vaccine used to prevent pertussis (whooping cough), saving countless lives around the world. After five years of work, Dr. Sauer developed the vaccine in 1931, inoculating children against pertussis, a respiratory infection that had been the most fatal disease for children under two years old. He later developed the DPT vaccine, which allowed the vaccines for diphtheria, pertussis and tetanus to be administered as a single injection. Dr. Sauer never asked for compensation for developing vaccines and told an interviewer later, "One doesn't do that thing for money."

[Why still whooping cough?].

Whooping cough is a human respiratory infection, dramatic for newborns and elderly, by the bacteria Bordetella pertussis and parapertussis. Intensive vaccination of children allowed an important decrease of mortality and morbidity. However, generalization of vaccination conducted to a change in the transmission of the disease due to the short duration of vaccinal immunity and the lack of vaccinal or natural boosters. The disease affects now adolescents and adults who contaminate new-borns too young to be vaccinated. For this reason, many countries including France, decided to add vaccine boosters for adolescents and young adults.

Sustained efficacy during the first 6 years of life of 3-component acellular pertussis vaccines administered in infancy: the Italian experience.

In 1992-1993, a randomized, double-blind, placebo-controlled clinical trial of two 3-component acellular pertussis vaccines was started in 4 of Italy's 20 regions. During the trial, the children had been randomized to receive 3 doses of 1 of 2 acellular pertussis vaccines combined with diphtheria and tetanus toxoids (DT) or of a DT vaccine only, at 2, 4, and 6 months of age. Both diphtheria-tetanus-acellular pertussis (DTaP) vaccines, 1 manufactured by SmithKline Beecham (DTaP SB; Infanrix) and 1 manufactured by Chiron Biocine (DTaP CB; Triacelluvax), contain pertussis toxin (PT), filamentous hemagglutinin, and pertactin. The results of the first period of follow-up, which ended in 1994 (stage 1), showed that both vaccines had a protective efficacy of 84% in the first 2 years of life; when the trial's follow-up was extended under partial blinding until the participating children had reached 33 months of age (stage 2 of the follow-up), these high levels of efficacy had persisted. Therefore, the objective of this study was to estimate the persistence of protection from 3 to 6 years of age of the 2 3-component DTaP vaccines administered as primary immunization in infancy. An unblinded prospective longitudinal study of vaccinated and unvaccinated children in 4 Italian regions, with active surveillance of cough, was conducted by study nurses, and Bordetella pertussis infections were confirmed laboratory. The present study (stage 3) included those children who completed stage 2 of the follow-up and were still under active surveillance as of October 1, 1995, accounting for 4217 children who had received DTaP SB (representing 94% of the vaccine's recipients in the initial phase of the trial), 4215 who had received DTaP CB (95% of the original recipients), and 266 who had received DT only (18% of the original recipients). Because the parents of most of the original DT placebo group accepted pertussis vaccination during stage 2 in 1995, an additional 856 children were recruited in the DT group at the initiation of stage 3. These additional children were identified from the census list of children born in the same period and living in the same areas as the trial participants but who had been vaccinated in infancy with DT only. Eligible children were included in stage 3 if they had no history of either pertussis or pertussis vaccination and if a serum sample obtained at the time of enrollment had undetectable immunoglobulin G (IgG) against PT. Parental consent to participate in the study was obtained. Active surveillance for pertussis was conducted in the field by 72 study nurses through monthly contact with each family in the study. A cough episode that lasted >/=7 days was considered to be a laboratory-confirmed infection by Bordetella pertussis if at least 1 of the following 5 criteria (listed in hierarchic order) was met: 1) B pertussis was obtained from nasopharyngeal culture (culture-confirmed infection); 2) the enzyme-linked immunosorbent assay (ELISA) IgG or IgA titer against PT in the convalescent-phase serum sample increased by at least 100% compared with the acute-phase sample; 3) the PT-neutralizing titers in Chinese hamster ovary assay in the convalescent-phase sample increased by at least 4-fold compared with the acute-phase sample; 4) the ELISA IgG or IgA titer against filamentous hemagglutinin in the convalescent-phase sample increased by at least 100% and the culture or the polymerase chain reaction assay on the nasopharyngeal aspirate was negative for B parapertussis; and 5) the ELISA IgG PT titer in 1 of the 2 serum samples exceeded the geometric mean titer computed on convalescent sera of the children with a culture-confirmed B pertussis infection in each study group. Incidence of laboratory-confirmed B pertussis infection, using case definitions that varied in terms of duration and type of cough, was computed and the proportion of cases prevented among DTaP recipients in comparison with DT recipients was calculated. A total of 391 laboratory-confirmed infections were identified in the 3-year follow-up period (138 DTaP SB, 126 DTaP CB, 127 DT recipients, respectively). The mean duration of cough in children with laboratory-confirmed infection was 48, 47, and 70 days for the DTaP SB, DTaP CB, and DT recipients, respectively; the mean duration of spasmodic cough was 15, 13, and 23 days, respectively. When using the primary case definition (ie, laboratory-confirmed B pertussis infection and >/=14 days of spasmodic cough or >/=21 days of any cough), the efficacy was 78% for the DTaP SB vaccine (95% confidence interval [CI]: 71%-83%) and 81% for the DTaP CB vaccine (95% CI: 74%-85%). When using the case definition based on a more severe clinical presentation (>/=21 days of spasmodic cough), the vaccine efficacy was 86% (95% CI: 79%-91%) for both vaccines. When using the case definition based on milder clinical presentation (any cough for >/=7 days), the efficacy was 76% (95% CI: 69%-81%) for the DTaP SB vaccine and 78% (95% CI: 72%-83%) for the DTaP CB vaccine. The persistence of protection through 6 years of age suggests that the fourth DTaP dose could be postponed until preschool age in children who received 3-component acellular pertussis vaccines in infancy, provided that immunity to diphtheria and tetanus is maintained. Additional booster doses could be administered at older ages to reduce reactogenicity induced by multiple administrations and to optimize the control of pertussis in adolescents and young adults.

