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Liu Y, Yang Y, Zhou J, Zhang X, Gu L, Xu Y, Lu Z, Xie Q, Zhang X, Hua C. Economic burden of pertussis in children: A single-center analysis in Hangzhou, China. Hum Vaccin Immunother 2024; 20:2343199. [PMID: 38647026 PMCID: PMC11037283 DOI: 10.1080/21645515.2024.2343199] [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: 01/15/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
The "reemergence of pertussis" has elicited international concerns, occurring paradoxically amidst the expansion of immunization programs. This study was aimed to evaluate quantitatively the economic burden and identify the determinants that influence the cost associated with treating pertussis in Chinese children. We evaluated the economic burden by Chinese children diagnosed with pertussis at the Children's Hospital, Zhejiang University School of Medicine in 2022. Direct medical expenses and the utilization of medical resources attributed to pertussis were calculated. A generalized linear regression model was applied to analyze the determinants that were associated with the direct medical expenses among patients. Among the 1110 pertussis patients included in the study, 1060 were outpatients and 50 were inpatients. The average direct medical cost was ¥1878.70(i.e. $279.33). Living in urban areas (OR:1.27, p = .04), complications (OR:1.40, p < .001), hospitalization (OR:10.04, p < .001), and ≥ 3 medical visits (OR:3.71, p < .001) were associated with increased direct medical expenses. Having received four doses of the pertussis vaccine was associated with reduced direct medical expenses (OR:0.81, p = .04). This study underscores a substantial economic burden of pertussis in Hangzhou, with pronounced implications for patients residing in urban areas, experiencing complications, requiring hospitalization, having multiple medical consultations, or lacking comprehensive pertussis vaccination.
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Affiliation(s)
- Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yingying Yang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jinsi Zhou
- Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuechao Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Lintao Gu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Zhaojun Lu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qixin Xie
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaoping Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Chunzhen Hua
- Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Rodrigues C, Bouchez V, Soares A, Trombert-Paolantoni S, Aït El Belghiti F, Cohen JF, Armatys N, Landier A, Blanchot T, Hervo M, Toubiana J, Brisse S. Resurgence of Bordetella pertussis, including one macrolide-resistant isolate, France, 2024. Euro Surveill 2024; 29:2400459. [PMID: 39092529 PMCID: PMC11295439 DOI: 10.2807/1560-7917.es.2024.29.31.2400459] [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: 07/15/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024] Open
Abstract
As other European countries, France is experiencing a resurgence of pertussis in 2024. Between 1 January and 31 May 2024, 5,616 (24.9%) positive Bordetella pertussis qPCR tests were identified, following a 3-year period of almost null incidence. Of 67 cultured and whole genome sequenced B. pertussis isolates, 66 produced pertactin and 56 produced FIM2, in contrast to pre-COVID-19 years. One isolate of genotype Bp-AgST4 was resistant to macrolides. Pertussis resurgence may favour isolates that produce FIM2 and pertactin.
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Affiliation(s)
- Carla Rodrigues
- These authors contributed equally to this work and share first authorship
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Valérie Bouchez
- These authors contributed equally to this work and share first authorship
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | | | | | - Fatima Aït El Belghiti
- Santé publique France, Infectious Diseases Department, The French Public Health Agency, Saint-Maurice, France
| | - Jérémie F Cohen
- Centre for Research in Epidemiology and Statistics (Inserm UMR 1153), Université Paris Cité, Paris, France
- Department of General Paediatrics and Paediatric Infectious Diseases, Université Paris Cité, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Nathalie Armatys
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Annie Landier
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | | | | | - Julie Toubiana
- These authors co-supervised the work and share last authorship
- Department of General Paediatrics and Paediatric Infectious Diseases, Université Paris Cité, Hôpital Necker-Enfants Malades, APHP, Paris, France
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Sylvain Brisse
- These authors co-supervised the work and share last authorship
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
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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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Lecorvaisier F. [Impact of vaccination on the evolution of Bordetella pertussis]. Med Sci (Paris) 2024; 40:161-166. [PMID: 38411424 DOI: 10.1051/medsci/2023219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Vaccines against pertussis, or whooping cough, have been commercialized and used in most countries worldwide for decades. The history of these vaccines is distinctive, marked by the transition from whole-cell vaccines to acellular vaccines in many developed countries over the last two decades. This particular history has had a significant impact on the evolution of Bordetella pertussis, the etiological agent of whooping cough. Both genetic and phenotypic changes appeared, with the emergence of novel alleles for antigens targeted by the vaccines and changes in the expression of these antigens. The main consequence of these changes is the resurgence of whooping cough in many countries and the appearance of strains capable of evading vaccine-induced immunity. The emergence of novel strains under vaccine pressure underscores the importance of considering biological evolution in the conception of new vaccines and vaccine strategies.
