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Arakkal AT, Cavanaugh JE, Polgreen PM, Miller AC. The Increase in Household Transmission of Pertussis Associated With Diagnostic Delays. Pediatr Infect Dis J 2024; 43:614-619. [PMID: 38534962 PMCID: PMC11189735 DOI: 10.1097/inf.0000000000004302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Pertussis is a highly contagious respiratory illness that can be especially dangerous to young children. Transmission of pertussis often occurs in household settings and is impacted by the timing of treatment and postexposure chemoprophylaxis. This study analyzes the risk for secondary household transmission and if delays in diagnosing pertussis increased the risk for household transmission. METHODS We conducted 2 population-based studies using a large nationally representative administrative claims database. The first study utilized a stratified monthly incidence model to compare the incidence of pertussis among enrollees exposed to a family member with pertussis versus those not exposed. The second study was conducted at a household level following the index case of pertussis in each household. We identified diagnostic delays in the initial household case and used a logistic regression model to evaluate if such delays were associated with a greater risk for transmission. RESULTS The incidence rate ratio of pertussis was 938.99 [95% confidence interval (CI): 880.19-1001.73] among enrollees exposed to a family member with pertussis relative to those not exposed. The odds of secondary household transmission in households where the index case experienced a diagnostic delay was 5.10 (CI: 4.44-5.85) times the odds of transmission when the index case was not delayed. We found that longer delays were associated with a greater risk for secondary household transmission ( P < 0.0001). CONCLUSIONS There is a high rate of secondary transmission of pertussis in household settings. Diagnostic delays increase the likelihood that pertussis will transmit in the household.
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Affiliation(s)
| | | | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Aaron C Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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2
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Domenech de Cellès M, Rohani P. Pertussis vaccines, epidemiology and evolution. Nat Rev Microbiol 2024:10.1038/s41579-024-01064-8. [PMID: 38907021 DOI: 10.1038/s41579-024-01064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/23/2024]
Abstract
Pertussis, which is caused by Bordetella pertussis, has plagued humans for at least 800 years, is highly infectious and can be fatal in the unvaccinated, especially very young infants. Although the rollout of whole-cell pertussis (wP) vaccines in the 1940s and 1950s was associated with a drastic drop in incidence, concerns regarding the reactogenicity of wP vaccines led to the development of a new generation of safer, acellular (aP) vaccines that have been adopted mainly in high-income countries. Over the past 20 years, some countries that boast high aP coverage have experienced a resurgence in pertussis, which has led to substantial debate over the basic immunology, epidemiology and evolutionary biology of the bacterium. Controversy surrounds the duration of natural immunity and vaccine-derived immunity, the ability of vaccines to prevent transmission and severe disease, and the impact of evolution on evading vaccine immunity. Resolving these issues is made challenging by incomplete detection of pertussis cases, the absence of a serological marker of immunity, modest sequencing of the bacterial genome and heterogeneity in diagnostic methods of surveillance. In this Review, we lay out the complexities of contemporary pertussis and, where possible, propose a parsimonious explanation for apparently incongruous observations.
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Affiliation(s)
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA, USA.
- Center of Ecology of Infectious Diseases, Athens, GA, USA.
- Department of Infectious Diseases, College for Veterinary Medicine, University of Georgia, Athens, GA, USA.
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3
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Kim AR, Sette A, da Silva Antunes R. Adaptive immune response to bordetella pertussis during vaccination and infection: emerging perspectives and unanswered questions. Expert Rev Vaccines 2024; 23:705-714. [PMID: 39037200 DOI: 10.1080/14760584.2024.2383745] [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: 04/23/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Whooping cough, also known as pertussis, remains a significant challenge as a vaccine-preventable disease worldwide. Since the switch from the whole-cell Pertussis (wP) vaccine to the acellular Pertussis vaccine (aP), cases of whooping cough have increased in countries using the aP vaccine. Understanding the immune system's response to pertussis vaccines and infection is crucial for improving current vaccine efficacy. AREAS COVERED This review of the literature using PubMed records offers an overview of the qualitative differences in antibody and T cell responses to B. pertussis (BP) in vaccination and infection, and their potential association with decreased efficacy of the aP vaccine in preventing infection and subclinical colonization. We further discuss how asymptomatic infections and carriage are widespread among vaccinated human populations, and explore methodologies that can be employed for their detection, to better understand their impact on adaptive immune responses and identify key features necessary for protection against the disease. EXPERT OPINION An underappreciated human BP reservoir, stemming from the decreased capacity of the aP vaccine to prevent subclinical infection, offers an alternative explanation for the increased incidence of clinical disease and recurrent outbreaks.
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Affiliation(s)
- A-Reum Kim
- Center for Vaccine Innovation, La Jolla Institute for Immunology (LJI), La Jolla, CA, USA
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology (LJI), La Jolla, CA, USA
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego (UCSD), La Jolla, CA, USA
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Abu-Raya B, Esser MJ, Nakabembe E, Reiné J, Amaral K, Diks AM, Imede E, Way SS, Harandi AM, Gorringe A, Le Doare K, Halperin SA, Berkowska MA, Sadarangani M. Antibody and B-cell Immune Responses Against Bordetella Pertussis Following Infection and Immunization. J Mol Biol 2023; 435:168344. [PMID: 37926426 DOI: 10.1016/j.jmb.2023.168344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Neither immunization nor recovery from natural infection provides life-long protection against Bordetella pertussis. Replacement of a whole-cell pertussis (wP) vaccine with an acellular pertussis (aP) vaccine, mutations in B. pertussis strains, and better diagnostic techniques, contribute to resurgence of number of cases especially in young infants. Development of new immunization strategies relies on a comprehensive understanding of immune system responses to infection and immunization and how triggering these immune components would ensure protective immunity. In this review, we assess how B cells, and their secretory products, antibodies, respond to B. pertussis infection, current and novel vaccines and highlight similarities and differences in these responses. We first focus on antibody-mediated immunity. We discuss antibody (sub)classes, elaborate on antibody avidity, ability to neutralize pertussis toxin, and summarize different effector functions, i.e. ability to activate complement, promote phagocytosis and activate NK cells. We then discuss challenges and opportunities in studying B-cell immunity. We highlight shared and unique aspects of B-cell and plasma cell responses to infection and immunization, and discuss how responses to novel immunization strategies better resemble those triggered by a natural infection (i.e., by triggering responses in mucosa and production of IgA). With this comprehensive review, we aim to shed some new light on the role of B cells and antibodies in the pertussis immunity to guide new vaccine development.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Mirjam J Esser
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eve Nakabembe
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Upper Mulago Hill Road, Kampala, P.O. Box 7072, Uganda
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Kyle Amaral
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Annieck M Diks
- Department of Immunology, Leiden University Medical Center, Albinusdreef 2, Leiden ZA 2333, the Netherlands
| | - Esther Imede
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sing Sing Way
- Department of Pediatrics, Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Ali M Harandi
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Microbiology and Immunology, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Gorringe
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Makerere University-Johns Hopkins University Research Collaboration, MU-JHU, Upper Mulago Hill, Kampala, P.O. Box 23491, Uganda
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Magdalena A Berkowska
- Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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5
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da Silva Antunes R, Garrigan E, Quiambao LG, Dhanda SK, Marrama D, Westernberg L, Wang E, Abawi A, Sutherland A, Armstrong SK, Brickman TJ, Sidney J, Frazier A, Merkel TJ, Peters B, Sette A. T cell reactivity to Bordetella pertussis is highly diverse regardless of childhood vaccination. Cell Host Microbe 2023; 31:1404-1416.e4. [PMID: 37490913 PMCID: PMC10528758 DOI: 10.1016/j.chom.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
The incidence of whooping cough due to Bordetella pertussis (BP) infections has increased recently. It is believed that the shift from whole-cell pertussis (wP) vaccines to acellular pertussis (aP) vaccines may be contributing to this rise. While T cells are key in controlling and preventing disease, nearly all knowledge relates to antigens in aP vaccines. A whole-genome mapping of human BP-specific CD4+ T cell responses was performed in healthy vaccinated adults and revealed unexpected broad reactivity to hundreds of antigens. The overall pattern and magnitude of T cell responses to aP and non-aP vaccine antigens are similar regardless of childhood vaccination, suggesting that asymptomatic infections drive the pattern of T cell reactivity in adults. Lastly, lack of Th1/Th2 polarization to non-aP vaccine antigens suggests these antigens have the potential to counteract aP vaccination Th2 bias. These findings enhance our insights into human T cell responses to BP and identify potential targets for next-generation pertussis vaccines.