[Whooping cough today].

Vaccination has totally modified the epidemiology of pertussis in France. The classically described childhood forms have become quite exceptional compared with early cases in infants and later cases in older children, adolescents and adults. Whooping cough is often misdiagnosed in adults as the expression is less typical, largely contributing to further transmission. Pertussis should be envisaged as a possible diagnosis in adults with persistent or worsening cough for more than 7 days. Early vaccination should be encouraged with a late booster at 11-13 years as recommended in the 1998 guidelines. Bacterial isolates provide the diagnosis, requiring samples as early as possible in the disease course both in the primary patient and in persons in his/her contact. The PCR is reimbursed by the French health insurance system. Serology can be useful for retrospective diagnosis, particularly in children and adults even in case of vaccination, as well as in mothers of young infants due to the prepartum serum. Whole-cell vaccine has proven its excellent efficacy and remains the only vaccine indicated for infants. New acellular pertussis vaccines are well tolerated and are indicated for boosters at 18 months and at 11-13 years.

Expanded Program on Immunization (Philippines)

General Principles in Infants/Children Immunization Because measles kills, every infant needs to be vaccinated against measles at the age of 9 months or as soon as possible after 9 months as part of the routine infant vaccination schedule. It is safe to vaccinate a sick child who is suffering from a minor illness (cough, cold, diarrhea, fever or malnutrition) or who has already been vaccinated against measles. If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule should be resumed using minimal intervals between doses to catch up as quickly as possible.

[Time for booster doses against whooping cough for 10-year-old children].

Acellular pertussis vaccine was introduced in Sweden in 1996 at the age of 3, 5 and 12 months, after a 17 year period without general vaccination against pertussis. At present, the incidence of notified pertussis has decreased to 1/10 of what was seen 10 years ago. In spite of the dramatic decrease, the disease is not eliminated. In accordance with the experience of other countries, most cases in Sweden are reported among older children and adults, while the highest risk of severe disease is still seen in infants. Many industrialized countries have introduced booster dose(s) in order to control the spread of pertussis. The Swedish National Board of Health and Welfare has recently initiated a major revision of the vaccines used and the schedule of the national vaccination program. Until the final proposal and in order not to miss the opportunity to boost pertussis immunity in children who were vaccinated as infants at the reintroduction of pertussis vaccination, the Board now recommends the Swedish municipalities as an interim measure to include pertussis in the current school booster against diphtheria and tetanus at 10 years of age with a full dose vaccine.

Pneumococcal conjugate vaccine

Children at special risk (e.g., sickle cell disease and asplenia) require as full protection as can be achieved using the conjugated vaccine, with the more extensive polysaccharide vaccine given after the second year of life: United States In 2001, the Centers for Disease Control and Prevention (CDC), upon advice from its Advisory Committee on Immunization Practices (ACIP), recommended the vaccine be administered to every infant and young child in the United States. The resulting demand outstripped production, creating shortages not resolved until 2004. All children, according to the U.S. vaccination schedule, should receive four doses, at two months, four months, six months, and again between one year and fifteen months of age. The CDC updated the pneumococcal vaccine guidelines for adults 65 years of age or older in 2019.

[Whooping cough: a retrospective study of the cases diagnosed over a period of 15 years].

Our objective was to study the whooping cough cases diagnosed in a 15-year period in our hospital, referring to its clinical features, epidemiology and analytical findings. A retrospective study based on 144 cases with a clinical diagnosis of whooping cough, from 1981 to 1995, was carried out. Special attention was paid to those cases with cultures positive for B. pertussis. Nasopharyngeal specimens for culture were taken in 119 cases. This was not carried-out in those with previous antibiotic therapy. Cultures were positive for B. pertussis in 46 patients (38.7%). The age varied between 20 days and 30 months. Twenty-one were female. The initial symptoms were: paroxysmal cough in 44 (95.7%), cyanosis in 34 (73.9%), inspiratory whoop in 27 (58.7%), respiratory distress in 12 (26.1%) and post-tussive vomiting in 10 (21.7%). Thirty-nine children (84.8%) of this group had not received any pertussis vaccine, the rest had received just the first dose. It had been contacted by persons having cough in 19 patients (41.3%). Leukocytosis (mean: 19,818/mm3), lymphocytosis (mean: 13,047/mm3) and high platelet count (mean 459,522/mm3) were common findings. Cultures were positive in 38.7% of the patients. There are similar findings by other authors. In this group, most of the children were unvaccinated, and less than 3 months of age. Typical symptoms of pertussis were observed in the majority of patients. In one forth of them respiratory distress was found, probably related to their young age. Vaccinated adults emerge as a contact group that should be studied.