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Affiliation(s)
- Florian Lecorvaisier
- Université Claude Bernard Lyon 1 LBBE, UMR 5558, CNRS, VAS, Villeurbanne, France
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Jia J, Zoeschg M, Barth H, Pulliainen AT, Ernst K. The Chaperonin TRiC/CCT Inhibitor HSF1A Protects Cells from Intoxication with Pertussis Toxin. Toxins (Basel) 2024; 16:36. [PMID: 38251252 PMCID: PMC10819386 DOI: 10.3390/toxins16010036] [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: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Pertussis toxin (PT) is a bacterial AB5-toxin produced by Bordetella pertussis and a major molecular determinant of pertussis, also known as whooping cough, a highly contagious respiratory disease. In this study, we investigate the protective effects of the chaperonin TRiC/CCT inhibitor, HSF1A, against PT-induced cell intoxication. TRiC/CCT is a chaperonin complex that facilitates the correct folding of proteins, preventing misfolding and aggregation, and maintaining cellular protein homeostasis. Previous research has demonstrated the significance of TRiC/CCT in the functionality of the Clostridioides difficile TcdB AB-toxin. Our findings reveal that HSF1A effectively reduces the levels of ADP-ribosylated Gαi, the specific substrate of PT, in PT-treated cells, without interfering with enzyme activity in vitro or the cellular binding of PT. Additionally, our study uncovers a novel interaction between PTS1 and the chaperonin complex subunit CCT5, which correlates with reduced PTS1 signaling in cells upon HSF1A treatment. Importantly, HSF1A mitigates the adverse effects of PT on cAMP signaling in cellular systems. These results provide valuable insights into the mechanisms of PT uptake and suggest a promising starting point for the development of innovative therapeutic strategies to counteract pertussis toxin-mediated pathogenicity.