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Affiliation(s)
- Ricardo da Silva Antunes
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA.
| | - Emily Garrigan
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Lorenzo G Quiambao
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Sandeep Kumar Dhanda
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Daniel Marrama
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Luise Westernberg
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Eric Wang
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Adam Abawi
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Aaron Sutherland
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Sandra K Armstrong
- Department of Microbiology and Immunology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Timothy J Brickman
- Department of Microbiology and Immunology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - John Sidney
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - April Frazier
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Tod J Merkel
- Division of Bacterial, Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Bjoern Peters
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA 92037, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA 92037, USA
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6
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da Silva Antunes R, Garrigan E, Quiambao LG, Dhanda SK, Marrama D, Westernberg L, Wang E, Sutherland A, Armstrong SK, Brickman TJ, Sidney J, Frazier A, Merkel T, Peters B, Sette A. Genome-wide characterization of T cell responses to Bordetella pertussis reveals broad reactivity and similar polarization irrespective of childhood vaccination profiles. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.24.534182. [PMID: 36993748 PMCID: PMC10055406 DOI: 10.1101/2023.03.24.534182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The incidence of whooping cough (pertussis), the respiratory disease caused by Bordetella pertussis (BP) has increased in recent years, and it is suspected that the switch from whole-cell pertussis (wP) to acellular pertussis (aP) vaccines may be a contributing factor to the rise in morbidity. While a growing body of evidence indicates that T cells play a role in the control and prevention of symptomatic disease, nearly all data on human BP-specific T cells is related to the four antigens contained in the aP vaccines, and data detailing T cell responses to additional non-aP antigens, are lacking. Here, we derived a full-genome map of human BP-specific CD4+ T cell responses using a high-throughput ex vivo Activation Induced Marker (AIM) assay, to screen a peptide library spanning over 3000 different BP ORFs. First, our data show that BP specific-CD4+ T cells are associated with a large and previously unrecognized breadth of responses, including hundreds of targets. Notably, fifteen distinct non-aP vaccine antigens were associated with reactivity comparable to that of the aP vaccine antigens. Second, the overall pattern and magnitude of CD4+ T cell reactivity to aP and non-aP vaccine antigens was similar regardless of aP vs wP childhood vaccination history, suggesting that the profile of T cell reactivity in adults is not driven by vaccination, but rather is likely driven by subsequent asymptomatic or sub-clinical infections. Finally, while aP vaccine responses were Th1/Th2 polarized as a function of childhood vaccination, CD4+ T cell responses to non-aP BP antigens vaccine responses were not, suggesting that these antigens could be used to avoid the Th2 bias associated with aP vaccination. Overall, these findings enhance our understanding of human T cell responses against BP and suggest potential targets for designing next-generation pertussis vaccines.
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Affiliation(s)
- Ricardo da Silva Antunes
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Emily Garrigan
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Lorenzo G Quiambao
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Sandeep Kumar Dhanda
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Daniel Marrama
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Luise Westernberg
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Eric Wang
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Aaron Sutherland
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Sandra K Armstrong
- Department of Microbiology and Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Timothy J Brickman
- Department of Microbiology and Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - John Sidney
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - April Frazier
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
| | - Tod Merkel
- Division of Bacterial, Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Bjoern Peters
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
- University of California San Diego School of Medicine, La Jolla, San Diego, California, USA
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, California, USA
- University of California San Diego School of Medicine, La Jolla, San Diego, California, USA
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7
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Blanchard-Rohner G. Novel approaches to reactivate pertussis immunity. Expert Rev Vaccines 2022; 21:1787-1797. [PMID: 36400443 DOI: 10.1080/14760584.2022.2149499] [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: 11/21/2022]
Abstract
INTRODUCTION Whole cell and acellular pertussis vaccines have been very effective in decreasing the deaths of neonates and infants from Bordetella pertussis. Despite high vaccine coverage worldwide, pertussis remains one of the most common vaccine-preventable diseases, thus suggesting that new pertussis vaccination strategies are needed. Several candidates are currently under development, such as acellular pertussis vaccines that use genetically detoxified pertussis toxin, acellular pertussis vaccines delivered with new adjuvants or new delivery systems, or an intranasally delivered, live attenuated vaccine. AREAS COVERED This review discusses the different possibilities for improving current pertussis vaccines and the present state of knowledge on the pertussis vaccine candidates under development. EXPERT OPINION Until there is a safe, effective, and affordable alternative to the two types of existing vaccines, we should maintain sufficient childhood coverage and increase the vaccination of pregnant women, adolescents, and young adults.
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Affiliation(s)
- Geraldine Blanchard-Rohner
- Center of Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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8
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Bordetella pertussis in School-Age Children, Adolescents and Adults: A Systematic Review of Epidemiology and Mortality in Europe. Infect Dis Ther 2021; 10:2071-2118. [PMID: 34435338 PMCID: PMC8387212 DOI: 10.1007/s40121-021-00520-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Pertussis (whooping cough) epidemics persist globally despite high vaccine coverage among infants and young children. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity, resulting in a pool of unprotected adolescents and adults. However, pertussis is generally less severe in adolescents and adults, and this difference in presentation means it can often be unrecognised by healthcare professionals, meaning that it is largely under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology and mortality in school-aged children, adolescents and adults in Europe. A formal statistical comparison (e.g. using meta-analyses) was not possible because of the mix of methodologies reported. There were 69 epidemiological studies and 19 mortality studies identified for review. Over the past decade, the reported incidence of notified pertussis cases varied widely between European countries, which is likely associated with differences in surveillance systems, diagnostic techniques and reporting regulations. However, several studies show that pertussis is circulating among adolescents and adults in Europe, and although pertussis-related morbidity and mortality are highest in infants, there is evidence that adults aged > 50 years are at increased risk. For example, in a hospital-based surveillance study in Portugal, between 2000 and 2015, 94% of hospitalised pertussis cases were infants aged < 1 year, with a case fatality rate (CFR) of 0.8%; however, among hospitalised adult cases of pertussis, the CFRs were 11.5% (aged 18–64 years) and 17.4% (aged > 65 years). Very few European countries currently include pertussis boosters for adults in the national immunisation strategy. In addition to increasing pertussis vaccination coverage in adolescents and adults, mitigation strategies in European countries should include improved diagnosis and treatment in these populations.
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Abstract
PURPOSE OF REVIEW Mass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj. RECENT FINDINGS The prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus during Hajj. Whilst MERS-CoV continues to circulate in the Middle East, no cases of MERS-CoV have yet been identified in pilgrims during Hajj. SUMMARY Respiratory tract infections are a major cause of morbidity in pilgrims attending mass gathering events. The management of severe respiratory infections should consider investigation and empirical coverage for the most likely agents based on syndromic surveillance data from hosting country and /or other relevant exposure history during events. Pneumococcal and Pertussis vaccines should be recommended for Hajj pilgrims.
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Esposito S, Stefanelli P, Fry NK, Fedele G, He Q, Paterson P, Tan T, Knuf M, Rodrigo C, Weil Olivier C, Flanagan KL, Hung I, Lutsar I, Edwards K, O'Ryan M, Principi N. Pertussis Prevention: Reasons for Resurgence, and Differences in the Current Acellular Pertussis Vaccines. Front Immunol 2019; 10:1344. [PMID: 31333640 PMCID: PMC6616129 DOI: 10.3389/fimmu.2019.01344] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/28/2019] [Indexed: 12/21/2022] Open
Abstract
Pertussis is an acute respiratory disease caused by Bordetella pertussis. Due to its frequency and severity, prevention of pertussis has been considered an important public health issue for many years. The development of the whole-cell pertussis vaccine (wPV) and its introduction into the pediatric immunization schedule was associated with a marked reduction in pertussis cases in the vaccinated cohort. However, due to the frequency of local and systemic adverse events after immunization with wPV, work on a less reactive vaccine was undertaken based on isolated B. pertussis components that induced protective immune responses with fewer local and systemic reactions. These component vaccines were termed acellular vaccines and contained one or more pertussis antigens, including pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN), and fimbrial proteins 2 (FIM2) and 3 (FIM3). Preparations containing up to five components were developed, and several efficacy trials clearly demonstrated that the aPVs were able to confer comparable short-term protection than the most effective wPVs with fewer local and systemic reactions. There has been a resurgence of pertussis observed in recent years. This paper reports the results of a Consensus Conference organized by the World Association for Infectious Disease and Immunological Disorders (WAidid) on June 22, 2018, in Perugia, Italy, with the goal of evaluating the most important reasons for the pertussis resurgence and the role of different aPVs in this resurgence.
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Affiliation(s)
- Susanna Esposito
- Department of Surgical and Biomedical Sciences, Paediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Norman K. Fry
- Immunisation and Countermeasures Division, Public Health England–National Infection Service, London, United Kingdom
| | - Giorgio Fedele
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Qiushui He
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Medical Microbiology, Capital Medical University, Beijing, China
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, The Vaccine Confidence Project TM, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Markus Knuf
- Children's Hospital, Helios HSk, Wiesbaden, Germany
- Department of Pediatrics, University Medicine, Mainz, Germany
| | - Carlos Rodrigo
- Department of Pediatrics, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine-Germans Trias i Pujol University Hospita, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Katie L. Flanagan
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Ivan Hung
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Iria Lutsar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kathryn Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
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11
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Wilk MM, Borkner L, Misiak A, Curham L, Allen AC, Mills KHG. Immunization with whole cell but not acellular pertussis vaccines primes CD4 T RM cells that sustain protective immunity against nasal colonization with Bordetella pertussis. Emerg Microbes Infect 2019; 8:169-185. [PMID: 30866771 PMCID: PMC6455184 DOI: 10.1080/22221751.2018.1564630] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Protective immunity wanes rapidly after immunization of children with acellular pertussis (aP) vaccines and these vaccines do not prevent nasal colonization or transmission of Bordetella pertussis in baboons. In this study, we examined the role of tissue-resident memory T (TRM) cells in persistent protective immunity induced by infection or immunization with aP and whole-cell pertussis (wP) vaccines in mice. Immunization of mice with a wP vaccine protected against lung and nasal colonization, whereas an aP vaccine failed to protect in the nose. IL-17 and IFN-γ-secreting CD69+CD4+ TRM cells were expanded in the lung and nasal tissue after B. pertussis challenge of mice immunized with wP, but not aP vaccines. However, previous infection induced the most persistent protection against nasal colonization and this correlated with potent induction of nasal tissue TRM cells, especially IL-17-secreting TRM cells. Blocking T cell migration to respiratory tissue during immunization with a wP vaccine impaired bacterial clearance, whereas transfer of TRM cells from convalescent or wP-immunized mice conferred protection to naïve mice. Our findings reveal that previous infection or wP vaccination are significantly more effective than aP vaccination in conferring persistent protective immunity against B. pertussis and that this is mediated by respiratory TRM cells.
