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Bennai RM, Zouaki A, El Amin G, Rahani A, Zirar J, Seffar M, Soully K, Mahraoui C, Kabbaj H. Pertussis outbreak in children hospitalized in Rabat (Morocco). Diagn Microbiol Infect Dis 2024; 109:116225. [PMID: 38492491 DOI: 10.1016/j.diagmicrobio.2024.116225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Cyclical pertussis epidemics primarily affect young infants. This study aims to estimate pertussis prevalence during the ongoing 2023 outbreak at our institution, focusing on affected age groups and clinical presentations. MATERIEL AND METHODS This retrospective study includes patients admitted to Rabat University Hospital Center from 1st January 2021 to 30th June 2023. Symptomatic patients underwent Multiplex Respiratory Panel PCR testing for respiratory infections. The analysis included cases where RT-PCR identified Bordetella spp., with data analysed using SPSS 15.0. RESULTS Pertussis cases sharply increased from December 2022, constituting 85.4 % of positive samples. Most cases (78.2 %) occurred in infants under 3 months, presenting symptoms such as coughing (94.5 %) and dyspnoea (94.5 %). Pertussis was suspected in 60 % of RT-PCR confirmed cases. B. pertussis DNA was identified in 81.8 % of cases and B. parapertussis DNA in 18.2 % of cases. CONCLUSION The study exposes a significant pertussis outbreak affecting predominantly young infants.
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Affiliation(s)
- Redouane Mammar Bennai
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco.
| | - Amal Zouaki
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Ghizlane El Amin
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Abdeljalil Rahani
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Jalila Zirar
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Myriam Seffar
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Karim Soully
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Central Laboratory of Bacteriology, Rabat, Morocco
| | - Chafik Mahraoui
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Children Hospital, Rabat, Morocco
| | - Hakima Kabbaj
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
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Remesh AT, Alagarasu K, Jadhav S, Prabhakar M, Viswanathan R. Pertussis Vaccines Scarcely Provide Protection against Bordetella parapertussis Infection in Children-A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:253. [PMID: 38543887 PMCID: PMC10974608 DOI: 10.3390/vaccines12030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Pertussis, or whooping cough, is a global public health concern. Pertussis vaccines have demonstrated good protection against Bordetella pertussis infections, but their effectiveness against Bordetella parapertussis remains debated due to conflicting study outcomes. METHODS A systematic review and meta-analysis were conducted to assess the effectiveness of pertussis vaccines in protecting children against B. parapertussis infection. A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted, and randomized controlled trials (RCTs) and observational studies that met inclusion criteria were included in the analysis. RESULTS The meta-analysis, involving 46,533 participants, revealed no significant protective effect of pertussis vaccination against B. parapertussis infection (risk ratio: 1.10, 95% confidence interval: 0.83 to 1.44). Subgroup analyses by vaccine type and study design revealed no significant protection. The dearth of recent data and a limited pool of eligible studies, particularly RCTs, underscore a critical gap that warrants future research in the domain. CONCLUSIONS These findings offer crucial insights into the lack of effectiveness of pertussis vaccines against B. parapertussis. Given the rising incidence of cases and outbreaks, coupled with the lack of cross-protection by the existing vaccines, there is an urgent need to develop vaccines that include specific antigens to protect against B. parapertussis.
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Affiliation(s)
| | - Kalichamy Alagarasu
- Dengue-Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India;
| | - Santoshkumar Jadhav
- Bioinformatics & Data Management Group, ICMR-National Institute of Virology, Pune 411001, India;
| | - Meera Prabhakar
- Bacteriology Group, ICMR-National Institute of Virology, Pune 411021, India; (A.T.R.); (M.P.)
| | - Rajlakshmi Viswanathan
- Bacteriology Group, ICMR-National Institute of Virology, Pune 411021, India; (A.T.R.); (M.P.)
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Clark LR, Johnson DR. Safety and Clinical Benefits of Adacel ® and Adacel ®-Polio Vaccination in Pregnancy: A Structured Literature Review. Infect Dis Ther 2023; 12:1955-2003. [PMID: 37653123 PMCID: PMC10505126 DOI: 10.1007/s40121-023-00847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023] Open
Abstract
Vaccination in pregnancy using a tetanus toxoid, reduced dose diphtheria toxoid, and reduced dose acellular pertussis (Tdap) vaccine is important for prevention of severe pertussis disease in young infants. The objectives of this systematic literature review were to search for original research studies evaluating the vaccine effectiveness, immunogenicity, and safety of Adacel®/Adacel-Polio® used during pregnancy to prevent pertussis disease in young infants. Medical databases used included EMBASE, BIOSIS Previews, and Chemical Abstracts, with search terms related to pregnancy, vaccines/immunization, safety, pertussis, effectiveness/efficacy, and immune response; other potentially eligible reports were included where applicable. Search results were restricted to literature published from 1 January 1995 to 26 July 2021. A total of 2021 articles and 4 other reports were identified for primary review. A total of 49 publications qualified for inclusion after primary and secondary reviews. Effectiveness studies of Adacel or Adacel-Polio given in pregnancy consistently showed high levels of protection from pertussis disease in the newborn (vaccine effectiveness: 91-93%). In immunogenicity studies, the response in pregnant women was consistent with that of non-pregnant women. Infants of mothers vaccinated with Adacel or Adacel-Polio in pregnancy had higher anti-pertussis antibody levels at birth and at 2 months of age compared to infants born to women vaccinated with comparator vaccines, placebo, or those not vaccinated during pregnancy. There was evidence of a slightly decreased response to primary pertussis vaccination in infants of mothers vaccinated with Adacel or Adacel-Polio, but this was not thought to be clinically significant. In safety studies, Adacel or Adacel-Polio vaccination was well tolerated by pregnant woman and not associated with pregnancy, postpartum, or neonatal complications. In conclusion, Adacel or Adacel-Polio vaccination in pregnancy is highly effective in protecting young infants from pertussis disease, with a favorable safety profile for both pregnant women and their infants.
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Affiliation(s)
- Liana R Clark
- Global Medical, Sanofi, 1 Discovery Drive, Swiftwater, PA, 18370, USA.
| | - David R Johnson
- Global Medical, Sanofi, 1 Discovery Drive, Swiftwater, PA, 18370, USA
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Moosa F, Tempia S, Kleynhans J, McMorrow M, Moyes J, du Plessis M, Carrim M, Treurnicht FK, Helferscee O, Mkhencele T, Mathunjwa A, Martinson NA, Kahn K, Lebina L, Wafawanaka F, Cohen C, von Gottberg A, Wolter N. Incidence and Transmission Dynamics of Bordetella pertussis Infection in Rural and Urban Communities, South Africa, 2016‒2018. Emerg Infect Dis 2023; 29:294-303. [PMID: 36692337 PMCID: PMC9881781 DOI: 10.3201/eid2902.221125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We conducted 3 prospective cohort studies (2016-2018), enrolling persons from 2 communities in South Africa. Nasopharyngeal swab specimens were collected twice a week from participants. Factors associated with Bordetella pertussis incidence, episode duration, and household transmission were determined by using Poisson regression, Weibull accelerated time-failure, and logistic regression hierarchical models, respectively. Among 1,684 participants, 118 episodes of infection were detected in 107 participants (incidence 0.21, 95% CI 0.17-0.25 infections/100 person-weeks). Children <5 years of age who had incomplete vaccination were more likely to have pertussis infection. Episode duration was longer for participants who had higher bacterial loads. Transmission was more likely to occur from male index case-patients and persons who had >7 days infection duration. In both communities, there was high incidence of B. pertussis infection and most cases were colonized.
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Automatic Identification of MALDI-TOF MS Database Using Classical Bordetella Species Isolates. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1679951. [PMID: 35756428 PMCID: PMC9217575 DOI: 10.1155/2022/1679951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022]
Abstract
Objective To evaluate and expand the automatic identification and clustering of clinical Bordetella species by MALDI-TOF MS. Methods Twenty-eight field isolated strains, identified by whole-gene sequencing analysis, were analyzed by MALDI-TOF MS, and the spectra obtained were used to replenish the internal database of the manufacturer. To evaluate and expand the robustness of the database, MALDI-TOF MS identified 91 clinical isolates (except those used for implementation). A distance tree based on mass spectrometry data is constructed to confirm similarity and clusters of each clinical Bordetella species by using the MALDI Biotyper 3.1 software. Results In this research, when we used the implemented Bruker Daltonics database in our laboratory, 91 clinical isolates were identified at the genus level (100%) and 93.4% were identified at the species level (85/91). We performed proteomics analysis and divided these 91 isolates into cluster I (2.2%) and cluster II (97.8%). The largest group is cluster II (n = 89 isolates), which has been divided into two subclusters. Trees created by analyzing the protein mass spectra of the three species of the clinical isolates reflected their classification. Conclusion MALDI-TOF MS may present an attractive alternative to automatically confirm and cluster the fastidious bacteria difficult to culture. Extension of identification of the MALDI-TOF MS database is viably fast, more efficient, and alternative to conventional methods in confirming the classical Bordetella species. This strategy could promote the epidemiological and taxonomic research of this important pathogen.
