title: Low seroprevalence of diphtheria, tetanus and pertussis in ambulatory adult patients: the need for lifelong vaccination.
abstract: BACKGROUND
  Tetanus, diphtheria, pertussis and measles are vaccine preventable diseases that have been reported to cause morbidity and mortality in adult population in the recent years. We aimed to document the seropositivity rates and vaccination indication for these four vaccine preventable diseases among adult and elderly patients who were seen as outpatients in a university hospital.
  
  
  METHODS
  Blood samples for tetanus, diphtheria, pertussis and measles antibodies were obtained. Results were evaluated with regards to protection levels and booster vaccine indications according to the cut-off values.
  
  
  RESULTS
  A total of 1367 patients consented for the study and 1303 blood samples were available for analysis at the end of the study. The antibody levels against measles conferred protection in 98% of patients. However, 65% of the patients had no protection for diphtheria, 69% had no protection for tetanus and 90% of the patients had no protection for pertussis. Only 1.3% of the study population had seropositivity against three of the diseases-Tdap booster was indicated in 98.7%. Multivariable logistic regression showed that tetanus protection decreased with increasing age. Having a chronic disease was associated with a lower rate of protective antibodies for pertussis.
  
  
  CONCLUSIONS
  We demonstrated very low rates of protection against three of the vaccine preventable diseases of childhood-diphtheria, pertussis and tetanus. Booster vaccinations are required in adult life in accordance with national and international adult vaccination guidelines. The concept of "lifelong vaccination" should be implemented and every encounter with the patient should be regarded as a chance for catch-up.
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, 06100, Sıhhiye, Ankara, Turkey. Electronic address: mdurusu@hacettepe.edu.tr.
authors.forename: Mine Durusu
authors.initials: MD
authors.lastname: Tanriover
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, 06100, Sıhhiye, Ankara, Turkey.
authors.forename: Canan
authors.initials: C
authors.lastname: Soyler
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Infectious Diseases Clinical Microbiology, 06100, Sıhhiye, Ankara, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Ascioglu
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Section of Geriatrics, 06100, Sıhhiye, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cankurtaran
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Infectious Diseases Clinical Microbiology, 06100, Sıhhiye, Ankara, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Unal
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D001886:Bordetella pertussis / Q000276:immunology*; D004165:Diphtheria / Q000453:epidemiology / Q000517:prevention & control; D004167:Diphtheria Toxin / Q000276:immunology*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D008297:Male; D008459:Measles virus / Q000276:immunology*; D008875:Middle Aged; D020380:Needs Assessment; D016036:Seroepidemiologic Studies; D013742:Tetanus / Q000453:epidemiology / Q000517:prevention & control; D013744:Tetanus Toxin / Q000276:immunology*; D014421:Turkey / Q000453:epidemiology; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000906:Antibodies; D004167:Diphtheria Toxin; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D013744:Tetanus Toxin
keywords: Diphtheria; Measles; Pertussis; Seroprevalance; Tetanus; Vaccine