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Affiliation(s)
- Mieszko M Wilk
- a Immune Regulation Research Group, School of Biochemistry and Immunology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland
| | - Lisa Borkner
- a Immune Regulation Research Group, School of Biochemistry and Immunology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland
| | - Alicja Misiak
- a Immune Regulation Research Group, School of Biochemistry and Immunology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland
| | - Lucy Curham
- a Immune Regulation Research Group, School of Biochemistry and Immunology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland
| | - Aideen C Allen
- a Immune Regulation Research Group, School of Biochemistry and Immunology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland
| | - Kingston H G Mills
- a Immune Regulation Research Group, School of Biochemistry and Immunology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland
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12
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ESPOSITO S. Prevention of pertussis: from clinical trials to Real World Evidence. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E177-E186. [PMID: 30397673 PMCID: PMC6196371 DOI: 10.15167/2421-4248/jpmh2018.59.3.1041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/16/2018] [Indexed: 12/22/2022]
Abstract
Pertussis, a highly contagious infective disease caused by Bordetella pertussis, was in the past very common among newborns and children, causing significant medical, social and economic issues burden, also due to frequent need of hospitalization and high mortality. Following the introduction of vaccines against pertussis, the burden of the disease dramatically decreased, although nowadays, this disease it is still the most widespread among the vaccine preventable ones. First vaccine formulations were composed with whole cell antigen of Bordetella pertussis and were followed by formulations with acellular antigens (PT, FHA, PRN, FIM), that showed to have similar efficacy and less reactogenicity. In particular, all the acellular vaccines, regardless the number of antigenic component included, demonstrated good immunogenicity in clinical trials and high effectiveness in real world evidence studies. Nevertheless, in the recent years it has been notified an increasing number of cases of pertussis. The most recent evidence demonstrated that for an effective control and prevention of pertussis it is necessary to strengthen vaccination coverage among the whole population, providing primary vaccination to newborns and booster in infancy, adolescence and adulthood every 10 years. Finally, vaccination of women at the third trimester of every pregnancy is the most effective intervention to protect the newborn from pertussis in his first months of life, before developing a protective response after the primary vaccination.
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Affiliation(s)
- S. ESPOSITO
- Pediatric Clinic, Department of Medical and Surgical Sciences, Università degli Studi di Perugia, Italy
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13
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Burdin N, Handy LK, Plotkin SA. What Is Wrong with Pertussis Vaccine Immunity? The Problem of Waning Effectiveness of Pertussis Vaccines. Cold Spring Harb Perspect Biol 2017; 9:a029454. [PMID: 28289064 PMCID: PMC5710106 DOI: 10.1101/cshperspect.a029454] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pertussis is resurgent in some countries, particularly those in which children receive acellular pertussis (aP) vaccines in early infancy and boosters later in life. Immunologic studies show that, whereas whole-cell pertussis (wP) vaccines orient the immune system toward Th1/Th17 responses, acellular pertussis vaccines orient toward Th1/Th2 responses. Although aP vaccines do provide protection during the first years of life, the change in T-cell priming results in waning effectiveness of aP as early as 2-3 years post-boosters. Although other factors, such as increased virulence of pertussis strains, better diagnosis, and better surveillance may play a role, the increase in pertussis appears to be the result of waning immunity. In addition, studies in baboon models, requiring confirmation in humans, show that aP is less able to prevent nasopharyngeal colonization of Bordetella pertussis than wP or natural infection.
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Affiliation(s)
- Nicolas Burdin
- EU Research and Non Clinical Safety, R&D, Sanofi Pasteur, Campus Mérieux, 69280 Marcy l'Etoile, France
| | - Lori Kestenbaum Handy
- Assistant Professor of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803
| | - Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, Pennsylvania 18902
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14
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Leroux-Roels G, Lattanzi M, Solis CD, Contorni M, Costantini M, Moraschini L, Bardelli M, Bertholet S, Borgogni E, Buricchi F, Cantisani R, Faenzi E, Finco O, Leuzzi R, Pizza M, Rosa D, Schiavetti F, Seubert A, Spensieri F, Volpini G, Zedda L, Giudice GD, Galgani I. A phase I, randomized, controlled, dose-ranging study of investigational acellular pertussis (aP) and reduced tetanus-diphtheria-acellular pertussis (TdaP) booster vaccines in adults. Hum Vaccin Immunother 2017; 14:45-58. [PMID: 29172945 PMCID: PMC5791588 DOI: 10.1080/21645515.2017.1385686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Despite high vaccination coverage worldwide, pertussis has re-emerged in many countries. This randomized, controlled, observer-blind phase I study and extension study in Belgium (March 2012-June 2015) assessed safety and immunogenicity of investigational acellular pertussis vaccines containing genetically detoxified pertussis toxin (PT) (NCT01529645; NCT02382913). 420 healthy adults (average age: 26.8 ± 5.5 years, 60% female) were randomized to 1 of 10 vaccine groups: 3 investigational aP vaccines (containing pertussis antigens PT, filamentous hemagglutinin [FHA] and pertactin [PRN] at different dosages), 6 investigational TdaP (additionally containing tetanus toxoid [TT] and diphtheria toxoid [DT]), and 1 TdaP comparator containing chemically inactivated PT. Antibody responses were evaluated on days 1, 8, 30, 180, 365, and approximately 3 years post-booster vaccination. Cell-mediated immune responses and PT neutralization were evaluated in a subset of participants in pre-selected groups. Local and systemic adverse events (AEs), and unsolicited AEs were collected through day 7 and 30, respectively; serious AEs and AEs leading to study withdrawal were collected through day 365 post-vaccination. Antibody responses against pertussis antigens peaked at day 30 post-vaccination and then declined but remained above baseline level at approximately 3 years post-vaccination. Responses to FHA and PRN were correlated to antigen dose. Antibody responses specific to PT, toxin neutralization activity and persistence induced by investigational formulations were similar or significantly higher than the licensed vaccine, despite lower PT doses. Of 15 serious AEs, none were considered vaccination-related; 1 led to study withdrawal (premature labor, day 364; aP4 group). This study confirmed the potential benefits of genetically detoxified PT antigen. All investigational study formulations were well tolerated.
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Affiliation(s)
- Geert Leroux-Roels
- a Centre for Vaccinology, Ghent University and University Hospital , Ghent , Belgium
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15
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Rahimian M, HosseiniB M. Serological study of Bordetella Pertussis, Mycoplasma Pneumonia and Chlamydia Pneumonia in Iranian hajj pilgrims with prolonged cough illnesses: A follow-up study. Respir Med 2017; 132:122-131. [PMID: 29229084 DOI: 10.1016/j.rmed.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hajj pilgrimage is the biggest and longest mass gathering in the Muslim world. Annually, about 50% of more than 2.5 million pilgrims participating in this ritual get involved in severe devastating coughs. Most coughs continue, so the pilgrims turn back home and transmit them to family members and other people. Despite the high prevalence of coughs for many years, what causes them remains unknown. Considering the pertussis-like clinical picture of the so-called "hajj coughs", the researchers conducted a study to measure antibodies against three known common atypical bacteria, namely Bordetella Pertussis, Chlamydia Pneumonia and Mycoplasma Pneumonia. PATIENTS AND METHODS The study was done on three out of eleven groups of pilgrims from Yazd province, central Iran. The sample was selected randomly and consisted of 202 pilgrims who completed an informed consent. Their blood samples were taken, and the plasma was separated and then stored at -70 °C. After turning back from the journey, the pilgrims had their second blood samples taken. As many as 52 pilgrims failed to come for the second sampling, and two samples were broken during transportation. The final analysis was performed on the remaining 148 pairs of samples. RESULTS Antibodies were already elevated in many pilgrims before the journey probably due to their old age (causing more exposure to pathogens) or unplanned pertussis vaccination. After their return, antibody elevation was only mild, again probably due to the old age of the participants (i.e. due to their weaker immune systems). Some antibodies even fell down without any known reason. In this study, previous hajj journey was assumed as a prophylactic factor, due to acquisition of immunity. Coughs with a prolonged pertussis-like picture were also presumed to be more related than other types of coughs to atypical pathogens. Statistical tests showed that the history of previous journeys had no prophylactic effect. Also, no correlation was found between the clinical pictures of coughs and infection with atypical bacteria. CONCLUSION Even though some rises and falls occurred in the antibodies titer, the variations could hardly be attributed to coughs in this study. Indeed, the variation of antibodies had no meaningful relationship with clinical factors. In this regard, further studies are needed to clarify the reason for the so-called "hajj coughs", but epidemiological studies will be difficult to do until easier and more reliable methods become available for accurate diagnosis.