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Taye S, Tigabu Z, Damtie D, Yismaw G, Moodley C, Nicol MP, Tessema B, Gelaw B, Moges F. Pertussis among patients with clinically compatible illness in the Amhara Regional State, Ethiopia. Int J Infect Dis 2021; 106:421-428. [PMID: 33794378 DOI: 10.1016/j.ijid.2021.03.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pertussis is an acute respiratory tract disease caused by Bordetella pertussis. In 2014, 24.1 million pertussis cases, resulting in 160,700 deaths, were estimated to have occurred worldwide. This study aimed to determine the epidemiology of pertussis among patients with clinically compatible illness who visited selected hospitals in the Amhara Regional State of Ethiopia. METHODS A cross-sectional study design was used to review pertussis patients with clinically compatible illness. Nasopharyngeal swabs were collected from 515 patients from July 2018 through February 2019. DNA was extracted from all nasopharyngeal swabs and samples were analyzed using real-time (RT-) PCR. Crude and adjusted odds ratios with corresponding 95% confidence intervals were estimated using bivariable and multivariable logistic regression analysis, respectively. RESULTS The overall prevalence of Bordetella species among the study participants was 156 of 515 (30.3%) [95% CI = 26.4-34.6] as determined by Bordetella RT-PCR, including: 65 (41.7%) B. pertussis, 89 (57.1%) indeterminate B. pertussis, one (0.6%) Bordetella holmesii and one (0.6%) Bordetella parapertussis. CONCLUSIONS This study found that pertussis is potentially endemic and a common health problem among patients visiting health institutions in the Amhara Regional State of Ethiopia. More data regarding pertussis in Ethiopia could inform development of effective prevention strategies.
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Affiliation(s)
- Solomon Taye
- Department of Medical Microbiology, University of Gondar, Gondar, Amhara Regional State, Ethiopia; Department of Medical Laboratory Sciences, Wachemo University, Hossana, South Nations Nationalities and Peoples Regional State, Ethiopia; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
| | - Zemene Tigabu
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Debasu Damtie
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Amhara Regional State, Ethiopia; The Ohio State University Global One Health LLC, Eastern Africa Regional Office, Addis Ababa, Ethiopia
| | - Gizachew Yismaw
- Department of Medical Microbiology, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Clinton Moodley
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Mark P Nicol
- Division of Infection and Immunity, University of Western Australia, Perth, Australia
| | - Belay Tessema
- Department of Medical Microbiology, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, University of Gondar, Gondar, Amhara Regional State, Ethiopia
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Virus Coinfection is a Predictor of Radiologically Confirmed Pneumonia in Children with Bordetella pertussis Infection. Infect Dis Ther 2020; 10:335-346. [PMID: 33270206 PMCID: PMC7954939 DOI: 10.1007/s40121-020-00376-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aimed to prospectively investigate the burden of pertussis in southeast Chinese children hospitalized with lower respiratory tract infection (LRTI) during a pertussis outbreak and to compare the outcomes of Bordetella pertussis infection with or without virus coinfections. Methods Children < 24 months of age hospitalized with LRTI were prospectively enrolled from January 2017 to December 2019. Demographic and clinical information were recorded, and respiratory tract samples were tested for the presence of B. pertussis and ten common viruses by polymerase chain reaction (PCR). Results Bordetella pertussis PCR was positive in 6.1% (202/4287) of the patients. Only 146 (72.3%) B. pertussis infections met the Centers for Disease Control and Prevention case definition for pertussis. Among the 202 subjects with B. pertussis infections, 81 (40.1%) were coinfected with at least 1 respiratory virus, with human rhinovirus being the most commonly detected virus (25.7%). No differences in clinical severity were observed between children with single B. pertussis infection and those with virus coinfection [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.39–1.44]. However, children with virus coinfection were significantly more likely to present with radiologically confirmed pneumonia than those with a single B. pertussis infection (OR 2.62; CI 1.39–4.91). Conclusions Bordetella pertussis infection contributed to a high proportion of LRTI hospitalizations among southeast Chinese children. There were no significant differences in clinical severity between children with virus coinfection and single B. pertussis infection, although children coinfected with virus coinfection presented with pneumonia more frequently than those with single B. pertussis infection. Electronic supplementary material The online version of this article (10.1007/s40121-020-00376-5) contains supplementary material, which is available to authorized users.
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Muloiwa R, Kagina BM, Engel ME, Hussey GD. The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis. BMC Med 2020; 18:233. [PMID: 32854714 PMCID: PMC7453720 DOI: 10.1186/s12916-020-01699-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An effective vaccine against Bordetella pertussis was introduced into the Expanded Programme on Immunisation (EPI) by WHO in 1974, leading to a substantial global reduction in pertussis morbidity and mortality. In low- and middle-income countries (LMICs), however, the epidemiology of pertussis remains largely unknown. This impacts negatively on pertussis control strategies in these countries. This study aimed to systematically and comprehensively review published literature on the burden of laboratory-confirmed pertussis in LMICs over the 45 years of EPI. METHODS Electronic databases were searched for relevant literature (1974 to December 2018) using common and MeSH terms for pertussis. Studies using PCR, culture or paired serology to confirm Bordetella pertussis and parapertussis in symptomatic individuals were included if they had clearly defined numerators and denominators to determine prevalence and mortality rates. RESULTS Eighty-two studies (49,167 participants) made the inclusion criteria. All six WHO regions were represented with most of the studies published after 2010 and involving mainly upper middle-income countries (n = 63; 77%). PCR was the main diagnostic test after the year 2000. The overall median point prevalence of PCR-confirmed Bordetella pertussis was 11% (interquartile range (IQR), 5-27%), while culture-confirmed was 3% (IQR 1-9%) and paired serology a median of 17% (IQR 3-23%) over the period. On average, culture underestimated prevalence by 85% (RR = 0.15, 95% CI, 0.10-0.22) compared to PCR in the same studies. Risk of pertussis increased with HIV exposure [RR, 1.4 (95% CI, 1.0-2.0)] and infection [RR, 2.4 (95% CI, 1.1-5.1)]. HIV infection and exposure were also related to higher pertussis incidences, higher rates of hospitalisation and pertussis-related deaths. Pertussis mortality and case fatality rates were 0.8% (95% CI, 0.4-1.4%) and 6.5% (95% CI, 4.0-9.5%), respectively. Most deaths occurred in infants less than 6 months of age. CONCLUSIONS Despite the widespread use of pertussis vaccines, the prevalence of pertussis remains high in LMIC over the last three decades. There is a need to increase access to PCR-based diagnostic confirmation in order to improve surveillance. Disease control measures in LMICs must take into account the persistent significant infant mortality and increased disease burden associated with HIV infection and exposure.
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Affiliation(s)
- Rudzani Muloiwa
- Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, 7925, Cape Town, Republic of South Africa.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, Republic of South Africa
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, 7925, Cape Town, Republic of South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, Republic of South Africa.,Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, Republic of South Africa
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Seroprevalence of Bordetella pertussis toxin antibodies in children and adolescents in Tunis, Tunisia. Epidemiol Infect 2020; 147:e199. [PMID: 31364527 PMCID: PMC6536764 DOI: 10.1017/s0950268819000840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pertussis remains a public health concern in most countries. This cross-sectional study aims to investigate the distribution of pertussis toxin antibodies (anti-PT IgG) in Tunisian children and adolescents aged 3–18 years, to define optimal age for booster vaccination. Anti-PT IgG concentrations of enrolled participants were measured using commercial enzyme-linked immunosorbent assay. Concentrations were classified as: indicative of current/recent infection if ⩾100 IU/ml, indicative of recent exposure to Bordetella pertussis within the last year if 40–100 IU/ml and less likely revealing a recent exposure to B. pertussis if <40 IU/ml. Between March and June 2018, a total of 304 participants (mean age: 9.3 years) were included in this study. Overall, 12.8% (95% confidence interval (CI) 9.1%–16.6%) were seropositive (IgG levels ⩾40 IU/ml). Among them, 14.7% (95% CI 2.3%–23.3%) had levels indicative of a current/recent infection. The multivariate Poisson regression analysis suggested associations between female gender, as well as age group 13–18 years and 3–5 years and higher anti-PT IgG concentrations. Our results are consistent with the notion that vaccine-induced immunity decline, as well as circulation of pertussis among school children and adolescents enables them to be reservoirs of infection and disease transmission to vulnerable infants. Booster dose of acellular pertussis vaccine for school entrants is therefore recommended.
