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Typical pertussis with paroxysmal cough > or = 21 days was present in 29/35 (83%) unvaccinated B pertussis cases, in contrast to 33/81 (41%) vaccinated B pertussis cases.

e. enhancing reproductive success of the parent) and offspring interests being aligned with mother's interests because of both indirect and direct benefits 5. Parameter estimates were used to gauge the effect of vaccinating household members (cocooning) to prevent the infection in young infants. However, in other autoimmune diseases, pregnancy is associated with no change symptoms or an exacerbation of symptoms 102, 103. There are three main hypotheses about the role of fetal cells in maternal health in the existing literature: (1) fetal cells are deleterious, contributing to an inflammatory response that can cause maternal tissue damage; (2) fetal cells are protective, with fetal progenitor cells helping to repair and maintain maternal tissues or (3) fetal cells are simply bystanders, having no causal effect on maternal health 30.Additionally, fetal microchimeric phenotypes may be under selective pressure to contribute to maternal health through enhancing wound healing. Fetal cells have been found less frequently in the blood and tissue of women with breast cancer compared to healthy controls 54, 55, 56, 57, suggesting that more fetal cells may actually be associated with better health of the mother. We assessed infant responses to antigens in the maternal vaccine and to those conjugated to tetanus (TT) or the diphtheria toxin variant, CRM. Low coverage whole genome sequencing of maternal plasma DNA is already used for sensitive non‐invasive prenatal testing 107, and could additionally be utilized to detect fetal cell microchimerism both during and after pregnancy. In countries with no pertussis booster until school age, continued monitoring of protection against pertussis is essential.

Tolerance to the fetus may help explain why some autoimmune disease symptoms are lessened during pregnancy in some women. Further, across tissues in the maternal body (in humans and mice), there is evidence that fetal cells differentiate into multiple cell types, including endothelial cells 16, neurons 47, smooth muscle cells, and cardiomyocytes 10, 48.e. low Apgar-score, neonatal intensive care unit admission, neonatal resuscitation or perinatal death.

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