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Affiliation(s)
- Masoud Rahimian
- Internal Medicine Department, Division of Pulmonology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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16
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Zöldi V, Sane J, Nohynek H, Virkki M, Hannila-Handelberg T, Mertsola J. Decreased incidence of pertussis in young adults after the introduction of booster vaccine in military conscripts: Epidemiological analyses of pertussis in Finland, 1995-2015. Vaccine 2017; 35:5249-5255. [PMID: 28823620 DOI: 10.1016/j.vaccine.2017.08.008] [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] [Received: 05/09/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In 2005, in Finland, the whole-cell pertussis vaccine was replaced by acellular given at 3-5-12months, and boosters at 4 and 11-15years of age. From July 2012, military conscripts have been offered a pertussis booster dose. Conscription is mandatory for Finnish men, and >95% were 19-21years old when enrolled during 2012-2015. We describe the epidemiology of pertussis in Finland during 1995-2015, and show the indirect effect of the booster in conscripts on pertussis incidence in the Finnish population. MATERIALS AND METHODS We extracted data on laboratory confirmed notified pertussis cases from the National Infectious Diseases Register. We calculated annual incidence using as denominator population data and incidence rate ratios (IRR) using Poisson regression. RESULTS The overall pertussis incidence peaked in 2004 (31/100,000) and was lowest in 2015 (3.0/100,000), with 66 reported cases in <3months infants in 2004 versus 6 in 2015. The majority of the cases were female (59%) with a male-to-female case ratio of 1:1.5. Cases were spread throughout the year with highest incidence during August-February. Among the 19- to 21-year-olds in the general population, incidence decreased from 49/100,000 in 2011 to 0.51/100,000 in 2015 (IRR=0.01; 95%CI, 0.00-0.16). Among the same age group, comparing the 3.5-year period before and after July 2012, incidence decreased from 33/100,000 to 5.3/100,000 (IRR=0.16; 95%CI, 0.06-0.40) in males and from 16/100,000 to 5.0/100,000 (IRR=0.31; 95%CI, 0.11-0.84) in females. CONCLUSIONS Implementation of the pertussis booster dose in Finnish military conscripts was followed by a significant decrease in pertussis incidence both among the 19- to 21-year-old males and females, possibly reflecting herd immunity effect. Together with booster doses in adolescents this has resulted in low incidence in the whole population including infants. Our results support the implementation of the booster dose for conscripts. We recommend continuing monitoring pertussis epidemiology to optimize pertussis vaccination strategies in Finland.
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Affiliation(s)
- Viktor Zöldi
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Jussi Sane
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Hanna Nohynek
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Maria Virkki
- Joint Authority for Päijät-Häme Social and Health Care, Lahti, Finland.
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17
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Godoy P, García-Cenoz M, Toledo D, Carmona G, Caylà JA, Alsedà M, Àlvarez J, Barrabeig I, Camps N, Plans P, Company M, Castilla J, Sala-Farré MR, Muñoz-Almagro C, Rius C, Domínguez À. Factors influencing the spread of pertussis in households: a prospective study, Catalonia and Navarre, Spain, 2012 to 2013. ACTA ACUST UNITED AC 2017; 21:30393. [PMID: 27918260 PMCID: PMC5144939 DOI: 10.2807/1560-7917.es.2016.21.45.30393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 02/28/2016] [Indexed: 11/24/2022]
Abstract
We aimed to investigate transmission rates of pertussis in household contacts of cases and factors associated with transmission. A prospective epidemiological study was conducted in 2012 and 2013 to determine the incidence of pertussis among household contacts of reported cases in Catalonia and Navarre, Spain. An epidemiological survey was completed for each case and contact, who were followed for 28 days to determine the source of infection (primary case) and detect the occurrence of secondary cases. Odds ratios (ORs) were used to estimate the effectiveness of vaccination and chemoprophylaxis in preventing new cases, using the formula (1 − OR) × 100. For the 688 primary cases, a total of 2,852 contacts were recorded. The household transmission rate was 16.1% (459/2,852) and rose according to the age (> 18 years) and lack of immunisation of the primary cases, and also the age (0–18 years), family relationship (siblings and children), lack of vaccination and chemoprophylaxis of contacts. Pertussis vaccine effectiveness in preventing new cases was 65.0% (95% confidence interval (CI): 11.6 to 86.2) for full vaccination (≥ 4 doses) and 59.7% (95% CI: −6.8 to 84.8) for incomplete vaccination (< 4 doses). The effectiveness of chemoprophylaxis was 62.1% (95% CI: 40.3 to 75.9). To reduce household transmission, contacts should be investigated to detect further cases and to administer chemoprophylaxis. The current vaccination status of cases and contacts can reduce household transmission.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Institut de Recerca Biomèdica de Lleida, IRBLleida, Lleida, Spain
| | - Manuel García-Cenoz
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain.,Universidad Pública de Navarra (UPNA), Navarre, Spain
| | - Diana Toledo
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Joan A Caylà
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Miquel Alsedà
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Institut de Recerca Biomèdica de Lleida, IRBLleida, Lleida, Spain
| | - Josep Àlvarez
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Neus Camps
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Pere Plans
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - María Company
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Jesús Castilla
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | | | - Carmen Muñoz-Almagro
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Hospital de Sant Joan de Dèu, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Rius
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Àngela Domínguez
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
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- Members of the group are listed at the end of the article
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18
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Domenech de Cellès M, Magpantay FMG, King AA, Rohani P. The pertussis enigma: reconciling epidemiology, immunology and evolution. Proc Biol Sci 2016; 283:rspb.2015.2309. [PMID: 26763701 DOI: 10.1098/rspb.2015.2309] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pertussis, a highly contagious respiratory infection, remains a public health priority despite the availability of vaccines for 70 years. Still a leading cause of mortality in developing countries, pertussis has re-emerged in several developed countries with high vaccination coverage. Resurgence of pertussis in these countries has routinely been attributed to increased awareness of the disease, imperfect vaccinal protection or high infection rates in adults. In this review, we first present 1980-2012 incidence data from 63 countries and show that pertussis resurgence is not universal. We further argue that the large geographical variation in trends probably precludes a simple explanation, such as the transition from whole-cell to acellular pertussis vaccines. Reviewing available evidence, we then propose that prevailing views on pertussis epidemiology are inconsistent with both historical and contemporary data. Indeed, we summarize epidemiological evidence showing that natural infection and vaccination both appear to provide long-term protection against transmission and disease, so that previously infected or vaccinated adults contribute little to overall transmission at a population level. Finally, we identify several promising avenues that may lead to a consistent explanation of global pertussis epidemiology and to more effective control strategies.
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Affiliation(s)
| | - Felicia M G Magpantay
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aaron A King
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pejman Rohani
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA Odum School of Ecology, University of Georgia, Athens, GA 30602, USA College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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19
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Hammer R, Capili C, Wi CI, Ryu E, Rand-Weaver J, Juhn YJ. A new socioeconomic status measure for vaccine research in children using individual housing data: a population-based case-control study. BMC Public Health 2016; 16:1000. [PMID: 27655468 PMCID: PMC5031352 DOI: 10.1186/s12889-016-3673-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background We recently developed HOUSES, an individual housing-based socioeconomic status (SES) measurement for health disparities research. We assessed whether HOUSES was associated with risk of pertussis and pertussis vaccine up-to-date status in children. Methods The study utilized a previous population-based case-control study cohort assembled during the 2004–2005 pertussis outbreak. We collected data on pertussis vaccine status (up-to-date status) at the time of the index date. Using a z-score for housing value, actual square footage, and numbers of bedrooms and bathrooms, HOUSES was formulated in continuous variable and categorized into quartiles. Vaccine up-to-date status was compared among subjects with different SES as measured by HOUSES using a chi-square test and logistic regression models. Results Of the 391 eligible pediatric subjects (median age of 13.1 years with male sex of 55 %), 363 (93 %) were successfully geocoded to formulate HOUSES index. HOUSES was not associated with the risk of pertussis (p = 0.82). Pertussis vaccine up-to-date statuses were 79, 86, 83, and 94 % for children in the first (the lowest SES), second, third, and fourth quartiles of HOUSES, respectively (p = 0.03). HOUSES as a continuous variable was associated with pertussis vaccine up-to-date status (adjusted OR: 1.15 per increment of one unit of HOUSES, 95 % CI: 1.04–1.27, p = 0.008). Conclusion While HOUSES is not associated with the risk of pertussis, it predicts vaccine up-to-date status among children with different SES. HOUSES may be a useful tool for vaccine delivery research among children.
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Affiliation(s)
- Rachel Hammer
- Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA, 70112, USA
| | - Conrad Capili
- Children's Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Chung-Il Wi
- Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer Rand-Weaver
- Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Rochester-Olmsted Planning Department, 2122 Campus Drive SE, Rochester, MN, 55904, USA
| | - Young J Juhn
- Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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20
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Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: Microbiology, Disease, Treatment, and Prevention. Clin Microbiol Rev 2016; 29:449-86. [PMID: 27029594 PMCID: PMC4861987 DOI: 10.1128/cmr.00083-15] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pertussis is a severe respiratory infection caused by Bordetella pertussis, and in 2008, pertussis was associated with an estimated 16 million cases and 195,000 deaths globally. Sizeable outbreaks of pertussis have been reported over the past 5 years, and disease reemergence has been the focus of international attention to develop a deeper understanding of pathogen virulence and genetic evolution of B. pertussis strains. During the past 20 years, the scientific community has recognized pertussis among adults as well as infants and children. Increased recognition that older children and adolescents are at risk for disease and may transmit B. pertussis to younger siblings has underscored the need to better understand the role of innate, humoral, and cell-mediated immunity, including the role of waning immunity. Although recognition of adult pertussis has increased in tandem with a better understanding of B. pertussis pathogenesis, pertussis in neonates and adults can manifest with atypical clinical presentations. Such disease patterns make pertussis recognition difficult and lead to delays in treatment. Ongoing research using newer tools for molecular analysis holds promise for improved understanding of pertussis epidemiology, bacterial pathogenesis, bioinformatics, and immunology. Together, these advances provide a foundation for the development of new-generation diagnostics, therapeutics, and vaccines.