DPT vaccine

A 2019 study in the American Economic Journal found that state requirements mandating the use of the Tdap vaccine "increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence by about 32 percent." Related combination vaccines Excluding Pertussis DT and Td vaccines, lack the pertussis component. The Td vaccine is administered to children over the age of seven as well as to adults. It is most commonly administered as a booster shot every 10 years. The Td booster shot may also be administered as protection from a severe burn or dirty wound. Including Polio In the United States, an inactivated polio vaccine (IPV) is administered along with the tetanus, diphtheria, and acellular pertussis vaccines (DTaP) and a pediatric dose of hepatitis B vaccine. In the UK, IPV is combined with tetanus, diphtheria, pertussis, and Haemophilus influenzae type b vaccines.

[The effect of the initial level of immunity on the efficacy of antidiphtheria inoculations in children and adults].

Based on results of examination in the passive hemagglutination test of 1440 subjects at different ages, several distinguishing features were revealed of formation of artificial active antidiphtheria immunity depending on the basic level of immunity. Single revaccination of those subjects presenting with the basic immunity of less than 0.03 IU/ml provides defence against diphtheria in only 33.3 percent of adults and 50 percent of children, in those subjects presenting with immunity between 0.03 to 0.99 IU/ml it is highly effective, in the immunity 1 IU/ml and beyond the effect of further immunization is very low since 25 to 33.3 percent of subjects demonstrate enhancement of immunity, whereas 16.7 to 25 percent show lowering of it. The analysis of the immunological structure of the population shows that 45 to 60 percent of adults in different age groups need to be exposed to single revaccination, 14 to 37 present will find it insufficient, 3 to 36 percent redundant. We suggest that revaccination against diphtheria be conducted under control of the level of antitoxic immunity.

Rohingya refugees in Bangladesh

In October 2017, a mass vaccination effort spearheaded by the Ministry of Health and Family Welfare and partners provided 900,000 doses of oral cholera vaccine in two phases. More than 700,000 people over 1 year of age received a single dose during the first phase; in the second, an additional dose of the oral cholera vaccine was administered to 199,472 children ages 1 to 5 years. In addition, 236,696 children under 5 years of age were also vaccinated against polio. No new cases of cholera were detected in the 3 months following mass vaccination. However, Rohingya refugees arriving after the mass vaccination remain unprotected. As a result, a new cholera vaccination campaign began in May 2018. Also in Cox's Bazar, Rohingya children up to age 6 were immunized in December 2017 against pneumococcal disease, pertussis, tetanus, influenza B, and diphtheria in an effort to prevent future outbreaks and to control the spread of diphtheria.

Association of Routine Infant Vaccinations With Antibody Levels Among Preterm Infants.

The standard schedule of national immunization programs for infants may not be sufficient to protect extremely and very preterm infants. To evaluate the immunogenicity of routine vaccinations administered to preterm infants. A multicenter, prospective, observational cohort study of preterm infants stratified according to gestational age recruited from 8 hospitals across the Netherlands between October 2015 and October 2017, with follow-up until 12 months of age (October 2018). In total, 296 premature infants were enrolled and compared with a control group of 66 healthy term infants from a 2011 study, immunized according to the same schedule with the same vaccines. Three primary doses of the diphtheria-tetanus toxoids-acellular pertussis-inactivated poliomyelitis-Haemophilus influenza type b-hepatitis B combination vaccine were given at 2, 3, and 4 months after birth followed by a booster at 11 months and a 10-valent pneumococcal conjugate vaccine at 2, 4, and 11 months after birth. Primary end points were (1) proportion of preterm infants who achieved IgG antibody against vaccine antigens at concentrations above the internationally defined threshold for protection after the primary series and booster dose and (2) serum IgG geometric mean concentrations after the primary series and booster vaccination. Proportions and geometric mean concentrations were compared in preterm infants and the control group of term infants. Of 296 preterm infants (56.1% male; mean gestational age, 30 weeks), complete samples before vaccination, 1 month after the primary series, and 1 month after the booster were obtained from 220 preterm infants (74.3%). After the primary series, the proportion of preterm infants across all gestational age groups who achieved protective IgG antibody levels against pertussis toxin, diphtheria, tetanus and 6 of 10 pneumococcal serotypes varied between 83.0% and 100%, Haemophilus influenzae type b between 34.7% and 46.2% (40.6% among all preterm infants overall), and pneumococcal serotypes 4, 6B, 18C, and 23F between 45.8% and 75.1%. After the booster dose, protective antibody levels were achieved in more than 95% of all preterm groups, except for Haemophilus influenzae type b (88.1%). In general, geometric mean concentrations of all vaccine-induced antibodies were significantly lower in all preterm infants vs term infants, except for pertussis toxin and pneumococcal serotypes 4 and 19F after the primary series and booster vaccination. Among preterm infants, administration of routine vaccinations during the first year of life was associated with protective antibody levels against most antigens in the majority of infants after the primary series and booster, except for Haemophilus influenzae type b. However, antibody concentrations were generally lower among preterm infants compared with historical controls.