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10
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Kamachi K, Otsuka N, Fumimoto R, Ozawa K, Yao SM, Chiang CS, Luu LDW, Lan R, Shibayama K, Watanabe M. A novel multilocus variable-number tandem repeat analysis for Bordetella parapertussis. J Med Microbiol 2019; 68:1671-1676. [PMID: 31613204 DOI: 10.1099/jmm.0.001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose. Human-adapted Bordetella parapertussis is one of the causative agents of whooping cough; however, there are currently no genotyping systems with high discriminatory power for this bacterial pathogen. We therefore aimed to develop a multilocus variable-number tandem repeat analysis (MLVA) for human-adapted B. parapertussis.Methodology. Four highly polymorphic variable number tandem repeat (VNTR) loci in the B. parapertussis genome were selected and amplified by multiplex PCR. MLVA was performed based on the number of tandem repeats at VNTR loci. The discriminatory power of MLVA was evaluated with three laboratory reference strains and 50 human isolates of B. parapertussis.Results. Multiplex PCR-based MLVA characterized 53 B. parapertussis reference strains and isolates into 25 MLVA types and the Simpson diversity index was 0.91 (95 % confidence interval, 0.86-0.97). The three reference strains exhibited different MLVA types. Thirty-one Japanese isolates, ten French isolates and three Taiwanese isolates belonged to fourteen, nine and three MLVA types, respectively. In contrast, all five Australian isolates belonged to the same type. Two Japanese isolates collected from patients with known epidemiological links had the same type.Conclusion. Our novel MLVA method has high discriminatory power for genotyping human B. parapertussis. Regarding this organism, this genotyping system is a promising tool for epidemiological surveillance and investigating outbreaks.
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Affiliation(s)
- Kazunari Kamachi
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Nao Otsuka
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Rei Fumimoto
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Japan.,Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kensuke Ozawa
- R & D Center for Diagnostic Reagents, Denka Seiken, Niigata, Japan
| | - Shu-Man Yao
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan, ROC
| | - Chuen-Sheue Chiang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan, ROC
| | - Laurence Don Wai Luu
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mineo Watanabe
- Present address: Division of Microbiology and Molecular Cell Biology, Nihon Pharmaceutical University, Saitama, Japan.,Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan
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11
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Ben Fraj I, Bouchez V, Smaoui H, Kechrid A, Brisse S. Genome characteristics of Bordetella pertussis isolates from Tunisia. J Med Microbiol 2019; 68:1320-1323. [PMID: 31329091 DOI: 10.1099/jmm.0.001042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The recent increase in pertussis cases observed in some countries may have several causes, including the evolution of Bordetella pertussis populations towards escape of vaccine-induced immunity. Most genomic studies of B. pertussis isolates performed so far are from countries that use acellular vaccines. The objective was to analyse genomic sequences of isolates collected during the 2014 whooping cough epidemic in Tunisia, a country where whole-cell vaccines are used. Ten Tunisian isolates and four vaccine strains were sequenced and compared to 169 isolates from countries where acellular vaccines are used. Phylogenetic analysis showed that Tunisian isolates are diverse, demonstrating a multi-strain 2014 epidemic peak, and are intermixed with those circulating in other world regions, showing inter-country transmission. Consistently, Tunisian isolates have antigen variant composition observed in other world regions. No pertactin-deficient strain was observed. The Tunisian B. pertussis population appears to be largely connected with populations from other countries.
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Affiliation(s)
- Ikram Ben Fraj
- University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Valérie Bouchez
- National Reference Center for Whooping Cough and other Bordetella infections, Paris, France.,Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Hanen Smaoui
- University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Amel Kechrid
- University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Sylvain Brisse
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.,National Reference Center for Whooping Cough and other Bordetella infections, Paris, France
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12
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Gopal Krishnan S, Fun WH, Ramadras MD, Yunus R, Lye YF, Sararaks S. Pertussis clinical case definition: Time for change in developing countries? PLoS One 2019; 14:e0219534. [PMID: 31291359 PMCID: PMC6619773 DOI: 10.1371/journal.pone.0219534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/27/2019] [Indexed: 01/29/2023] Open
Abstract
Background Developing countries still struggle with late detection and mortality from pertussis. A review of clinical case definitions is necessary for early disease detection. This paper aimed to study possible clinical characteristics for earlier pertussis detection in a sporadic setting. Methods We conducted a retrospective review of medical and laboratory records in a general paediatric ward of a district hospital in a developing country. Inclusion criteria were all children hospitalised with nasopharyngeal swab taken for Bordetella pertussis. We compared sensitivity and specificity of World Health Organization diagnostic criteria with other clinical characteristics. Polymerase chain reaction Bordetella pertussis was the gold standard used. Results Out of 207 eligible admissions, the study retrieved 128 complete records. Approximately half of the children were less than 3 months old. The World Health Organization diagnostic criteria had a low sensitivity (15%), but high specificity (92%). In comparison, combinations that included paroxysmal cough, ill contact and facial congestion had higher sensitivity. Increasing cough duration improved specificity while compromising sensitivity. Conclusion Several clinical characteristics such as paroxysmal cough, facial congestion and a history of ill contact have potential for early clinical detection. Conventional emphasis on cough duration may hamper early detection.
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Affiliation(s)
| | - Weng Hong Fun
- Centre For Health Outcomes Research, Institute For Health Systems Research, Selangor, Malaysia
- * E-mail:
| | | | - Rahmah Yunus
- Paediatrics Department, Hospital Kulim, Kedah, Malaysia
| | - Yik Fan Lye
- Paediatrics Department, Hospital Kulim, Kedah, Malaysia
| | - Sondi Sararaks
- Centre For Health Outcomes Research, Institute For Health Systems Research, Selangor, Malaysia
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Moosa F, du Plessis M, Wolter N, Carrim M, Cohen C, von Mollendorf C, Walaza S, Tempia S, Dawood H, Variava E, von Gottberg A. Challenges and clinical relevance of molecular detection of Bordetella pertussis in South Africa. BMC Infect Dis 2019; 19:276. [PMID: 30898099 PMCID: PMC6429695 DOI: 10.1186/s12879-019-3869-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background We assessed the utility of a multi-target, real-time PCR assay for Bordetella pertussis detection and diagnosis in patients with severe respiratory illness (SRI), influenza-like illness (ILI), and asymptomatic controls. Methods Real-time PCR detection of IS481, pIS1001, hIS1001 and ptxS1 was performed on nasopharyngeal specimens (SRI, ILI and controls) and induced sputum (SRI) collected from June 2012 to May 2016 through respiratory illness surveillance. Using PCR cycle threshold (Ct) value cut-offs, IS481 positive cases were classified as confirmed (Ct < 35) or possible (Ct 35–39) pertussis disease. Results Among 12,922 samples, 146 (1.1%) were IS481 positive of which 62% (90/146) were classified as confirmed. The attributable fraction (AF) was 92.2% (95% CI, 65.6 to 98.2%) and 90.5% (95% CI, 57.5 to 97.9%) amongst SRI and ILI PCR-confirmed pertussis cases, respectively. Amongst possible pertussis cases, AF was 36.9% (95% CI, − 142.3 to 83.6%) and 67.5% (95% CI, − 30.6 to 91.9%) in the SRI and ILI groups, respectively. Conclusion All IS481 positive specimens could be considered as B. pertussis infection, and potentially pertussis disease with supportive clinical information. Electronic supplementary material The online version of this article (10.1186/s12879-019-3869-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fahima Moosa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Claire von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Halima Dawood
- Pietermaritzburg Metropolitan Hospitals, KwaZulu-Natal, and Caprisa, University of KwaZulu-Natal, Durban, South Africa
| | - Ebrahim Variava
- University of the Witwatersrand, Johannesburg, South Africa.,Klerksdorp-Tshepong Hospital, North West Province, Klerksdorp, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
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14
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Ben Fraj I, Kechrid A, Guillot S, Bouchez V, Brisse S, Guiso N, Smaoui H. Pertussis epidemiology in Tunisian infants and children and characterization of Bordetella pertussis isolates: results of a 9-year surveillance study, 2007 to 2016. J Med Microbiol 2018; 68:241-247. [PMID: 30526740 DOI: 10.1099/jmm.0.000892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Pertussis remains a public health concern in most countries. Our study aimed to prospectively explore the epidemiology of pertussis in the Tunis area of Tunisia between 2007 and 2016, and to characterize the virulence-associated genes of the collected Bordetella pertussis isolates. METHODOLOGY Infants and children hospitalized at the Children's Hospital of Tunis, Tunisia, between 2007 and 2016 for suspicion of pertussis were enrolled in the study. Culture and real-time PCR (qPCR) assays targeting IS481, IS1001, recA, H-IS1001 and ptxP were used to confirm the pertussis diagnosis. Phenotypic and genotypic characterization of recovered isolates was performed.Results/Key findings. A total of 1844 children were included in the study. Overall, 306 children (16.6 %) with Bordetella infection were confirmed by qPCR. Among them, 265 (86.6 %) were confirmed as having B. pertussis (IS481+, ptxP+, H-IS1001-), 18 (5.9 %) as having Bordetella parapertussis (IS481-, IS1001+) and 11 (3.6 %) as having Bordetella spp. (IS481+, ptxP-, H-IS1001-). No Bordetella holmesii (IS481+, IS1001-, H-IS1001+) was identified. The estimated pertussis incidence in the Tunis area was 134/100 000 in children aged less than 5 years. Two epidemic peaks were observed in 2009 and 2014. Ten B. pertussis isolates were cultured and characterized. Deficiency in pertactin expression was not observed, and genotyping of the isolates revealed a predominant allelic profile: ptxP3-ptxA1-prn2-fim2-1-fim3-2. CONCLUSION This study demonstrated that pertussis is still present as a cyclical disease in Tunisia, despite high primo-vaccination coverage with a pertussis whole-cell vaccine. The predominant genotype of Tunisian B. pertussis isolates is similar to isolates circulating in countries using the acellular vaccine.