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Affiliation(s)
- Paul E Kilgore
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Abdulbaset M Salim
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Marcus J Zervos
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Health System and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Heinz-Josef Schmitt
- Medical and Scientific Affairs, Pfizer Vaccines, Paris, France Department of Pediatrics, Johannes Gutenberg-University, Mainz, Germany
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21
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Ward A, Caro J, Bassinet L, Housset B, O'Brien JA, Guiso N. Health and Economic Consequences of an Outbreak of Pertussis Among Healthcare Workers in a Hospital in France. Infect Control Hosp Epidemiol 2016; 26:288-92. [PMID: 15796282 DOI: 10.1086/502541] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground:Bordetella pertussisis highly contagious, and because immunity wanes after vaccination, it continues to be a cause of cough among adults.Objective:To describe the healthcare services used and productivity losses accrued by healthcare workers (HCWs) missing work due to pertussis.Methods:After 3 pertussis cases were confirmed among HCWs, all hospital employees and patients with a cough were screened between November 2000 and March 2001. Each potential case underwent diagnostic tests and received antibiotics (spiramycin or azithromycin) when appropriate. Symptomatic employees were not allowed to return to work until they received an antibiotic for at least 5 days. Services used (physician visits and calls, antibiotics, diagnostic tests, hospitalization, and treatment provided to their contacts) were combined with cost estimates (in 2002 euros) for these services in France.Results:Ninety-one potential cases were identified (77 HCWs, 12 patients, and 2 family members). Of them, 89% received antibiotics and 22% had at least one contact who was also treated. Approximately half (55%) of the HCWs who were cases missed 5 days of work. Four patients were admitted to the hospital as a result of the infection. The average medical cost was 297 euros per potential case: diagnostic tests accounted for 32% and hospitalization for 31%. Total cost (medical and productivity) was 46,661 euros for 91 cases, 42% from productivity losses. An investigation to identify these potential cases also accrued additional costs.Conclusion:Serious adverse health and economic consequences arose from transmission of pertussis among HCWs, their families, and patients.
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van Twillert I, Bonačić Marinović AA, van Gaans-van den Brink JAM, Kuipers B, Berbers GAM, van der Maas NAT, Verheij TJM, Versteegh FGA, Teunis PFM, van Els CACM. The Use of Innovative Two-Component Cluster Analysis and Serodiagnostic Cut-Off Methods to Estimate Prevalence of Pertussis Reinfections. PLoS One 2016; 11:e0148507. [PMID: 26848833 PMCID: PMC4743910 DOI: 10.1371/journal.pone.0148507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/19/2016] [Indexed: 01/13/2023] Open
Abstract
Bordetella pertussis circulates even in highly vaccinated countries affecting all age groups. Insight into the scale of concealed reinfections is important as they may contribute to transmission. We therefore investigated whether current single-point serodiagnostic methods are suitable to estimate the prevalence of pertussis reinfection. Two methods based on IgG-Ptx plasma levels alone were used to evaluate the proportion of renewed seroconversions in the past year in a cohort of retrospective pertussis cases ≥ 24 months after a proven earlier symptomatic infection. A Dutch population database was used as a baseline. Applying a classical 62.5 IU/ml IgG-Ptx cut-off, we calculated a seroprevalence of 15% in retrospective cases, higher than the 10% observed in the population baseline. However, this method could not discriminate between renewed seroconversion and waning of previously infection-enhanced IgG-Ptx levels. Two-component cluster analysis of the IgG-Ptx datasets of both pertussis cases and the general population revealed a continuum of intermediate IgG-Ptx levels, preventing the establishment of a positive population and the comparison of prevalence by this alternative method. Next, we investigated the complementary serodiagnostic value of IgA-Ptx levels. When modelling datasets including both convalescent and retrospective cases we obtained new cut-offs for both IgG-Ptx and IgA-Ptx that were optimized to evaluate renewed seroconversions in the ex-cases target population. Combining these cut-offs two-dimensionally, we calculated 8.0% reinfections in retrospective cases, being below the baseline seroprevalence. Our study for the first time revealed the shortcomings of using only IgG-Ptx data in conventional serodiagnostic methods to determine pertussis reinfections. Improved results can be obtained with two-dimensional serodiagnostic profiling. The proportion of reinfections thus established suggests a relatively increased period of protection to renewed infection after clinical pertussis.
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Affiliation(s)
- Inonge van Twillert
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Axel A. Bonačić Marinović
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Betsy Kuipers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Guy A. M. Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nicoline A. T. van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Theo J. M. Verheij
- Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Florens G. A. Versteegh
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, the Netherlands
- Ghent University Hospital, department of pediatrics, Ghent, Belgium
| | - Peter F. M. Teunis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- RSPH, Emory University, Atlanta, United States of America
| | - Cécile A. C. M. van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail:
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Salim AM, Liang Y, Kilgore PE. Protecting Newborns Against Pertussis: Treatment and Prevention Strategies. Paediatr Drugs 2015; 17:425-41. [PMID: 26542059 DOI: 10.1007/s40272-015-0149-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pertussis is a potentially severe respiratory disease, which affects all age groups from young infants to older adults and is responsible for an estimated 195,000 deaths occurred globally in 2008. Active research is ongoing to better understand the pathogenesis, immunology, and diagnosis of pertussis. For diagnosis, molecular assays (e.g., polymerase chain reaction) for detection of Bordetella pertussis have become more widely available and support improved outbreak detection. In children, pertussis vaccines have been incorporated into routine immunization schedules and deployed for pertussis outbreak control. Lower levels of vaccine coverage are now being observed in communities where vaccine hesitancy is rising. Additionally, recognition that newborn babies are at risk of pertussis in the USA and UK has led to recommendations to immunize pregnant women. Among adolescents and older adults in the USA, Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular pertussis (Tdap) Vaccines are recommended, but substantial individual- and system-level barriers exist that will make achieving national Healthy People 2020 targets for immunization challenging. Current antimicrobial regimens for pertussis are focused on reducing the severity of disease, reducing rates of sequelae, and minimizing transmission of infection to susceptible individuals. Continued surveillance for pertussis will be important to identify opportunities for reducing young infants' exposure and reducing the impact of outbreaks among school-aged children. Laboratory-based surveillance for newly emerging strains of B. pertussis will be important to identify strains that may evade protection elicited by currently available vaccines. Efforts to develop new-generation pertussis vaccines should be considered now in anticipation of vaccine development programs, which may require ten or more years to deliver a licensed vaccine.
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Affiliation(s)
- Abdulbaset M Salim
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
| | - Yan Liang
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA. .,Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College, Kunming, China.
| | - Paul E Kilgore
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
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Abstract
The introduction of vaccination in the 1950s significantly reduced the morbidity and mortality of pertussis. However, since the 1990s, a resurgence of pertussis has been observed in vaccinated populations, and a number of causes have been proposed for this phenomenon, including improved diagnostics, increased awareness, waning immunity, and pathogen adaptation. The resurgence of pertussis highlights the importance of standardized, sensitive, and specific laboratory diagnoses, the lack of which is responsible for the large differences in pertussis notifications between countries. Accurate laboratory diagnosis is also important for distinguishing between the several etiologic agents of pertussis-like diseases, which involve both viruses and bacteria. If pertussis is diagnosed in a timely manner, antibiotic treatment of the patient can mitigate the symptoms and prevent transmission. During an outbreak, timely diagnosis of pertussis allows prophylactic treatment of infants too young to be (fully) vaccinated, for whom pertussis is a severe, sometimes fatal disease. Finally, reliable diagnosis of pertussis is required to reveal trends in the (age-specific) disease incidence, which may point to changes in vaccine efficacy, waning immunity, and the emergence of vaccine-adapted strains. Here we review current approaches to the diagnosis of pertussis and discuss their limitations and strengths. In particular, we emphasize that the optimal diagnostic procedure depends on the stage of the disease, the age of the patient, and the vaccination status of the patient.
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Affiliation(s)
- Anneke van der Zee
- Molecular Diagnostics Unit, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Frits R Mooi
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
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Abstract
The intensive use of pertussis vaccines has dramatically reduced the incidence of whooping cough during the 20th century. However, recent outbreaks in countries with high vaccination coverage illustrate the shortcomings of current vaccination regimens, and immunity induced by the most recent, acellular vaccines wanes much faster than anticipated. As an alternative, live attenuated vaccine candidates have recently been developed in order to mimic natural infection, which induces long-lasting immunity. One of them has successfully completed a Phase I trial in humans and is now undergoing further product and clinical developments. This article describes the development of such vaccines, discusses their advantages over existing vaccines and their interesting bystander properties as powerful anti-inflammatory agents, which widens their potential use far beyond that for protection against whooping cough.
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Affiliation(s)
- Camille Locht
- Institut Pasteur de Lille, Center for Infection and Immunity of Lille, 1, rue du Prof. Calmette, F-59019 Lille, France
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Cherry JD. Adult pertussis in the pre- and post-vaccine eras: lifelong vaccine-induced immunity? Expert Rev Vaccines 2014; 13:1073-80. [DOI: 10.1586/14760584.2014.935765] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wendelboe AM, Van Rie A. Diagnosis of pertussis: a historical review and recent developments. Expert Rev Mol Diagn 2014; 6:857-64. [PMID: 17140372 DOI: 10.1586/14737159.6.6.857] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The accurate and timely diagnosis of pertussis continues to be challenging. The widespread use of pertussis vaccines has dramatically altered the epidemiology and clinical presentation of pertussis disease, such that many cases do not present with the hallmark symptoms, such as inspiratory whoop, post-tussive vomiting and paroxysmal cough. A variety of laboratory tools are available to aid in the diagnosis of pertussis, including culture, direct fluorescent antibody testing, PCR, and paired and single serology techniques. This article reviews the strengths and limitations, including the sensitivity and specificity, of each of these diagnostic tools.