Transcortical have preserved repetition. Broca's aphasia has preserved comprehension and absence of fluent speech. Wernicke's aphasia is characterized by fluent speech (even in excess) with paraphasias and problems with comprehension, nomination and repetition.

A patient who presents with problems in understanding spoken and written language, inability to name objects and repeat words that are said to him, incomprehensible fluent speech with semantic and phonemic paraphasias. This is a:

Frontal-opercular aphasia.

The standard nomenclature divides nonfluent aphasic syndromes with relatively spared comprehension into Broca's aphasia and transcortical motor aphasia. We report on a patient with a persistent nonfluent aphasia from a discrete, primarily cortical, frontal-opercular lesion who had impaired syntax but intact repetition and, therefore, did not conform to the traditional classification. Based on this patient's behavior and a review of other cases, we have divided the nonfluent aphasias with intact comprehension into five disorders. (1) Verbal akinesia-exhibiting diminished intention or drive to speak and associated with medial frontal lesions (supplementary motor area and cingulate gyrus) or with lesions damaging the efferent projections from these areas. (2) Disorders of syntax-telegraphic and agrammatic utterances that may be associated with dominant pars opercularis lesions. (3) Phonemic disintegration-a failure to correctly produce phonemes, which may be associated with injury to the opercular primary motor cortex or efferent projections from this area. (4) Defects of lexical access-patients who struggle to find words and are impaired at timed word-generation tasks. Defects of lexical access may be associated with lesions of the pars triangularis and adjacent prefrontal cortex. (5) Mixed defects. According to this model, the traditional patient with Broca's aphasia would exhibit disorders of syntax, phonemic disintegration, and defects of lexical access, whereas the traditional patient with transcortical motor aphasia would have verbal akinesia or defects of lexical access or both. Our patient had defects of lexical access and syntax, but only mild symptoms of phonemic disintegration, suggesting that his opercular primary motor cortex was relatively intact. Our patient's ability to repeat normally while his propositional speech remained telegraphic suggests that different neural mechanisms subserve these functions.

Mixed transcortical aphasia

Symptoms and language characteristics Mixed transcortical aphasia is characterized by severe speaking and comprehension impairment, but with preserved repetition. People who suffer mixed transcortical aphasia struggle greatly to produce propositional language or to understand what is being said to them, yet they can repeat long, complex utterances or finish a song once they hear the first part. Persons with mixed transcortical aphasia are often nonfluent, and in most cases do not speak unless they are spoken to, do not comprehend spoken language, cannot name objects, and cannot read or write. However, they often have the ability to repeat what is said to them. In fact, persons with mixed transcortical aphasia often repeat in a parrot-like fashion. Some patients with this disorder can experience many different types neurological symptoms including, bilateral paralysis, lack of voluntary speech, and difficulty with producing spontaneous speech.

[Spontaneous speech disturbances in so called transcortical motor aphasia--comparison of 3 cases with the different lesion sites].

So called transcortical motor aphasia (TCMA) is frequently subdivided, because the clinical features and the localization of the lesions are variable. The authors have been attempting to classify TCMA into three types according to the distribution of the lesions, such as Type F 1, Type F 2 and Type F 3. Case 1 N.S. belongs to Type F 1 showing the clinical features of TCMA with bleeding in the territory of the left anterior cerebral artery. Case 2 M.E. belongs to Type F 2 (published case). This case is similar to Luria's dynamic aphasia in its clinical features and results from the lesions including the posterior parts of left middle frontal gyrus. Case 3 N.T. belongs to Type F 3 who recovered from typical Broca aphasia after language training for four years. The case is similar to Goldstein's Type 1 of TCMA in its clinical features. These three cases are compared with regard to the fundamental bases of spontaneous speech disturbance. The items of comparison are as follows; the volume of speech production and the the time taken to start speech, word fluency test, cue effects necessary for the success of sentence constructions grammatical ability. The results are summerized in Table 2. Type F1 shows the most conspicuous defect of spontaneous speech, but no disturbance in grammatical ability. And when the top word of a sentence (a subject word) is given by the examiner, the patient can construct a structurally correct sentence. These findings imply that the spontaneous speech disturbance of Type F 1 is due to a defect of the starting mechanism of speech.(ABSTRACT TRUNCATED AT 250 WORDS)

Mixed transcortical aphasia

For most patients, formal and informal language assessments are initially administered during his/her acute hospital stay by a licensed speech-language pathologist. However, a standardized assessment may provide further information regarding an aphasia classification. While there are different classifications of aphasia (i.e., Broca’s, Wernicke’s, Conduction, Anomia), they each have hallmark deficits. Research has shown, a patient presenting with mixed transcortical aphasia will have impairments in all communicative areas, with the exception of the preserved ability to repeat a person’s words or phrases. Patients with mixed transcortical aphasia demonstrate similar deficits as those seen in patients with global aphasia. Therefore, assessment of repetition is most critical in order to differentially diagnose. Specifically, language based standardized assessments such as the Western Aphasia Battery (WAB), and the Folstein Mini Mental State Exam include a repetition subtest amongst

[The phonological variant of primary progressive aphasia, a single case study].