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Affiliation(s)
- Ikram Ben Fraj
- 1University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Amel Kechrid
- 1University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Sophie Guillot
- 2Biodiversity and Epidemiology of Bacterial Pathogens Unit, Institut Pasteur, Paris, France
- 3National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Valérie Bouchez
- 2Biodiversity and Epidemiology of Bacterial Pathogens Unit, Institut Pasteur, Paris, France
- 3National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Sylvain Brisse
- 2Biodiversity and Epidemiology of Bacterial Pathogens Unit, Institut Pasteur, Paris, France
- 3National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Nicole Guiso
- 3National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Hanen Smaoui
- 1University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
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Seroprevalence of pertussis among healthcare workers: A cross-sectional study from Tunisia. Vaccine 2018; 37:109-112. [PMID: 30459070 DOI: 10.1016/j.vaccine.2018.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/15/2018] [Accepted: 11/12/2018] [Indexed: 01/14/2023]
Abstract
This cross-sectional study aimed to assess pertussis seroprevalence among healthy healthcare workers (HCW) of the Children's Hospital of Tunis, Tunisia. During the study period, 236 blood samples were obtained to determine HCW exposure to pertussis. Concentrations of immunoglobulin G (IgG) to pertussis toxin (PT) were measured using a commercial enzyme-linked immunosorbent assay. Cut-offs values used were 40 and 100 IU/ml, respectively indicative of an infection within the last year and a current/recent infection. Overall, seropositivity rate was 11.4% (95% CI 7.4-15.5) and 2.5% (95% CI 0.5-4.6) of ELISA results were indicative of a current infection. Seroprevalence was significantly most important in nurses (p = 0.03) and in participants aged 21-31y (p = 0.009). Our study confirmed that pertussis is circulating in hospital settings and affecting Tunisian HCW, in close contact with infants. Therefore, a booster dose of acellular pertussis vaccine needs to be considered.
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16
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Multicenter Evaluation of BioFire FilmArray Respiratory Panel 2 for Detection of Viruses and Bacteria in Nasopharyngeal Swab Samples. J Clin Microbiol 2018; 56:JCM.01945-17. [PMID: 29593057 PMCID: PMC5971546 DOI: 10.1128/jcm.01945-17] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/22/2018] [Indexed: 11/20/2022] Open
Abstract
The FilmArray Respiratory Panel 2 (RP2) is a multiplex in vitro diagnostic test for the simultaneous and rapid (∼45-min) detection of 22 pathogens directly from nasopharyngeal swab (NPS) samples. It contains updated (and in some instances redesigned) assays that improve upon the FilmArray Respiratory Panel (RP; version 1.7), with a faster run time. The organisms identified are adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza virus A, influenza virus A H1, influenza virus A H1-2009, influenza virus A H3, influenza virus B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella pertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae. Two new targets are included in the FilmArray RP2: Middle East respiratory syndrome coronavirus and Bordetella parapertussis. This study provides data from a multicenter evaluation of 1,612 prospectively collected NPS samples, with performance compared to that of the FilmArray RP or PCR and sequencing. The overall percent agreement between the FilmArray RP2 and the comparator testing was 99.2%. The RP2 demonstrated a positive percent agreement of 91.7% or greater for detection of all but three analytes: coronavirus OC43, B. parapertussis, and B. pertussis. The FilmArray RP2 also demonstrated a negative percent agreement of ≥93.8% for all analytes. Of note, the adenovirus assay detects all genotypes, with a demonstrated increase in sensitivity. The FilmArray RP2 represents a significant improvement over the FilmArray RP, with a substantially shorter run time that could aid in the diagnosis of respiratory infections in a variety of clinical scenarios.
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17
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Pertussis in Africa: Findings and recommendations of the Global Pertussis Initiative (GPI). Vaccine 2018; 36:2385-2393. [PMID: 29602703 DOI: 10.1016/j.vaccine.2018.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 11/23/2022]
Abstract
Pertussis remains a major cause of morbidity and mortality, particularly in infants and young children, and despite the availability of vaccines and pertinent national and international guidelines. The disease burden is more severe in low- and middle-income countries (LMICs), especially in the African continent. Pertussis is more prevalent among young infants in Africa. Poor or no pertussis surveillance, lack of disease awareness, diagnostic limitations, and competing health priorities are considered key contributory factors for this high pertussis burden in Africa. Most African countries use whole-cell pertussis (wP) vaccines, but coverage with three primary doses of diphtheria-tetanus-pertussis vaccines falls short of the World Health Organization's recommended goal of >90%. The Global Pertussis Initiative (GPI) works toward developing recommendations through systematic evaluation and prioritization of strategies to prevent pertussis-related infant and child deaths, as well as reducing global disease burden to acceptable national, regional, and local levels. For countries using wP vaccines, the GPI recommends continuing to use wP to improve primary and toddler booster vaccination coverage. Vaccination during pregnancy is the next priority when acellular pertussis (aP) vaccines and other resources are available that directly protect newborns too young to be vaccinated, followed by, in order of priority, booster doses in older children, adolescents, healthcare workers and finally, all adults. Improved surveillance should be a high priority for African LMICs assessing true disease burden and vaccine effectiveness to inform policy. More research is warranted to evaluate the safety and efficacy of wP and aP vaccines and strategies, and to determine their optimal use.
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18
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du Plessis NM, Ntshoe G, Reubenson G, Kularatne R, Blumberg L, Thomas J, Avenant T. Risk factors for pertussis among hospitalized children in a high HIV prevalence setting, South Africa. Int J Infect Dis 2018; 68:54-60. [PMID: 29410230 DOI: 10.1016/j.ijid.2018.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, including South Africa, the epidemiology of pertussis in relation to immunization, nutritional, and HIV status is poorly described. This article reports on risk factors in South African children hospitalized with pertussis. METHODS A prospective, hospital-based, sentinel surveillance programme for pertussis was conducted in Gauteng Province, South Africa. Hospitalized children (≤10 years) meeting the surveillance criteria for clinically suspected pertussis were screened and enrolled. Nasopharyngeal specimens were collected for real-time multiplex PCR and culture of Bordetella species. RESULTS Bordetella pertussis was detected in 6.2% (61/992) of children. Pertussis was significantly more prevalent in infants younger than 3 months (9.8%; 38/392) and in young children between the ages of 5 and 9 years (12%; 4/34) (p=0.0013). Of the 61 confirmed pertussis cases, 17 were too young for vaccination. Of the remaining 44 infants, vaccination DTP1 was administered in 73% (32/44) of pertussis-confirmed patients who were eligible, DTP2 in 50% (16/32), DTP3 in 54% (14/26), and DTP4 in 56% (5/9) of vaccine-eligible cases at 18 months of age. B. pertussis infection was less likely in children immunized at least once (5%, 32/692) than in unvaccinated children (10%, 24/230) (p=0.0001). HIV exposure and infection status were determined in 978 (99%) patients: 69% (678/978) were HIV-unexposed and uninfected and 31% (300/978) were HIV-exposed. Of these HIV-exposed patients, 218 (22%) were proven HIV-exposed and uninfected and 82 patients were HIV-infected (8.4%, 82/978). HIV prevalence was similar in pertussis-positive (6%, 5/82) and pertussis-negative (6%, 55/896) children (p=0.90). B. pertussis infection was unrelated to poor nutritional status. CONCLUSIONS In South Africa, B. pertussis poses a greater risk to infants who are too young for the first vaccine dose, those who are not vaccinated in a timely manner, and those who do not receive all three primary doses. HIV infection and HIV exposure were not associated with pertussis infection.
