Pertussis vaccine and new mutations in the pathogen that existing vaccines are unable to effectively control. 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. 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. A single later booster is given at four to six years of age (US
Dieterich's disease Dieterich's disease Dieterich’s disease, also known as avascular necrosis of the metacarpal hand, is an extremely rare condition characterized by temporary or permanent loss of blood supply to the metacarpal head of the metacarpal bone, resulting in loss of bone tissue. The five metacarpal bones are long bones located between the carpals of the wrist and phalanges of the fingers. Collectively, the metacarpals are referred to as the "metacarpus." The metacarpals are important in maintaining grip strength and mobility of the fingers. Dieterich's disease is often confused with Mauclaire disease, which is characterized by symmetrical flattening of all metacarpal heads.