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by an insidious onset and gradual progression of deficits that can involve any aspect of language, including word finding, object naming, fluency, syntax, phonology and word comprehension. The initial symptoms occur in the absence of major deficits in other cognitive domains, including episodic memory, visuospatial abilities and visuoconstruction. According to recent diagnostic guidelines, PPA is typically divided into three variants: nonfluent variant PPA (also termed progressive nonfluent aphasia), semantic variant PPA (also termed semantic dementia) and logopenic/phonological variant PPA (also termed logopenic progressive aphasia). The paper describes a 79-yr old man, who presented with normal motor speech and production rate, impaired single word retrieval and phonemic errors in spontaneous speech and confrontational naming. Confrontation naming was strongly affected by lexical frequency. He was impaired on repetition of sentences and phrases. Reading was intact for regularly spelled words but not for irregular words (surface dyslexia). Comprehension was spared at the single word level, but impaired for complex sentences. He performed within the normal range on the Dutch equivalent of the Pyramids and Palm Trees (PPT) Pictures Test, indicating that semantic processing was preserved. There was, however, a slight deficiency on the PPT Words Test, which appeals to semantic knowledge of verbal associations. His core deficit was interpreted as an inability to retrieve stored lexical-phonological information for spoken word production in spontaneous speech, confrontation naming, repetition and reading aloud.

Transcortical sensory aphasia

Transcortical sensory aphasia is characterized as a fluent aphasia. Fluency is determined by direct qualitative observation of the patient’s speech to determine the length of spoken phrases, and is usually characterized by a normal or rapid rate; normal phrase length, rhythm, melody, and articulatory agility; and normal or paragrammatic speech. Transcortical sensory aphasia is a disorder in which there is a discrepancy between phonological processing, which remains intact, and lexical-semantic processing, which is impaired. Therefore, patients can repeat complicated phrases, however they lack comprehension and propositional speech. This disconnect occurs since Wernicke’s area is not damaged in patients with TSA, therefore repetition is spared while comprehension is affected. Patients with intact repetition can repeat both simple and complex phrases spoken by others, e.g. when asked if the patient would like to go for a walk, he or she would respond "go for walk." Although patients can

Aphasia

Recent classification schemes adopting this approach, such as the Boston-Neoclassical Model, also group these classical aphasia subtypes into two larger classes: the nonfluent aphasias (which encompasses Broca's aphasia and transcortical motor aphasia) and the fluent aphasias (which encompasses Wernicke's aphasia, conduction aphasia and transcortical sensory aphasia). These schemes also identify several further aphasia subtypes, including: anomic aphasia, which is characterized by a selective difficulty finding the names for things; and global aphasia, where both expression and comprehension of speech are severely compromised. Many localizationist approaches also recognize the existence of additional, more "pure" forms of language disorder that may affect only a single language skill. For example, in pure alexia, a person may be able to write but not read, and in pure word deafness, they may be able to produce speech and to read, but not understand speech when it is spoken to them.

Transcortical sensory aphasia

Naming Naming involves the ability to recall an object. Patients with TSA, as well as patients with all other aphasia subtypes, exhibit poor naming. Clinical assessment of naming involves the observer first asking the patient to name high frequency objects such as clock, door, and chair. TSA patients who name common objects with ease generally have difficulty naming both uncommon objects and specific parts of objects such as lapel, or the dial on a watch. Paraphasia Patients with TSA typically exhibit paraphasia; their speech is fluent but often error-prone. Their speech is often unintelligible as they tend to use the wrong words, e.g. tree instead of train or uses words in senseless and incorrect combinations. Diagnosis Clinical assessment

Aphasia

Individuals with conduction aphasia have deficits in the connections between the speech-comprehension and speech-production areas. This might be caused by damage to the arcuate fasciculus, the structure that transmits information between Wernicke's area and Broca's area. Similar symptoms, however, can be present after damage to the insula or to the auditory cortex. Auditory comprehension is near normal, and oral expression is fluent with occasional paraphasic errors. Paraphasic errors include phonemic/literal or semantic/verbal. Repetition ability is poor. Conduction and transcortical aphasias are caused by damage to the white matter tracts. These aphasias spare the cortex of the language centers but instead create a disconnection between them. Conduction aphasia is caused by damage to the arcuate fasciculus. The arcuate fasciculus is a white matter tract that connects Broca's and Wernicke's areas. People with conduction aphasia typically have good language comprehension, but poor

Transcortical motor aphasia

There are some other forms of aphasia that relate to TMoA. For instance, adynamic aphasia is a form of TMoA that is characterized by sparse speech. This occurs as a result of executive functioning in the frontal lobe. Another form of aphasia related to TMoA is dynamic aphasia. Patients with this form of aphasia may present with a contiguity disorder in which they have difficulty combining linguistic elements. For dynamic aphasia, this is most apparent when the patient is asked to sequence at the sentence level whereas for other aphasias contiguity disorder can be seen at the phoneme or word level.

Errors resembling semantic paralexias in Spanish-speaking aphasics.

Forty-one Spanish-speaking left-hemisphere-damaged patients were selected and divided into seven groups (transcortical, Broca's aphasia, conduction aphasia, Wernicke's aphasia, anomic aphasia, alexia without agraphia, and global aphasia). A reading battery composed of eight different subtests was given to each patient (reading of letters, reading of syllables, reading of pseudowords, reading of words, reading of sentences, understanding commands, reading and comprehension of texts, and logographic reading). Different types of reading errors were analyzed. Only in the logographic reading subtest were some word-recognition errors found, resembling semantic paralexias. It is proposed that semantic paralexias in English (and other languages) depend upon the partial logographic nature of the reading system. The importance of cross-linguistic analysis of reading errors, taking into account reading system idiosyncracies, is emphasized.