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McGirr AA, Tuite AR, Fisman DN. Estimation of the underlying burden of pertussis in adolescents and adults in Southern Ontario, Canada. PLoS One 2013; 8:e83850. [PMID: 24376767 PMCID: PMC3871538 DOI: 10.1371/journal.pone.0083850] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 11/17/2013] [Indexed: 01/16/2023] Open
Abstract
Despite highly successful vaccination programs and high vaccine uptake, both endemic pertussis and periodic pertussis outbreaks continue to occur. The under-recognized role of adolescents and adults in disease transmission, due to waning immunity following natural infection and vaccination, and reduced likelihood of correct diagnosis, may contribute to pertussis persistence. We constructed a mathematical model to describe the transmission of pertussis in Southern Ontario in both pre-vaccine and vaccine eras, to estimate the underlying burden of pertussis in the population. The model was well calibrated using the best available data on pertussis in the pre-vaccination (1880–1929) and vaccination (1993–2004) eras in Ontario. Pertussis under-reporting by age group was estimated by comparing model-projected incidence to reported laboratory-confirmed cases for Greater Toronto. Best-fit model estimates gave a basic reproductive number of approximately 10.6, (seasonal range 9.9 to 11.5). Under-reporting increased with age, and approximately >95% of infections in children were caused by infections in persons with waning immunity to pertussis following prior infection or vaccination. A well-calibrated model suggests that under-recognized cases of pertussis in older individuals are likely to be an important driver of ongoing pertussis outbreaks in children. Model projections strongly support enhancement of booster vaccination efforts in adults.
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Affiliation(s)
- Ashleigh A. McGirr
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashleigh R. Tuite
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David N. Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Lavine JS, King AA, Andreasen V, Bjørnstad ON. Immune boosting explains regime-shifts in prevaccine-era pertussis dynamics. PLoS One 2013; 8:e72086. [PMID: 23991047 PMCID: PMC3753349 DOI: 10.1371/journal.pone.0072086] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
Understanding the biological mechanisms underlying episodic outbreaks of infectious diseases is one of mathematical epidemiology’s major goals. Historic records are an invaluable source of information in this enterprise. Pertussis (whooping cough) is a re-emerging infection whose intermittent bouts of large multiannual epidemics interspersed between periods of smaller-amplitude cycles remain an enigma. It has been suggested that recent increases in pertussis incidence and shifts in the age-distribution of cases may be due to diminished natural immune boosting. Here we show that a model that incorporates this mechanism can account for a unique set of pre-vaccine-era data from Copenhagen. Under this model, immune boosting induces transient bursts of large amplitude outbreaks. In the face of mass vaccination, the boosting model predicts larger and more frequent outbreaks than do models with permanent or passively-waning immunity. Our results emphasize the importance of understanding the mechanisms responsible for maintaining immune memory for pertussis epidemiology.
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Affiliation(s)
- Jennie S. Lavine
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, United States of America
- Fogarty International Center, NIH, Bethesdsa, Maryland, United States of America
| | - Aaron A. King
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, United States of America
- Fogarty International Center, NIH, Bethesdsa, Maryland, United States of America
- Department of Mathematics, University of Michigan, Ann Arbor, Michigan, United States of America
- Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Viggo Andreasen
- Fogarty International Center, NIH, Bethesdsa, Maryland, United States of America
- Department of Science, Systems and Models, Roskilde University, Roskilde, Denmark
| | - Ottar N. Bjørnstad
- Fogarty International Center, NIH, Bethesdsa, Maryland, United States of America
- Department of Entomology and Biology, Pennsylvania State University, University Park, Pennsylvania, United States of America
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Abstract
We estimated the incidence of pertussis in patients consulting general practitioners (GPs). Between July 2009 and April 2011, we conducted a prospective cohort study of patients attending 78 general practices (158 863 persons overall). We included patients aged ≥ 3 years, with cough lasting 2-15 weeks, who gave informed consent. GPs interviewed eligible patients, collected a blood specimen, and a nasopharyngeal swab. At follow-up 30-60 days after the initial visit, physicians collected a second blood specimen and conducted patient interview. Cases were confirmed by specific IgA and/or IgG antibody titre exceeding significantly the general population background level or detection of bacterial DNA by real-time PCR. During the study period, 3864 patients with prolonged cough consulted the participating GPs, of those 1852 met the inclusion criteria, 1232 were recruited, and 288 were confirmed as pertussis cases (4% by PCR, 96% by serology). The adjusted incidence rate was 201.1/100 000 person-years [95% confidence interval (CI) 133.9-302.0], ranging from 456.5 (95% CI 239.3-870.8) in the 15-19 years group to 94.0 (95% CI 33.4-264.5) in the 25-29 years group. The reporting ratio was 61, ranging from 4 in those aged 3-5 years, to 167 in those aged 65-69 years. The study confirmed high incidence of pertussis in all age groups in the general population, in particular in adults, not appropriately documented by the existing surveillance system.
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Manzanares S, Lafuente S, Martí M, Simon P, Gorrindo P, Caylà JA. Evolución de la incidencia de tos ferina en la ciudad de Barcelona entre 1999 y 2011. Enferm Infecc Microbiol Clin 2013; 31:156-8. [DOI: 10.1016/j.eimc.2012.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 10/27/2022]
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Baron-Epel O, Madjar B, Grefat R, Rishpon S. Trust and the demand for autonomy may explain the low rates of immunizations among nurses. Hum Vaccin Immunother 2012; 9:100-7. [PMID: 23108353 DOI: 10.4161/hv.22503] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rates of vaccinations of healthcare workers with recommended vaccines are generally low in the developed countries. Our goals were to identify attitudes associated with self-reported vaccinations against pertussis and seasonal influenza among Israeli nurses in Mother and Child Healthcare Centers (MCHC) in the Haifa District. Over 100 nurses answered a self-administered questionnaire. Forty two percent of the nurses reported receiving the pertussis vaccine in the last five years and 44% reported receiving the influenza vaccine during the previous year. Attitudes toward the importance of vaccinating nurses, trust in the public health authorities and demand for autonomy were associated with receiving the pertussis vaccine. Attitudes toward the importance of vaccinating nurses and trust were associated with receiving the influenza vaccine in a bivariant analysis. However, in the logistic regression models only attitudes toward the importance of vaccinating nurses were associated with vaccinations [odds ratio (OR)- 3.66, 95% confidence interval (CI)- 1.4-9.6 for pertussis and OR- 4.53, CI-1.6-13.0 for influenza]. Jewish nurses reported more often receiving the influenza vaccine compared with the Arab nurses, whereas there was no difference between them in receiving the pertussis vaccine. Low levels of positive attitudes toward the importance of vaccinating nurses may inhibit nurses in MCHC from receiving vaccines. The demand for autonomy and low levels of trust may, in part, form these low levels of positive attitudes toward the importance of vaccinating nurses.
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Affiliation(s)
- Orna Baron-Epel
- School of Public Health; Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Pertussis Epidemiology in Greece and Emerging Risk Groups during the Vaccination Era (1980-2008). Adv Prev Med 2012; 2012:303846. [PMID: 23019527 PMCID: PMC3457588 DOI: 10.1155/2012/303846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/09/2012] [Accepted: 08/23/2012] [Indexed: 11/18/2022] Open
Abstract
To study the epidemiology of pertussis in Greece and epidemiologic changes throughout a period of twenty-nine years, we conducted a retrospective analysis of available data of pertussis cases for the past twenty-nine years (1980-2008) and a prospective analysis of hospitalized pertussis cases from a children's hospital in Athens for eight years (2001-2008). From 1980 through 2008, the incidence of pertussis in Greece declined from 11.2 to 0.05 cases per 100,000. Epidemic cycles occurring every 3 to 5 years were observed. Since pertussis circulation cannot be fully controlled by present immunization programs, efforts should be made to vaccinate infants at the recommended age, early diagnose, treatment as well as contact tracing of pertussis cases. Control of pertussis in social susceptible populations is necessary. A national program with adolescent and adult booster could decrease the circulation of B. pertussis. Despite an overall decrease for pertussis cases, pertussis is still a present and future challenge of public health service in Greece.
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Influenza and tetanus, diphtheria, and acellular pertussis vaccinations during pregnancy. Obstet Gynecol Surv 2012; 67:251-7. [PMID: 22495061 DOI: 10.1097/ogx.0b013e3182524cee] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Vaccinations in pregnancy are an important aspect of prenatal care and of improving not only maternal health but also neonatal outcomes. Only 2 vaccines are specifically recommended during pregnancy: influenza and tetanus, diphtheria, and acellular pertussis (Tdap). Because influenza illness disproportionately affects pregnant women compared with other populations, annual prevention of influenza illness is recommended for all women who will be pregnant during influenza season (October to May). Influenza vaccination has been recently reported to also result in decreased febrile respiratory illnesses in the newborn, likely through passive antibody transfer. Pertussis infection rates are rising in the United States as vaccine-induced immunity wanes, with the mortality burden primarily seen in infants aged <6 months. Pertussis immunization with Tdap is now recommended for all pregnant women during the late second (>20 weeks) or third trimester with the intent to both protect the pregnant woman and provide passive antibody to the infant before vaccination at 2 months of age. Provider support for these recommendations regarding both annual influenza vaccination and postpartum Tdap vaccination during pregnancy is critical to ensuring vaccine delivery and improving both maternal and fetal health. The article reviews the epidemiology and clinical aspects of influenza and pertussis infection with particular attention to pregnancy and recommendations for vaccination in these women. TARGET AUDIENCE Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physicians LEARNING OBJECTIVES After completing this CME activity, obstetricians and gynecologists should be better able to analyze how influenza infection disproportionally affects pregnant women. Assess how influenza vaccination improves maternal and likely neonatal outcomes. Evaluate pertussis infection and immunity in adults, and counsel pregnant women as to the benefits of Tdap vaccination, particularly for the infant.