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Affiliation(s)
- N M du Plessis
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - G Ntshoe
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Kularatne
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand and NHLS Helen Joseph Hospital, Johannesburg, South Africa
| | - L Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - J Thomas
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - T Avenant
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Wagner K, Springer B, Imkamp F, Opota O, Greub G, Keller PM. Detection of respiratory bacterial pathogens causing atypical pneumonia by multiplex Lightmix ® RT-PCR. Int J Med Microbiol 2018; 308:317-323. [PMID: 29397298 DOI: 10.1016/j.ijmm.2018.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/15/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022] Open
Abstract
Pneumonia is a severe infectious disease. In addition to common viruses and bacterial pathogens (e.g. Streptococcus pneumoniae), fastidious respiratory pathogens like Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella spp. can cause severe atypical pneumonia. They do not respond to penicillin derivatives, which may cause failure of antibiotic empirical therapy. The same applies for infections with B. pertussis and B. parapertussis, the cause of pertussis disease, that may present atypically and need to be treated with macrolides. Moreover, these fastidious bacteria are difficult to identify by culture or serology, and therefore often remain undetected. Thus, rapid and accurate identification of bacterial pathogens causing atypical pneumonia is crucial. We performed a retrospective method evaluation study to evaluate the diagnostic performance of the new, commercially available Lightmix® multiplex RT-PCR assay that detects these fastidious bacterial pathogens causing atypical pneumonia. In this retrospective study, 368 clinical respiratory specimens, obtained from patients suffering from atypical pneumonia that have been tested negative for the presence of common agents of pneumonia by culture and viral PCR, were investigated. These clinical specimens have been previously characterized by singleplex RT-PCR assays in our diagnostic laboratory and were used to evaluate the diagnostic performance of the respiratory multiplex Lightmix® RT-PCR. The multiplex RT-PCR displayed a limit of detection between 5 and 10 DNA copies for different in-panel organisms and showed identical performance characteristics with respect to specificity and sensitivity as in-house singleplex RT-PCRs for pathogen detection. The Lightmix® multiplex RT-PCR assay represents a low-cost, time-saving and accurate diagnostic tool with high throughput potential. The time-to-result using an automated DNA extraction device for respiratory specimens followed by multiplex RT-PCR detection was below 4 h, which is expected to significantly improve diagnostics for atypical pneumonia-associated bacterial pathogens.
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Affiliation(s)
- Karoline Wagner
- Institute of Medical Microbiology, University of Zurich, Switzerland
| | - Burkard Springer
- Institute of Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Graz, Austria
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zurich, Switzerland
| | - Onya Opota
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland; Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Peter M Keller
- Institute of Medical Microbiology, University of Zurich, Switzerland.
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Campbell PT, McVernon J, McIntyre P, Geard N. Influence of Population Demography and Immunization History on the Impact of an Antenatal Pertussis Program. Clin Infect Dis 2017; 63:S213-S220. [PMID: 27838675 PMCID: PMC5106613 DOI: 10.1093/cid/ciw520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background. Antenatal pertussis vaccination is being considered as a means to reduce the burden of infant pertussis in low- and middle-income countries (LMICs), but its likely impact in such settings is yet to be quantified. Methods. An individual-based model was used to simulate the demographic structure and dynamics of a population with characteristics similar to those of LMICs. Transmission of pertussis within this population was simulated to capture the incidence of infection in (1) the absence of vaccination; (2) with a primary course only (three doses of diphtheria, tetanus, and pertussis vaccines [DTP3] commencing in 1985, 1995, or 2005 at 20%, 50%, or 80% coverage); and (3) with the addition of an antenatal pertussis program. Results. Modeled annual incidence averaged over the period 2015–2024 reduced with increasing DTP3 coverage, regardless of the year childhood vaccination commenced. Over the same period, the proportion of infants born with passive protection did not change substantially compared with the prevaccination situation, regardless of DTP3 coverage and start year. We found minimal impact of antenatal vaccination on infection in all infants when mothers were eligible for a single antenatal dose. When mothers were eligible for multiple antenatal doses, incidence in infants aged 0–2 months was reduced by around 30%. This result did not hold for the full 0- to 1-year age group, for whom antenatal vaccination did not reduce infection levels. Conclusions. While antenatal vaccination could potentially reduce infant mortality in LMICs, broader gains at the population level are likely to be achieved by focusing efforts on increasing DTP3 coverage.
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Affiliation(s)
- Patricia Therese Campbell
- Melbourne School of Population and Global Health, University of Melbourne.,Infection and Immunity, Murdoch Childrens Research Institute, Royal Children's Hospital
| | - Jodie McVernon
- Melbourne School of Population and Global Health, University of Melbourne.,Infection and Immunity, Murdoch Childrens Research Institute, Royal Children's Hospital.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, New South Wales, Australia
| | - Nicholas Geard
- Melbourne School of Population and Global Health, University of Melbourne
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Al Maani A, Al Qayoudhi A, Nazir HF, Omar H, Al Jardani A, Al Muharrmi Z, Wali Y. Pertussis and Pertussis like Illness: Pediatric Experience in Oman. Oman Med J 2017; 32:396-402. [PMID: 29026471 DOI: 10.5001/omj.2017.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A resurgence of pertussis or whooping cough has been observed worldwide despite broad vaccination coverage. Pertussis like illness (PLI) refers to a clinical syndrome compatible with pertussis infection but lacking laboratory confirmation or an epidemiological link to a confirmed case. Our study aimed to estimate the contribution of Bordetella pertussis infection and identifying predictors of its diagnosis in a cohort of children with PLI. METHODS Demographic and clinical information were retrospectively collected from the medical records of children < 13 years old and hospitalized for PLI in two pediatric units in Oman from 1 January 2012 to 31 December 2013. The laboratory data of all cases were reviewed and confirmed cases of pertussis were identified, analyzed, and compared with non-confirmed cases. RESULTS A total of 131 patients were enrolled in this study. The majority (95.4% [125/131]) were infants. Only 54.1% (71/131) of admitted children with PLI were tested for pertussis. The incidence of pertussis infection among the tested group was 16.9% (12/71) with a 95% confidence interval 8.2-25.6. Severe illness occurred in 56.4% (74/131) of patients, and six were confirmed to have pertussis. Pediatric intensive care unit admission was required for one confirmed case of pertussis and eight cases from the PLI group (three were negative for pertussis, and five were not tested). Receiver operator characteristic curve analysis revealed that a white blood cell count 3 23.5 × 109/L had 96.6% specificity and lymphocytes 3 17 × 109/L had 98.3% specificity. CONCLUSIONS Taking into consideration that the number tested for pertussis was limited, the incidence of pertussis was 16.9% (12 out of 71 patients). Lymphocytosis can be used as a reliable predictor for the diagnosis of pertussis especially in the absence of specific confirmatory tests or until their results are available.
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Affiliation(s)
- Amal Al Maani
- Unit of Pediatric Infectious Diseases, Child Health Department, Royal Hospital, Muscat, Oman
| | - Abdullah Al Qayoudhi
- Unit of Pediatric Infectious Diseases, Child Health Department, Royal Hospital, Muscat, Oman
| | - Hanan Fawzi Nazir
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman; Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | - Heba Omar
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University,Cairo, Egypt
| | | | | | - Yasser Wali
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman; Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
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Abstract
Since the first description of Bordetella holmesii in 1995, almost 100 publications have contributed to the increasing knowledge of this emerging bacterium. Although first reported to induce bacteremia mainly in immunocompromised patients, it has also been isolated in healthy persons and has shown the capacity to induce pertussis-like symptoms and other clinical entities, such as meningitis, arthritis, or endocarditis. Respiratory diseases are generally less severe than those induced by Bordetella pertussis. However, B. holmesii was found to have a higher capacity of invasiveness given the various infection sites in which it was isolated. The diagnosis is difficult, particularly as it is a slow-growing organism but also because respiratory infections are systematically misdiagnosed as B. pertussis. Treatment is delicate, as its susceptibility to macrolides (prescribed in respiratory infections) and ceftriaxone (used in invasive disease) is challenged. Regarding prevention, there is no consensus on prophylactic treatment following index cases and no vaccine is available. Epidemiological data are also sparse, with few prevalence studies available. In this chapter, we provide an overview of the current state of knowledge on B. holmesii.