Transcortical motor aphasia

TMoA is classified as a non-fluent aphasia that is characterized by a significantly reduced output of speech, but good auditory comprehension. Auditory comprehension skills remain intact because the arcuate fasciculus and Wernicke's area are not impaired. Individuals with TMoA also exhibit good repetition skills and can repeat long, complex phrases effortlessly and without error. However, spontaneous speech often presents with paraphasias (a wide category of speech errors that are caused by aphasia). Regardless of any relative communication strengths, individuals with TMoA are typically poor conversational partners. Due to damage in the anterior superior frontal lobe, people with TMoA have deficits in initiation and maintenance of conversations, which results in reduced speech output. A person with TMoA may seldomly produce utterances and typically remain silent. The utterances that they do produce are typically only one to two words long. However, in more structured and predictable

Aphasia

Transcortical motor aphasia and transcortical sensory aphasia, which are similar to Broca's and Wernicke's aphasia respectively, but the ability to repeat words and sentences is disproportionately preserved.

Neurology_Adams

Language is clearly affected in a restricted way in Broca aphasia. Speech is sparse (10 to 15 words per minute as compared with the normal 100 to 115 words per minute) and consists mainly of nouns, transitive verbs, or important adjectives; phrase length is abbreviated and many of the small words (articles, prepositions, conjunctions) are omitted, giving the speech an abbreviated, telegraphic character (so-called agrammatism). The substantive content of the patient’s language permits the crude communication of ideas, sometimes despite gross expressive difficulties. Repetition of the examiner’s spoken language is as abnormal as the patient’s own speech. If a patient with nonfluent Broca aphasia has no difficulty in repetition, the condition is termed transcortical motor aphasia (see further on). Furthermore, a true defect in language production is evidenced by impairment in the content of written words and sentences. Should the right hand be paralyzed, the patient cannot print with the

Wernicke's area

to more complex phrases. Both comprehension and repetition would be abnormal in Wernicke's aphasia. Content should also be assessed, by listening to a patient's spontaneous or instructed speech. Content abnormalities include paraphasic errors and neologisms, both indicative of a diagnosis of Wernicke's aphasia. Neologisms are novel words that may resemble existing words. Patients with severe Wernicke's aphasia may also produce strings of such neologisms with a few connecting words, known as jargon. Errors in the selection of phonemes of patients with Wernicke's aphasia include addition, omission, or change in position. Another symptom of Wernicke's aphasia is use of semantic paraphasias or "empty speech" which is the use of generic terms like "stuff" or "things" to stand in for the specific words that the patient cannot think of. Some Wernicke's aphasia patients also talk around missing words, which is called "circumlocution." Patients with Wernicke's aphasia can tend to run on when

Boston Diagnostic Aphasia Examination

The Boston Diagnostic Aphasia Examination provides a comprehensive exploration of a range of communicative abilities. Its results are used to classify patient's language profiles into one of the localization based classifications of aphasia: Broca's, Wernicke's, anomic, conduction, transcortical, transcortical motor, transcortical sensory, and global aphasia syndromes, although the test does not always provide a diagnosis or a therapeutic approach. The assessment provides a severity rating. The Examination is designed to go beyond simple functional definitions of aphasia into the components of language dysfunctions (symptoms) that have been shown to underlie the various aphasic syndromes. Thus, this test evaluates various perceptual modalities (e.g., auditory, visual, and gestural), processing functions (e.g., comprehension, analysis, problem-solving), and response modalities (e.g., writing, articulation, and manipulation). This approach allows for the neuropsychological analysis and

Language center

There are numerous distinctive ways in which language can be affected. Phonemic paraphasia, an attribute of conduction aphasia and Wernicke aphasia, is not the speech comprehension impairment. Instead, it is the speech production damage, where the desire phonemes are selected erroneously or in an incorrect sequence. Therefore, although Wernicke’s aphasia, a combination of phonological retrieval and semantic systems impairment, affects speech comprehension, it also involves speech production damage. Phonemic paraphasia and anomia (impaired word retrieval) are the results of phonological retrieval impairment.

Aphasia

Individuals with anomic aphasia have difficulty with naming. People with this aphasia may have difficulties naming certain words, linked by their grammatical type (e.g., difficulty naming verbs and not nouns) or by their semantic category (e.g., difficulty naming words relating to photography but nothing else) or a more general naming difficulty. People tend to produce grammatic, yet empty, speech. Auditory comprehension tends to be preserved. Anomic aphasia is the aphasial presentation of tumors in the language zone; it is the aphasial presentation of Alzheimer's disease. Anomic aphasia is the mildest form of aphasia, indicating a likely possibility for better recovery. Individuals with transcortical sensory aphasia, in principle the most general and potentially among the most complex forms of aphasia, may have similar deficits as in receptive aphasia, but their repetition ability may remain intact.