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Zhang Q, Zheng H, Liu M, Han K, Shu J, Wu C, Xu N, He Q, Luo H. The seroepidemiology of immunoglobulin G antibodies against pertussis toxin in China: a cross sectional study. BMC Infect Dis 2012; 12:138. [PMID: 22892100 PMCID: PMC3447642 DOI: 10.1186/1471-2334-12-138] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/11/2012] [Indexed: 11/17/2022] Open
Abstract
Background Pertussis is a reported vaccine-preventable respiratory disease in China. Because the routine laboratory methods for diagnosis are not in use, the reported cases are mainly in infants with classical paroxysmal cough and the true incidence related to pertussis is most likely under estimated. In China, however, few studies have attempted to address this issue. The purpose of this cross sectional study was to estimate the incidence rates using the method of sero-epidemiology of immunoglobulin (Ig) G antibodies against pertussis toxin (PT) among healthy populations in China. Methods Blood samples were obtained from 1313 healthy individuals aged 0 to 95 years in Guangdong province of China throughout September 2010. Serum IgG antibodies against PT were determined by commercial ELISA kits. Subjects with concentration of anti-PT IgG higher than 30 IU/mL were indicated to have recent Bordetella pertussis infection, if they have not received a booster dose of pertussis vaccine within one year. Results Of the 1313 study subjects, 117 (8.91%) were found to have anti-PT antibodies higher than 30 IU/mL. The estimated incidence of recent infection was thus 9395 per 100,000 for individuals older than 7 years. Peaks of the estimated incidence rate of recent infection were found to be 11561 per 100,000 in age group of 41–50 years and 11428 per 100,000 in the group aged 13–19 years. Conclusions Our study indicated that B.pertussis infections are considerablely common, particularly in adolescents and adults in China. The study also stresses the importance of laboratory diagnosis for pertussis and employment of booster dose of pertussis vaccine in adolescents and adults in this country.
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Affiliation(s)
- Qi Zhang
- National Institute for Communicable Disease Control and Prevention, State Key Laboratory for Infectious Diseases Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, People's Republic of China
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Torres J, Godoy P, Artigues A, Codina G, Bach P, Mòdol I, Duró MÀ, Trilla C. Brote de tos ferina con elevada tasa de ataque en niños y adolescentes bien vacunados. Enferm Infecc Microbiol Clin 2011; 29:564-7. [DOI: 10.1016/j.eimc.2011.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/11/2011] [Accepted: 04/29/2011] [Indexed: 10/17/2022]
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Adverse events after tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine administered to adults 65 years of age and older reported to the Vaccine Adverse Event Reporting System (VAERS), 2005-2010. Vaccine 2011; 29:9404-8. [PMID: 21920404 DOI: 10.1016/j.vaccine.2011.05.100] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine was not licensed for use in adults aged ≥65 years due to lack of sufficient efficacy and safety data. OBJECTIVE To characterize reports to the Vaccine Adverse Event Reporting System (VAERS) among adults aged ≥65 years who received Tdap vaccine 'off-label' to assess for potential vaccine safety concerns. METHODS We searched VAERS for US reports of adverse events (AEs) in subjects aged ≥65 years who received Tdap vaccine from 9/1/2005 to 9/08/2010. Medical records were requested for all reports coded as serious (death, hospitalization, prolonged hospitalization, permanent disability, life-threatening-illness). Proportional reporting ratio (PRR) was used to assess for higher proportionate reporting for AEs after Tdap compared with Td reports in subjects aged ≥65 years. RESULTS VAERS received 243 reports following Tdap administered to persons aged ≥65 years. Eleven (4.5%) reports were serious, including two deaths. Most common AEs were local reactions in 100 (41.2%) reports. Seventy-eight (32.1%) reports contained coding terms that denoted inappropriate administration of vaccine. 'Cough' was the only term associated with disproportionately higher reporting after Tdap compared with Td. Six of seven Tdap reports containing the term 'Cough' were non-serious. Clinical review of serious reports identified no unusual patterns of AEs. CONCLUSION Our VAERS review of the 'off-label' use of Tdap vaccine in adults ≥65 years did not find any safety concerns that warrant further study. These data will provide useful baseline information to assist CDC and FDA with monitoring efforts as permissive recommendations for Tdap in older persons are adopted.
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Hendrikx LH, Öztürk K, de Rond LG, Veenhoven RH, Sanders EA, Berbers GA, Buisman AM. Identifying long-term memory B-cells in vaccinated children despite waning antibody levels specific for Bordetella pertussis proteins. Vaccine 2011; 29:1431-7. [DOI: 10.1016/j.vaccine.2010.12.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 11/23/2010] [Accepted: 12/13/2010] [Indexed: 11/29/2022]
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Lavine J, Broutin H, Harvill ET, Bjørnstad ON. Imperfect vaccine-induced immunity and whooping cough transmission to infants. Vaccine 2010; 29:11-6. [PMID: 21034823 DOI: 10.1016/j.vaccine.2010.10.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 09/29/2010] [Accepted: 10/12/2010] [Indexed: 11/26/2022]
Abstract
Whooping cough, caused by B. pertussis and B. parapertussis, has increased in incidence throughout much of the developed world since the 1980s despite high vaccine coverage, causing an increased risk of infection in infants who have substantial disease-induced mortality. Duration of immunity and epidemically significant routes of transmission across age groups remain unclear and deserve further investigation to inform vaccination strategies to better control pertussis burden. The authors analyze age- and species-specific whooping cough tests and vaccine histories in Massachusetts from 1990 to 2008. On average, the disease-free duration is 10.5 years. However, it has been decreasing over time, possibly due to a rising force of infection through increased circulation. Despite the importance of teenage cases during epidemics, wavelet analyses suggest that they are not the most important source of transmission to infants. In addition, the data indicate that the B. pertussis vaccine is not protective against disease induced by B. parapertussis.
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Affiliation(s)
- Jennie Lavine
- Department of Biology, 501 ASI Bldg, Penn State University, University Park, PA 16802, USA.
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40
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Okada K, Komiya T, Yamamoto A, Takahashi M, Kamachi K, Nakano T, Nagai T, Okabe N, Kamiya H, Nakayama T. Safe and effective booster immunization using DTaP in teenagers. Vaccine 2010; 28:7626-33. [PMID: 20883738 DOI: 10.1016/j.vaccine.2010.09.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/02/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
Abstract
The incidence of reported cases with pertussis has increased in young adults in Japan and the lack of additional booster immunizations containing pertussis components is suspected to be one of the causal reasons. Instead of DT immunization at 11-12 years of age, safety and immunogenicity were investigated using 0.2 ml and 0.5 ml of DTaP. 176 subjects in DTaP 0.5ml, 178 in DTaP 0.2 ml, and 197 in DT 0.1 ml groups were enrolled in clinical trial. The relative risk of local reactions in the DTaP 0.2 ml group compared to the DT 0.1 ml group was 1.13 (95% CI: 0.97-1.30), and that of the DTaP 0.5 ml to the DT 0.1 ml group was 1.34 (95% CI: 1.18-1.53). The relative risks of local pain and heat were 1.62 (95% CI: 1.33-1.98) and 1.59 (95% CI: 1.19-2.13), respectively, in the DTaP 0.5 ml group compared to the DT 0.1 ml group. Sero-positive rates against PT and FHA were 54% and 82% before immunization and increased to >95% for both after vaccination with no significant difference in GMT. Instead of the scheduled DT program, 0.2 ml of DTaP was acceptable and demonstrated efficient immunogenicity.
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Affiliation(s)
- Kenji Okada
- National Fukuoka Hospital, Department of Pediatrics, Japan
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41
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de Sousa SG, Barros H. Pertussis em Portugal – A importância de uma nova estratégia vacinal. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30053-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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42
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Gama de Sousa S, Barros H. Pertussis in Portugal - time for a new strategy. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:573-588. [PMID: 20700556 DOI: 10.1016/s2173-5115(10)70060-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
The introduction of routine vaccination against Bordetella pertussis led to a drastic decline in the number of reported cases of pertussis. Nevertheless, a gradual increase in pertussis notifications has been observed in the last years, and political vaccination changes have been conducted in some countries. Pertussis epidemiology is reviewed, taking into account mathematical models studies concerning new vaccinal strategies for pertussis prevention and new international recommendations. Regarding Portugal, the need for a "booster" in adolescence is emphasized, and other recommendations for pertussis control are suggested.