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Katfy K, Guiso N, Diawara I, Zerouali K, Slaoui B, Jouhadi Z, Zineddine A, Belabbes H, Elmdaghri N. Epidemiology of pertussis in Casablanca (Morocco): contribution of conventional and molecular diagnosis tools. BMC Infect Dis 2017; 17:348. [PMID: 28511667 PMCID: PMC5434547 DOI: 10.1186/s12879-017-2452-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Pertussis, a vaccine preventable disease, is still responsible of significant morbidity and mortality around the world, mostly in newborns. The aim of the present study was (1) to introduce pertussis surveillance in the major pediatric hospital of Casablanca (2) to analyze the prevalence of pertussis among children under 14 years of age and their entourage in Casablanca, Morocco. Methods This is a prospective and non-case controlled study, including children suspected of Pertussis admitted at the Abderrahim Harouchi Pediatric Hospital in Casablanca, from January 2013 to June 2015. Nasopharyngeal samples were obtained for Bordetella spp. culture and Real time PCR detection (RT-PCR) with specific primers of Bordetella spp., B. pertussis, B. parapertussis and B. holmesii. The detection of Bordetella spp. was also performed in some household contacts of the children suspected of pertussis. Results During the 2.5-years period, a total of 282 samples were collected from hospitalized children (156) and in some of their contacts (126). Among 156 samples from the children (from whom 57% were under 2 month of age), Bordetella DNA was detected in 61% (96/156) by RT-PCR. Among these positive samples, 91.7% (88/96) corresponded to B. pertussis DNA. Furthermore, in 39.5% (38/96) of the Bordetella positive samples, B. holmesii DNA was also detected. B. parapertussis DNA was detected in only one sample (1/156). Out of the 156 samples collected from the hospitalized children, only 48 were tested by culture, and 4 B. pertussis were isolated (8.3%). Among the 126 samples from the contacts of the children, mostly mothers (115 cases), Bordetella DNA was detected in 47% (59/126), 90% (53/59) being B. pertussis DNA. Moreover, B. holmesii DNA was also detected in 18.6% (11/59) of the Bordetella positive samples, and coexistence of B. pertussis and B. holmesii DNA in 36.5% (35/96). Two B. pertussis were isolated by culture performed on 43 samples of the contacts of the children (4.6%). Conclusions This study highlights the circulation of B. pertussis but also of B. holmesii in Casablanca-Morocco with a high proportion of co-infections B. holmesii/B. pertussis in infants and their mothers, indicate that infection of non-vaccinated infants could be more associated with young parents. Moreover, the RT- PCR provides a sensitive and specific diagnosis of B. pertussis infections and distinguishes it from other Bordetella species, and is therefore suitable for implementation in the diagnostic laboratory.
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Affiliation(s)
- Khalid Katfy
- Laboratoire de Microbiologie, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, B, P 5696, Casablanca, Morocco. .,Service de Microbiologie, CHU Ibn Rochd, B, P 2698, Casablanca, Morocco. .,Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco.
| | - Nicole Guiso
- Molecular Prevention and Therapy of Human Diseases, Institut Pasteur, 25 rue du Dr Roux, 75015, Paris, France
| | - Idrissa Diawara
- Laboratoire de Microbiologie, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, B, P 5696, Casablanca, Morocco.,Service de Microbiologie, CHU Ibn Rochd, B, P 2698, Casablanca, Morocco
| | - Khalid Zerouali
- Laboratoire de Microbiologie, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, B, P 5696, Casablanca, Morocco.,Service de Microbiologie, CHU Ibn Rochd, B, P 2698, Casablanca, Morocco
| | - Bouchra Slaoui
- Service des Maladies Respiratoires Pédiatriques, Hôpital d'Enfants Abderrahim Harouchi, CHU Ibn Rochd de Casablanca, Casablanca, Morocco
| | - Zineb Jouhadi
- Service des Maladies Infectieuses Pédiatriques, Hôpital d'Enfants Abderrahim Harouchi, CHU Ibn Rochd de Casablanca, Casablanca, Morocco
| | - Abdelhadi Zineddine
- Service d'Accueil des Urgences Pédiatriques, Hôpital d'Enfants Abderrahim Harouchi, CHU Ibn Rochd de Casablanca, Casablanca, Morocco
| | - Houria Belabbes
- Laboratoire de Microbiologie, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, B, P 5696, Casablanca, Morocco.,Service de Microbiologie, CHU Ibn Rochd, B, P 2698, Casablanca, Morocco
| | - Naima Elmdaghri
- Laboratoire de Microbiologie, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, B, P 5696, Casablanca, Morocco.,Service de Microbiologie, CHU Ibn Rochd, B, P 2698, Casablanca, Morocco
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Moore A, Ashdown HF, Shinkins B, Roberts NW, Grant CC, Lasserson DS, Harnden A. Clinical Characteristics of Pertussis-Associated Cough in Adults and Children: A Diagnostic Systematic Review and Meta-Analysis. Chest 2017; 152:353-367. [PMID: 28511929 DOI: 10.1016/j.chest.2017.04.186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping, and posttussive vomiting, but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough. METHODS We systematically searched CINAHL, Embase, Medline, and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations. Two authors independently completed screening, data extraction, and quality and bias assessments. For each characteristic, RevMan was used to produce descriptive forest plots. The bivariate meta-analysis method was used to generate pooled estimates of sensitivity and specificity. RESULTS Of 1,969 identified papers, 53 were included. Forty-one clinical characteristics were assessed for diagnostic accuracy. In adult patients, paroxysmal cough and absence of fever have a high sensitivity (93.2% [CI, 83.2-97.4] and 81.8% [CI, 72.2-88.7], respectively) and low specificity (20.6% [CI, 14.7-28.1] and 18.8% [CI, 8.1-37.9]), whereas posttussive vomiting and whooping have low sensitivity (32.5% [CI, 24.5-41.6] and 29.8% [CI, 8.0-45.2]) and high specificity (77.7% [CI, 73.1-81.7] and 79.5% [CI, 69.4-86.9]). Posttussive vomiting in children is moderately sensitive (60.0% [CI, 40.3-77.0]) and specific (66.0% [CI, 52.5-77.3]). CONCLUSIONS In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test.
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Affiliation(s)
- Abigail Moore
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
| | - Helen F Ashdown
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Nia W Roberts
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel S Lasserson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
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Karalius VP, Rucinski SL, Mandrekar JN, Patel R. Bordetella parapertussis outbreak in Southeastern Minnesota and the United States, 2014. Medicine (Baltimore) 2017; 96:e6730. [PMID: 28514288 PMCID: PMC5440125 DOI: 10.1097/md.0000000000006730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Whooping cough is traditionally ascribed to Bordetella pertussis; however, Bordetella parapertussis can cause a similar clinical syndrome. This study describes an outbreak of B. parapertussis in Southeastern Minnesota and the United States (US) in 2014. This was a retrospective analysis of Mayo Clinic and Mayo Medical Laboratories patients who tested positive for B. parapertussis from 2012 to 2014. The medical records of Mayo Clinic patients who tested positive in 2014 were reviewed for demographic information, presenting symptoms, disease course, and vaccination history. In Southeast Minnesota, 81% of the 31 patients who tested positive for B. parapertussis in 2014 were found to be positive from October through December. Their mean age was 5.9 years. Five reported "exposure to pertussis." Two pairs of siblings were affected. Patients reported having had symptoms for an average of 2.6 weeks before nasopharyngeal specimen collection for B. parapertussis testing. Cough was the primary symptom reported. Forty percent reported posttussive vomiting, 40% coryza, 32% apnea/sleep disturbance, and 12% sore throat. All were current with pertussis vaccination. Based on the review of national data, an outbreak occurred nationally in the Northeast and Midwest US over the same time period. In 2014, there was an outbreak of B. parapertussis in Southeastern Minnesota and likely other parts of the US. The presenting illness was similar to that of B. pertussis. All patients were vaccinated against pertussis, suggesting that pertussis vaccination is ineffective against B. parapertussis.
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Affiliation(s)
| | - Stefanea L. Rucinski
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology
| | - Jayawant N. Mandrekar
- Division of Biomedical Statistics and Informatics, Department of Laboratory Medicine and Pathology
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, MN
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Sobanjo-Ter Meulen A, Duclos P, McIntyre P, Lewis KDC, Van Damme P, O'Brien KL, Klugman KP. Assessing the Evidence for Maternal Pertussis Immunization: A Report From the Bill & Melinda Gates Foundation Symposium on Pertussis Infant Disease Burden in Low- and Lower-Middle-Income Countries. Clin Infect Dis 2016; 63:S123-S133. [PMID: 27838664 PMCID: PMC5106619 DOI: 10.1093/cid/ciw530] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Implementation of effective interventions has halved maternal and child mortality over the past 2 decades, but less progress has been made in reducing neonatal mortality. Almost 45% of under-5 global mortality now occurs in infants <1 month of age, with approximately 86% of neonatal deaths occurring in low- and lower-middle-income countries (LMICs). As an estimated 23% of neonatal deaths globally are due to infectious causes, maternal immunization (MI) is one intervention that may reduce mortality in the first few months of life, when direct protection often relies on passively transmitted maternal antibodies. Despite all countries including pertussis-containing vaccines in their routine childhood immunization schedules, supported through the Expanded Programme on Immunization, pertussis continues to circulate globally. Although based on limited robust epidemiologic data, current estimates derived from modeling implicate pertussis in 1% of under-5 mortality, with infants too young to be vaccinated at highest risk of death. Pertussis MI programs have proven effective in reducing infant pertussis mortality in high-income countries using tetanus-diphtheria-acellular pertussis (Tdap) vaccines in their maternal and infant programs; however, these vaccines are cost-prohibitive for routine use in LMICs. The reach of antenatal care programs to deliver maternal pertussis vaccines, particularly with respect to infants at greatest risk of pertussis, needs to be further evaluated. Recognizing that decisions on the potential impact of pertussis MI in LMICs need, as a first step, robust contemporary mortality data for early infant pertussis, a symposium of global key experts was held. The symposium reviewed current evidence and identified knowledge gaps with respect to the infant pertussis disease burden in LMICs, and discussed proposed strategies to assess the potential impact of pertussis MI.