Wernicke Aphasia -- History and Physical

In Wernicke's aphasia language output is fluent with a normal rate and intonation. However, the content is often difficult to understand because of paraphrastic errors. Paraphasic errors come in two forms: semantic paraphasia errors where  one word is substituted for another and phenomic paraphrastic errors where one sound or syllable is substituted for another. An example of a semantic paraphasia error would be a patient saying "watch" instead of "clock."  An example of a phonemic paraphasic error would be a patient saying "dock" instead of "clock." In severe cases, these errors can result in neologisms (new words) or word salad which makes communication nearly unintelligible. Because of these deficits, patients may find it easier to substitute a generic word such as "thing" or "stuff" instead of saying the word they wish to say. Reading involves the comprehension of written words, and thus reading is also often impaired in Wernicke's aphasia. As with Broca's aphasia, repetition is also impaired.

Receptive aphasia

Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent speech, which is characterized by typical speech rate, intact syntactic abilities and effortless speech output. Writing often reflects speech in that it tends to lack content or meaning. In most cases, motor deficits (i.e. hemiparesis) do not occur in individuals with Wernicke's aphasia. Therefore, they may produce a large amount of speech without much meaning. Individuals with Wernicke's aphasia are typically unaware of their errors in speech and do not realize their speech may lack meaning. They typically remain unaware of even their most profound language deficits.

Hypothesis on the nature of comprehension deficit in a patient with transcortical mixed aphasia with preserved naming.

Patients with poor comprehension and preserved naming have been occasionally described. Such patients, who are affected by transcortical aphasia, have been taken as evidence of the possibility of naming an object while bypassing the semantic system. We describe a patient affected with mixed transcortical aphasia who presented a clear dissociation between ability in naming and difficulties in performing word-picture matching tasks. The pattern is explained by the existence of covert compulsory automatic naming that interferes with less automatic procedures involved in word-picture matching. In fact, when we tried to oppose automatic naming by using, in word-picture matching tasks, pictures difficult to name, the comprehension improved. This finding excludes a semantic deficit at the basis of poor comprehension of our patient. We suggest that the dissociation between naming and comprehension could be an expression of a computational limitation within the processes involved in word-picture matching, due to the competition for limited processing resources by automatically activated hyperactive naming.

Transcortical motor aphasia

Treatment Treatment for all types of aphasia, including transcortical motor aphasia, is usually provided by a speech-language pathologist. The SLP chooses specific therapy tasks and goals based on the speech and language abilities and needs of the individual. In general for individuals with TMoA, treatment should capitalize on their strong auditory comprehension and repetition skills and address the individual's reduced speech output and difficulty initiating and maintaining a conversation. New research in aphasia treatment is showing the benefit of the Life Participation Approach to Aphasia (LPAA) in which goals are written based on the skills needed by the individual patient to participate in specific real-life situations (i.e. communicating effectively with nurses or gaining employment). Based on the specific needs of the patient, SLPs can provide a variety of treatment activities.

Paraphasia

Wernicke’s aphasia is characterized by fluent language with made up or unnecessary words with little or no meaning to speech. Those who suffer from this type of aphasia have difficulty understanding others speech and are unaware of their own mistakes. When corrected they will repeat their verbal paraphasias and have trouble finding the correct word. Wernicke’s area is found in the dominant hemisphere of the posterior gyrus of the first temporal convolution of the brain, whereas Broca’s area is found anterior to the Wernicke’s area. Symptoms

Aphasia

Transcortical aphasias include transcortical motor aphasia, transcortical sensory aphasia, and mixed transcortical aphasia. People with transcortical motor aphasia typically have intact comprehension and awareness of their errors, but poor word finding and speech production. People with transcortical sensory and mixed transcortical aphasia have poor comprehension and unawareness of their errors. Despite poor comprehension and more severe deficits in some transcortical aphasias, small studies have indicated that full recovery is possible for all types of transcortical aphasia.

Aphasia -- Introduction

Specific aphasia syndromes are dependent on the location of the lesion in the brain. [3] In fluent aphasia, the patient can speak in sentences that sound like normal speech, but some of the words are made-up words or have some sounds that are not correct.  People with non-fluent aphasia struggle to get words out, omit words, and speak in very short sentences. Specific non-fluent aphasia syndromes include Broca, transcortical motor, mixed transcortical, and global. Fluent aphasia syndromes include Wernicke, transcortical sensory, conduction, and anomic.

Mixed transcortical aphasia

If a client has deficits in the following areas, drawing therapy might be an appropriate therapy technique: Western Aphasia Battery (WAB) 1. Responsive Speech ("What do you write with?") 2. Spontaneous Speech a. Conversational questions b. Picture descriptions Boston Diagnostic Aphasia Examination (BDAE) 1. Oral expression (word reading, sentence reading) 2. Written section (writing to dictation, writing to describe a picture) Overall, drawing therapy offers a means of accessing language to patients with aphasia who have difficulty expressing themselves with different modalities. Assessment

Transcortical sensory aphasia

intact repetition can repeat both simple and complex phrases spoken by others, e.g. when asked if the patient would like to go for a walk, he or she would respond "go for walk." Although patients can respond appropriately, due to the extent of their TSA, it is most likely that they do not comprehend what others ask them. In addition to problems in comprehension, transcortical sensory aphasia is further characterized based on deficits in naming and paraphasia.