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Affiliation(s)
- Susana Gama de Sousa
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
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43
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Broutin H, Viboud C, Grenfell BT, Miller MA, Rohani P. Impact of vaccination and birth rate on the epidemiology of pertussis: a comparative study in 64 countries. Proc Biol Sci 2010; 277:3239-45. [PMID: 20534609 DOI: 10.1098/rspb.2010.0994] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Bordetella pertussis infection remains an important public health problem worldwide despite decades of routine vaccination. A key indicator of the impact of vaccination programmes is the inter-epidemic period, which is expected to increase with vaccine uptake if there is significant herd immunity. Based on empirical data from 64 countries across the five continents over the past 30-70 years, we document the observed relationship between the average inter-epidemic period, birth rate and vaccine coverage. We then use a mathematical model to explore the range of scenarios for duration of immunity and transmission resulting from repeat infections that are consistent with empirical evidence. Estimates of pertussis periodicity ranged between 2 and 4.6 years, with a strong association with susceptible recruitment rate, defined as birth rate × (1 - vaccine coverage). Periodicity increased by 1.27 years on average after the introduction of national vaccination programmes (95% CI: 1.13, 1.41 years), indicative of increased herd immunity. Mathematical models suggest that the observed patterns of pertussis periodicity are equally consistent with loss of immunity that is not as rapid as currently thought, or with negligible transmission generated by repeat infections. We conclude that both vaccine coverage and birth rate drive pertussis periodicity globally and that vaccination induces strong herd immunity effects. A better understanding of the role of repeat infections in pertussis transmission is critical to refine existing control strategies.
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Affiliation(s)
- H Broutin
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
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44
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Rendi-Wagner P, Tobias J, Moerman L, Goren S, Bassal R, Green M, Cohen D. The seroepidemiology of Bordetella pertussis in Israel--Estimate of incidence of infection. Vaccine 2010; 28:3285-90. [PMID: 20226250 DOI: 10.1016/j.vaccine.2010.02.104] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/16/2010] [Accepted: 02/24/2010] [Indexed: 11/29/2022]
Abstract
This study was undertaken to estimate the magnitude of Bordetella pertussis infections in a highly vaccinated population in Israel in order to evaluate the relationship between clinical notification data and serology-based evidence of infection. A cross-sectional survey was conducted on a total of 1982 serum samples from the National Serum Bank, collected from January 2000 through December 2001, in order to monitor high levels of pertussis toxin (PT) IgG antibody indicative of recent B. pertussis infection, by standardized methods. The estimation yielded an infection incidence rate of 2448 per 100,000 population (> or =3 years of age) for the year 2000 compared to an annual incidence of reported pertussis of 5.6 per 100,000 for the same period. The peaks of estimated incidence of infection were found in the groups of 15-19-year olds (5245 per 100,000) and older than 60 years (6469 per 100,000), whereas the majority of clinical pertussis cases were reported for the 10-14-year olds (20.5 per 100,000). The findings clearly show that despite a high vaccination coverage rate (>93%), there is still a considerable circulation of B. pertussis, particularly in adolescents and elderly. Population-based serosurveillance for pertussis offers the potential to assist interpretation of trends independent of notification and diagnostic bias.
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Affiliation(s)
- Pamela Rendi-Wagner
- Department of Epidemiology and Preventive Health, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel.
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45
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Baptista P, Magalhães V, Rodrigues L. The role of adults in household outbreaks of pertussis. Int J Infect Dis 2010; 14:e111-4. [DOI: 10.1016/j.ijid.2009.03.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 10/02/2008] [Accepted: 03/31/2009] [Indexed: 10/20/2022] Open
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46
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IgG responses after booster vaccination with different pertussis vaccines in Dutch children 4 years of age: Effect of vaccine antigen content. Vaccine 2009; 27:6530-6. [DOI: 10.1016/j.vaccine.2009.08.052] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 08/05/2009] [Accepted: 08/16/2009] [Indexed: 11/21/2022]
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47
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Wearing HJ, Rohani P. Estimating the duration of pertussis immunity using epidemiological signatures. PLoS Pathog 2009; 5:e1000647. [PMID: 19876392 PMCID: PMC2763266 DOI: 10.1371/journal.ppat.1000647] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 10/05/2009] [Indexed: 11/18/2022] Open
Abstract
Case notifications of pertussis have shown an increase in a number of countries with high rates of routine pediatric immunization. This has led to significant public health concerns over a possible pertussis re-emergence. A leading proposed explanation for the observed increase in incidence is the loss of immunity to pertussis, which is known to occur after both natural infection and vaccination. Little is known, however, about the typical duration of immunity and its epidemiological implications. Here, we analyze a simple mathematical model, exploring specifically the inter-epidemic period and fade-out frequency. These predictions are then contrasted with detailed incidence data for England and Wales. We find model output to be most sensitive to assumptions concerning naturally acquired immunity, which allows us to estimate the average duration of immunity. Our results support a period of natural immunity that is, on average, long-lasting (at least 30 years) but inherently variable. The eradication of vaccine-preventable infectious diseases remains an important public health priority. To achieve this goal, the level of immunity afforded needs to be high and long-lasting. For pertussis, one of the leading causes of mortality in infants, immunity has been shown to wane in some individuals. The epidemiological impacts of this observation depend critically on the duration of protective immunity in the entire population, which remains notoriously difficult to estimate. We approach this problem by exploring the agreement between model dynamics and case notification data from England & Wales. Our estimates suggest the average duration of immunity is much longer than is currently thought (at least 30 years), but that some individuals would lose immunity quite rapidly.
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Affiliation(s)
- Helen J Wearing
- Department of Biology and Department of Mathematics & Statistics, University of New Mexico, Albuquerque, New Mexico, USA.
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48
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Zhang X, Rodríguez ME, Harvill ET. O antigen allows B. parapertussis to evade B. pertussis vaccine-induced immunity by blocking binding and functions of cross-reactive antibodies. PLoS One 2009; 4:e6989. [PMID: 19750010 PMCID: PMC2737124 DOI: 10.1371/journal.pone.0006989] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/19/2009] [Indexed: 02/06/2023] Open
Abstract
Although the prevalence of Bordetella parapertussis varies dramatically among studies in different populations with different vaccination regimens, there is broad agreement that whooping cough vaccines, composed only of B. pertussis antigens, provide little if any protection against B. parapertussis. In C57BL/6 mice, a B. pertussis whole-cell vaccine (wP) provided modest protection against B. parapertussis, which was dependent on IFN-gamma. The wP was much more protective against an isogenic B. parapertussis strain lacking O-antigen than its wild-type counterpart. O-antigen inhibited binding of wP-induced antibodies to B. parapertussis, as well as antibody-mediated opsonophagocytosis in vitro and clearance in vivo. aP-induced antibodies also bound better in vitro to the O-antigen mutant than to wild-type B. parapertussis, but aP failed to confer protection against wild-type or O antigen-deficient B. parapertussis in mice. Interestingly, B. parapertussis-specific antibodies provided in addition to either wP or aP were sufficient to very rapidly reduce B. parapertussis numbers in mouse lungs. This study identifies a mechanism by which one pathogen escapes immunity induced by vaccination against a closely related pathogen and may explain why B. parapertussis prevalence varies substantially between populations with different vaccination strategies.
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Affiliation(s)
- Xuqing Zhang
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Maria Eugenia Rodríguez
- Department of Chemistry, Centre of Applied Biotechnology (CINDEFI, CCyT La Plata), School of Science, La Plata University, La Plata, Argentina
| | - Eric T. Harvill
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania, United States of America
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49
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Higginbotham TW, Cleveland KW. Decreasing childhood pertussis infection through vaccination of the elderly. ACTA ACUST UNITED AC 2009; 23:976, 979-81. [PMID: 19275466 DOI: 10.4140/tcp.n.2008.976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Reported cases of pertussis (also known as whooping cough) are increasing among infants and adolescents. This rise parallels the number of reported infant deaths associated with pertussis infection, which is caused by the gram-positive bacterium Bordetella pertussis. Adults are a significant vector for transmission of pertussis to children, and people 65 years of age and older make up a substantial portion of this potential transmission pool. Evidence exists of waning immunity in the adult population after either infection or vaccination. A recommendation for the use of a pertussis-containing vaccine (Tdap) in persons 64 years of age and older would be of considerable benefit to the public in preventing some transmission of pertussis to children. Neither of the two Tdap vaccines (pediatric or adult) is licensed for persons older than 65 years of age, and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention gives no off-label recommendation for use of Tdap in patients 65 years of age or older.
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50
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Gabutti G, Bergamini M, Bonanni P, Guido M, Fenoglio D, Giammanco A, Sindoni L, Zotti C, Boddi V, Bamfi F, Severini R, Bechini A, Boccalini S, Crovari P. Assessment of humoral and cell-mediated immunity against Bordetella pertussis in adolescent, adult, and senior subjects in Italy. Epidemiol Infect 2008; 136:1576-84. [PMID: 18198000 PMCID: PMC2870754 DOI: 10.1017/s0950268807000192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2007] [Indexed: 11/07/2022] Open
Abstract
Humoral and cell-mediated immunity (CMI) against B. pertussis was assessed in a sample of adolescent, adult and senior subjects distributed in five different geographical areas in Italy. Most (99.1%) subjects had IgG anti-pertussis toxin (PT) antibodies exceeding the minimum detection level [> or = 2 ELISA units (EU)/ml]. There were no significant differences between the genders; 6.2% samples recorded titres > or = 100 EU/ml. CMI was positive [stimulation index (SI) > or = 5] against PT in 39.0% of all samples. This study suggests that B. pertussis continues to circulate in age groups that have been previously considered to be uninvolved in the circulation of this pathogen and that adolescent and adult pertussis boosters may be of value in these populations. Nevertheless, over the last 10 years, large increases in vaccination coverage rates have contributed to reduce the spread of the aetiological agent, especially in the immunized population.
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Affiliation(s)
- G Gabutti
- Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy.
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