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Affiliation(s)
| | | | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Westmead, New South Wales, Australia
| | | | - Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Tan T, Dalby T, Forsyth K, Halperin SA, Heininger U, Hozbor D, Plotkin S, Ulloa-Gutierrez R, Wirsing von König CH. Pertussis Across the Globe: Recent Epidemiologic Trends From 2000 to 2013. Pediatr Infect Dis J 2015; 34:e222-32. [PMID: 26376316 DOI: 10.1097/inf.0000000000000795] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pertussis has reemerged as a problem across the world. To better understand the nature of the resurgence, we reviewed recent epidemiologic data and we report disease trends from across the world. Published epidemiologic data from January 2000 to July 2013 were obtained via PubMed searches and open-access websites. Data on vaccine coverage and reported pertussis cases from 2000 through 2012 from the 6 World Health Organization regions were also reviewed. Findings are confounded not only by the lack of systematic and comparable observations in many areas of the world but also by the cyclic nature of pertussis with peaks occurring every 3-5 years. It appears that pertussis incidence has increased in school-age children in North America and western Europe, where acellular pertussis vaccines are used, but an increase has also occurred in some countries that use whole-cell vaccines. Worldwide, pertussis remains a serious health concern, especially for infants, who bear the greatest disease burden. Factors that may contribute to the resurgence include lack of booster immunizations, low vaccine coverage, improved diagnostic methods, and genetic changes in the organism. To better understand the epidemiology of pertussis and optimize disease control, it is important to improve surveillance worldwide, irrespective of pertussis vaccine types and schedules used in each country.
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Affiliation(s)
- Tina Tan
- *Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; †Department of Immunology, Microbiology, and Molecular Biology, Statens Serum Institut, Copenhagen, Denmark; ‡Department of Pediatrics, Flinders University, Adelaide, Australia; §Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; ¶Department of Pediatrics, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland; ‖Department of Pediatrics, Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, Argentina; **Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; ††Department of Pediatrics, Hospital Nacional de Niños de Costa Rica "Dr. Carlos Sáenz Herrera," San José, Costa Rica; and ‡‡Labor:Medizin Krefeld MVZ, Krefeld, Germany
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Pertussis prevalence and its determinants among children with persistent cough in urban Uganda. PLoS One 2015; 10:e0123240. [PMID: 25874411 PMCID: PMC4398436 DOI: 10.1371/journal.pone.0123240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control. METHODS In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting ≥14 days were enrolled and evaluated for pertussis using DNA polymerase chain reaction (PCR) and ELISA serology tests. RESULTS Pertussis prevalence was 67 (15% (95% Confidence Interval (CI): 12-18)) and 81 (20% (95% CI: 16-24)) by PCR and ELISA, respectively among 449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination coverage of 94% in this age group. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30%) had a coughing household member and 316 (70%) did not. Among 133 children that had a coughing household member, sex of child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR) 7.16 (95% CI: 1.24-41.44)). Among the 316 children that did not have a coughing household member, age <23 months, having or contact with a coughing individual in neighborhood, a residence with one room, and having a caretaker with >40 years of age were the factors associated with pertussis. Age <23months was three times more likely to be associated with pertussis compared to age 24-59 months (OR 2.97 (95% CI: 1.07-8.28)). CONCLUSION Findings suggest high prevalence of pertussis among children with persistent cough at a health facility and it was marked in children >59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.
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Evaluation of Level of Agreement in Bordetella Species Identification in Three U.S. Laboratories during a Period of Increased Pertussis. J Clin Microbiol 2015; 53:1842-7. [PMID: 25809969 DOI: 10.1128/jcm.03567-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 11/20/2022] Open
Abstract
While PCR is the most common method used for detecting Bordetella pertussis in the United States, most laboratories use insertion sequence 481 (IS481), which is not specific for B. pertussis; therefore, the relative contribution of other Bordetella species is not understood. The objectives of this study were to evaluate the proportion of other Bordetella species misidentified as B. pertussis during a period of increased pertussis incidence, determine the level of agreement in Bordetella species detection between U.S. commercial laboratories and the CDC, and assess the relative diagnostic sensitivity of CDC's PCR assay when using a different PCR master mix. Specimens collected between May 2012 and May 2013 were tested at two U.S. commercial laboratories for B. pertussis and B. parapertussis detection. Every fifth specimen positive for IS481 and/or IS1001 with cycle threshold (CT) values of ≤35 was sent to CDC for PCR testing that identifies Bordetella species. Specimens with indeterminate or negative results in the CDC PCR were tested using an alternate PCR master mix. Of 755 specimens, there was agreement in species identification for 83.4% (n = 630). Of the specimens with different identifications (n = 125), 79.2% (n = 99) were identified as indeterminate B. pertussis at CDC. Overall, 0.66% (n = 5) of the specimens were identified as B. holmesii or B. bronchiseptica at CDC. Of 115 specimens with indeterminate or negative results, 46.1% (n = 53) were B. pertussis positive when tested by an alternate master mix, suggesting a possible increase in assay sensitivity. This study demonstrates good agreement between the two U.S. commercial laboratories and CDC and little misidentification of Bordetella species during the 2012 U.S. epidemic.
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Sedaghat M, Nakhost Lotfi M, Talebi M, Saifi M, Pourshafie MR. Status of pertussis in iran. Jundishapur J Microbiol 2014; 7:e12421. [PMID: 25774274 PMCID: PMC4332236 DOI: 10.5812/jjm.12421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/28/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pertussis is a respiratory and contagious disease which is mostly caused by Bordetella pertussis and B. parapertussis. It usually spreads from person to personduring the incubation or catarrhal phase of the disease. Despite of large-scale vaccination, whooping cough is still an endemic disease with several outbreaks. OBJECTIVES The aim of this study was to determine the prevalence of pertussis and identify its causative agents, B. pertussis or B. parapertussis, from specimens collected from Iranian patients from 2004 to 2008. PATIENTS AND METHODS Nasopharyngeal swab samples from 347 suspected pertussis cases were collected from 18 provinces of Iran. The patients were in different age groups and were either unvaccinated or vaccinated for pertussis with whole cell vaccine (WCV). Bacterial culture, agglutination tests and quantitative PCR (qPCR) targeting IS481 and IS1001 for B. pertussis and B. parapertussis were done for every specimen, respectively. RESULTS The results showed that seven nasopharyngeal swab samples (2%) were positive for B. pertussis (1.7%) and B. parapertussis (0.3%) by culture and agglutination test and 30 patients had positive qPCR test results (9%). CONCLUSIONS Despite the fact that bacterial culture is the golden standard for the detection of B. pertussis, direct detection of bacteria from nasopharyngeal specimens can be performed by a rapid qPCR assay. In this study, high percentage of positive qPCR cases may indicate that the patients might have recovered from pertussis following antibiotic treatment before samples were collected. Rapid detection by qPCR could be important for immediate diagnosis and treatment of patients with pertussis.
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Affiliation(s)
- Manijeh Sedaghat
- Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran
| | | | - Malihe Talebi
- Department of Microbiology, School of Medicine, Iran Medical University, Tehran, IR Iran
- Corresponding authors: Malihe Talebi, Department of Microbiology, School of Medicine, Iran Medical University, Tehran, IR Iran. Tel/Fax: +98-2166405535, E-mail: ; Mohammad Reza Pourshafie, Pasteur Institute of Iran, Tehran, IR Iran. Tel/Fax +98-2166405535, E-mail:
| | - Mahnaz Saifi
- Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran
- Corresponding authors: Malihe Talebi, Department of Microbiology, School of Medicine, Iran Medical University, Tehran, IR Iran. Tel/Fax: +98-2166405535, E-mail: ; Mohammad Reza Pourshafie, Pasteur Institute of Iran, Tehran, IR Iran. Tel/Fax +98-2166405535, E-mail:
| | - Mohammad Reza Pourshafie
- Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran
- Corresponding authors: Malihe Talebi, Department of Microbiology, School of Medicine, Iran Medical University, Tehran, IR Iran. Tel/Fax: +98-2166405535, E-mail: ; Mohammad Reza Pourshafie, Pasteur Institute of Iran, Tehran, IR Iran. Tel/Fax +98-2166405535, E-mail:
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Abstract
Pertussis, or whooping cough, has had a dramatic resurgence in the past several years and is the most common vaccine-preventable disease in the world. The year 2012 marked the most cases in the United States in > 50 years. Large outbreaks have occurred in multiple states, and infant deaths have drawn the attention of not only health-care providers but also the media. Although the disease is theoretically preventable by vaccination, it remains a challenge to control. New vaccination strategies have been implemented across different age groups and populations of patients, but vaccine coverage remains dismally low. Acellular vaccines, although safe, do not afford the same long-lasting immunity as the previously used whole-cell vaccine. Ultimately, improvements in the development of vaccines and in vaccination coverage will be essential to decrease the burden of pertussis on society. This article provides a review of pertussis infection and discusses advances related to the epidemiology, diagnosis, treatment, and prevention of infection, as well as continued areas of uncertainty.