Mixed transcortical aphasia

the BDAE can rule out global aphasia if the ability to repeat is present. If verbal fluency is depressed transcortical aphasia gets ruled out and if auditory processing and comprehension is weak then it cannot be transcortical motor aphasia.

Varieties of semantic 'access' deficit in Wernicke's aphasia and semantic aphasia.

Comprehension deficits are common in stroke aphasia, including in cases with (i) semantic aphasia, characterized by poor executive control of semantic processing across verbal and non-verbal modalities; and (ii) Wernicke's aphasia, associated with poor auditory-verbal comprehension and repetition, plus fluent speech with jargon. However, the varieties of these comprehension problems, and their underlying causes, are not well understood. Both patient groups exhibit some type of semantic 'access' deficit, as opposed to the 'storage' deficits observed in semantic dementia. Nevertheless, existing descriptions suggest that these patients might have different varieties of 'access' impairment-related to difficulty resolving competition (in semantic aphasia) versus initial activation of concepts from sensory inputs (in Wernicke's aphasia). We used a case series design to compare patients with Wernicke's aphasia and those with semantic aphasia on Warrington's paradigmatic assessment of semantic 'access' deficits. In these verbal and non-verbal matching tasks, a small set of semantically-related items are repeatedly presented over several cycles so that the target on one trial becomes a distractor on another (building up interference and eliciting semantic 'blocking' effects). Patients with Wernicke's aphasia and semantic aphasia were distinguished according to lesion location in the temporal cortex, but in each group, some individuals had additional prefrontal damage. Both of these aspects of lesion variability-one that mapped onto classical 'syndromes' and one that did not-predicted aspects of the semantic 'access' deficit. Both semantic aphasia and Wernicke's aphasia cases showed multimodal semantic impairment, although as expected, the Wernicke's aphasia group showed greater deficits on auditory-verbal than picture judgements. Distribution of damage in the temporal lobe was crucial for predicting the initially 'beneficial' effects of stimulus repetition: cases with Wernicke's aphasia showed initial improvement with repetition of words and pictures, while in semantic aphasia, semantic access was initially good but declined in the face of competition from previous targets. Prefrontal damage predicted the 'harmful' effects of repetition: the ability to reselect both word and picture targets in the face of mounting competition was linked to left prefrontal damage in both groups. Therefore, patients with semantic aphasia and Wernicke's aphasia have partially distinct impairment of semantic 'access' but, across these syndromes, prefrontal lesions produce declining comprehension with repetition in both verbal and non-verbal tasks.

Wernicke's area

Diagnosis of aphasia, as well as characterization of type of aphasia, is done with language testing by the provider. Testing should evaluate fluency of speech, comprehension, repetition, ability to name objects, and writing skills. Fluency is assessed by observing the patient's spontaneous speech. Abnormalities in fluency would include shortened phrases, decreased number of words per minute, increased effort with speech, and agrammatism. Patients with Wernicke's aphasia should have fluent speech, so abnormalities in fluency may indicate a different type of aphasia. Comprehension is assessed by giving the patient commands to follow, beginning with simple commands and progressing to more complex commands. Repetition is evaluated by having the patient repeat phrases, progressing from simple to more complex phrases. Both comprehension and repetition would be abnormal in Wernicke's aphasia. Content should also be assessed, by listening to a patient's spontaneous or instructed speech.

Impairments of lexical-semantic processing in aphasia: evidence from the processing of lexical ambiguities.

Broca's and Wernicke's aphasics performed speeded lexical decisions on the third member of auditorily presented triplets consisting of two word primes followed by either a word or a nonword. In three of the four priming conditions, the second prime was a homonym with two unrelated meanings. The relation of the first prime and the target with the two meanings of the homonym was manipulated in the different priming conditions. The two readings of the ambiguous words either shared their grammatical form class (noun-noun ambiguities) or not (noun-verb ambiguities). The silent intervals between the members of the triplets were varied between 100, 500, and 1250 msec. Priming at the shortest interval is mainly attributed to automatic lexical processing, and priming at the longest interval is mainly due to forms of controlled lexical processing. For both Broca's and Wernicke's aphasics overall priming effects were obtained at ISIs of 100 and 500 msec, but not at an ISI of 1250 msec. This pattern of results is consistent with the view that both types of aphasics can automatically access the semantic lexicon, but might be impaired in integrating lexical-semantic information into the context. Broca's aphasics showed a specific impairment in selecting the contextually appropriate reading of noun-verb ambiguities, which is suggested to result from a failure either in the on-line morphological parsing of complex word forms into a stem and an inflection or in the on-line exploitation of the syntactic implications of the inflectional suffix. In a final experiment patients were asked to explicitly judge the semantic relations between a subset of the primes that were used in the lexical decision study. Wernicke's aphasics performed worse than both Broca's aphasics and normal controls, indicating a specific impairment for these patients in consciously operating on automatically accessed lexical-semantic information.

Transcortical sensory aphasia

Transcortical sensory aphasia (TSA) is a kind of aphasia that involves damage to specific areas of the temporal lobe of the brain, resulting in symptoms such as poor auditory comprehension, relatively intact repetition, and fluent speech with semantic paraphasias present. TSA is a fluent aphasia similar to Wernicke's aphasia (receptive aphasia), with the exception of a strong ability to repeat words and phrases. The person may repeat questions rather than answer them ("echolalia").