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Affiliation(s)
- Joshua D Hartzell
- Infectious Diseases Clinic, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jason M Blaylock
- Infectious Diseases Clinic, Walter Reed National Military Medical Center, Bethesda, MD.
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Predictors of Mortality in Mechanically Ventilated Critical Pertussis in a low Income Country. Mediterr J Hematol Infect Dis 2014; 6:e2014059. [PMID: 25237472 PMCID: PMC4165494 DOI: 10.4084/mjhid.2014.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/25/2014] [Indexed: 11/26/2022] Open
Abstract
Background Critical pertussis is characterized by severe respiratory failure, important leukocytosis, pulmonary hypertension, septic shock and encephalopathy. Aim To describe the clinical course of critical pertussis, and identify predictors of death at the time of presentation for medical care. Methodology Retrospective study conducted in children’s hospital Tunisian PICU between 01 January and 31 October 2013. Patients with critical pertussis confirmed by RT-PCR and requiring mechanical ventilation were included. Predictors of death were studied. Results A total of 17 patients was studied. Median age was 50 days. Mortality was 23%. Predictors risk of mortality were : high PRISM score (Pediatric Risk of Mortality Score) (p=0,007), shock (p=0,002), tachycardia (p=0,005), seizures (p=0,006), altered mental status (p=0,006), elevated WBC count (p=0,003) and hemodynamic support (p=0022). However, the difference did not reach statistical significance in comorbidity, pneumoniae, high pulmonary hypertension or exchange transfusion. Concomitant viral or bacterial co-infection was not related to poor outcome. Conclusion Young infants are at high risk to have critical pertussis. Despite advances in life support and the treatment of organ failure in childhood critical illness, critical pertussis remains difficult to treat.
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Jusot V, Aberrane S, Alé F, Laouali B, Moussa I, Alio SA, Adehossi E, Collard JM, Grais RF. Prevalence of Bordetella infection in a hospital setting in niamey, niger. J Trop Pediatr 2014; 60:223-30. [PMID: 24531376 DOI: 10.1093/tropej/fmu001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bordetella pertussis still poses an important health threat in developing countries. In Niger, notified pertussis cases are few despite the low diphtheria-tetanus-pertussis/pentavalent vaccine coverage. We aimed to estimate the prevalence of B. pertussis in children aged <5 years consulting at a pediatric ward. A 5-month study in 2011 recruited 342 children with respiratory symptoms at the National Hospital of Niamey. Nasopharyngeal aspirates were tested by culture and real-time polymerase chain reaction. Overall, 34 (11.2%) of the 305 available nasopharyngeal aspirates tested by real-time polymerase chain reaction were positive for a Bordetella spp., with an estimated prevalence of 8.2 cases per 1000 children aged <5. None was notified to the surveillance network. A single specimen was positive on culture. This study, the first to provide laboratory-confirmed data on pertussis in Niger, highlights the need to sensitize health care personnel to actively notify clinical cases and to integrate laboratory diagnosis in the existing surveillance system.
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Affiliation(s)
| | - Said Aberrane
- Laboratoire de Microbiologie, Centre Hospitalier Intercommunal, Créteil, France
| | | | - Boubou Laouali
- Hopital National, Laboratoire de Biologie, Niamey, Niger
| | - Issa Moussa
- Hopital National, Laboratoire de Biologie, Niamey, Niger
| | - Sanda A Alio
- CERMES, Unite de Biologie, Plateforme PCR, Niamey, Niger
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Pittet LF, Emonet S, Schrenzel J, Siegrist CA, Posfay-Barbe KM. Bordetella holmesii: an under-recognised Bordetella species. THE LANCET. INFECTIOUS DISEASES 2014; 14:510-9. [PMID: 24721229 DOI: 10.1016/s1473-3099(14)70021-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bordetella holmesii, first described in 1995, is believed to cause both invasive infections (bacteraemia, meningitis, endocarditis, pericarditis, pneumonia, and arthritis) and pertussis-like symptoms. Infection with B holmesii is frequently misidentified as being with B pertussis, the cause of whooping cough, because routine diagnostic tests for pertussis are not species-specific. In this Review, we summarise knowledge about B holmesii diagnosis and treatment, and assess research needs. Although no fatal cases of B holmesii have been reported, associated invasive infections can cause substantial morbidities, even in previously healthy individuals. Antimicrobial treatment can be problematic because B holmesii's susceptibility to macrolides (used empirically to treat B pertussis) and third-generation cephalosporins (often used to treat invasive infections) is lower than would be expected. B holmesii's adaptation to human beings is continuing, and virulence might increase, causing the need for better diagnostic assays and epidemiological surveillance.
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Affiliation(s)
- Laure F Pittet
- Department of Paediatrics, Division of General Paediatrics, Children's Hospital, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Stéphane Emonet
- Department of Genetics and Laboratory Medicine, Department of Medical Specialties, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Department of Genetics and Laboratory Medicine, Department of Medical Specialties, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Department of Paediatrics, Division of General Paediatrics, Children's Hospital, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland; Neonatal Immunology, Departments of Pathology-Immunology and Paediatrics, University of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Department of Paediatrics, Division of General Paediatrics, Children's Hospital, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.
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Pittet LF, Emonet S, François P, Bonetti EJ, Schrenzel J, Hug M, Altwegg M, Siegrist CA, Posfay-Barbe KM. Diagnosis of whooping cough in Switzerland: differentiating Bordetella pertussis from Bordetella holmesii by polymerase chain reaction. PLoS One 2014; 9:e88936. [PMID: 24586447 PMCID: PMC3929760 DOI: 10.1371/journal.pone.0088936] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 01/14/2014] [Indexed: 11/20/2022] Open
Abstract
Bordetella holmesii, an emerging pathogen, can be misidentified as Bordetella pertussis by routine polymerase chain reaction (PCR). In some reports, up to 29% of the patients diagnosed with pertussis have in fact B. holmesii infection and invasive, non-respiratory B. holmesii infections have been reported worldwide. This misdiagnosis undermines the knowledge of pertussis' epidemiology, and may lead to misconceptions on pertussis vaccine's efficacy. Recently, the number of whooping cough cases has increased significantly in several countries. The aim of this retrospective study was to determine whether B. holmesii was contributing to the increase in laboratory-confirmed cases of B. pertussis in Switzerland. A multiplex species-specific quantitative PCR assay was performed on 196 nasopharyngeal samples from Swiss patients with PCR-confirmed Bordetella infection (median age: 6 years-old, minimum 21 days-old, maximum 86 years-old), formerly diagnosed as Bordetella pertussis (IS481+). No B. holmesii (IS481+, IS1001−, hIS1001+) was identified. We discuss whether laboratories should implement specific PCR to recognize different Bordetella species. We conclude that in Switzerland B. holmesii seems to be circulating less than in neighboring countries and that specific diagnostic procedures are not necessary routinely. However, as the epidemiological situation may change rapidly, periodic reevaluation is suggested.
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Affiliation(s)
- Laure F. Pittet
- Department of Paediatrics, Division of General Paediatrics, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Emonet
- Laboratory of Bacteriology, Department of Genetics and Laboratory Medicine, Department of Medical Specialties, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Patrice François
- Genomic Research Laboratory, Department of Genetics and Laboratory Medicine, Department of Medical Specialties, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Eve-Julie Bonetti
- Genomic Research Laboratory, Department of Genetics and Laboratory Medicine, Department of Medical Specialties, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Laboratory of Bacteriology, Department of Genetics and Laboratory Medicine, Department of Medical Specialties, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | | | | | - Claire-Anne Siegrist
- Department of Paediatrics, Division of General Paediatrics, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
- Centre for Vaccinology and Neonatal Immunology, Departments of Pathology-Immunology and Paediatrics, University of Geneva, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Department of Paediatrics, Division of General Paediatrics, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
- * E-mail:
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