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Affiliation(s)
- Jinfang Jia
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, Ulm University Medical Center, 89081 Ulm, Germany
| | - Manuel Zoeschg
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, Ulm University Medical Center, 89081 Ulm, Germany
| | - Holger Barth
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, Ulm University Medical Center, 89081 Ulm, Germany
| | | | - Katharina Ernst
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, Ulm University Medical Center, 89081 Ulm, Germany
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Pehlivan T, Dinleyici EC, Kara A, Kurugöl Z, Tezer H, Aksakal NB, Biri A, Azap A. The Present and Future Aspects of Life-Long Pertussis Prevention: Narrative Review with Regional Perspectives for Türkiye. Infect Dis Ther 2023; 12:2495-2512. [PMID: 37815753 PMCID: PMC10651609 DOI: 10.1007/s40121-023-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023] Open
Abstract
Pertussis, caused by Bordetella pertussis, remains one of the most widespread, contagious, and vaccine-preventable diseases. It results in notable morbidity and mortality as well as severe medical, social, and economic burden. Despite high global vaccine coverage, pertussis continues to be a significant epidemiologic problem, with outbreak episodes every few years just as in the pre-vaccination era. In Türkiye, there is a lack of comprehensive data on the current burden of pertussis in different age and risk groups, leading to underdiagnosis and underreporting of the disease, especially in adults who are often not considered at risk. Available data from Türkiye also reveal inadequate levels of protective antibodies in preterm newborns, emphasizing the need for additional preventive measures. Authors stated that improving physician awareness of pertussis symptoms in patients with prolonged cough, increasing access to routine pertussis tests, and conducting surveillance studies would aid in accurate diagnosis and reporting in Türkiye. As the Turkish Ministry of Health Antenatal Care Management Guide suggests routine second and third pregnancy check-up visits at weeks 18-24 and 28-32 correspondingly, this period can be considered the ideal vaccination time for Türkiye. Introducing a booster dose of Tdap at around 10 years of age or during national military service would reduce transmission and protect susceptible individuals. Identifying individuals at high risk of severe pertussis and prioritizing them for a booster dose is also crucial in Türkiye. Enhancing surveillance systems, increasing healthcare professionals' awareness through training, and organizing catch-up visits for missed vaccinations during the COVID-19 pandemic are mentioned as additional strategies to improve pertussis prevention in Türkiye. This review focuses on the global and regional burden of pertussis and obstacles to effective prevention and evaluates existing strategies to achieve lifelong pertussis prevention. Literature and current strategies were also discussed from a Turkish national standpoint.
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Affiliation(s)
- Tamer Pehlivan
- Public Health, Remedium Consulting Group, Izmir, Türkiye.
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University School of Medicine, Eskisehir, Türkiye
| | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Zafer Kurugöl
- Department of Pediatric Infectious Diseases, Ege University School of Medicine, Izmir, Türkiye
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Türkiye
| | - Nur Baran Aksakal
- Department of Public Health, Gazi University School of Medicine, Ankara, Türkiye
| | - Aydan Biri
- Department of Obstetrics and Gynaecology, Koru Ankara Hospital, Ankara, Türkiye
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Türkiye
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Hempel K, McDonald W, Osgood ND, Fisman D, Halperin SA, Crowcroft N, Klein NP, Rohani P, Doroshenko A. Evaluation of the effectiveness of maternal immunization against pertussis in Alberta using agent-based modeling: A Canadian immunization research network study. Vaccine 2023; 41:2430-2438. [PMID: 36775775 DOI: 10.1016/j.vaccine.2022.12.071] [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: 03/16/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The re-emergence of pertussis has occurred in the past two decades in developed countries. The highest morbidity and mortality is seen among infants. Vaccination in pregnancy is recommended to reduce the pertussis burden in infants. METHODS We developed and validated an agent-based model to characterize pertussis epidemiology in Alberta. We computed programmatic effectiveness of pertussis vaccination during pregnancy (PVE) in relation to maternal vaccine coverage and pertussis disease reporting thresholds. We estimated the population preventable fraction (PFP) of different levels of maternal vaccine coverage against counterfactual "no-vaccination" scenario. We modeled the effect of immunological blunting and measured protection through interruption of exposure pathways. RESULTS PVE was inversely related to duration of passive immunity from maternal immunization across most simulations. In the scenario of 50% maternal vaccine coverage, PVE was 87% (95% quantiles 82-91%), with PFP of 44% (95% quantiles 41-45%). For monthly age intervals of 0-2, 2-4, 4-6 and 6-12, PVE ranged between 82 and 99%, and PFP ranged between 41 and 49%. At 75% maternal vaccine coverage, PVE and PFP were 90% (95% quantiles 86-92%) and 68% (95% quantiles 65-69%), respectively. At 50% maternal vaccine coverage and 10% blunting, PVE and PFP were 86% (95% quantiles 77-87%) and 43% (95% quantiles 39-44%), respectively, while at 50% blunting, the corresponding values of PVE and PFP were 76% (95% quantiles 70-81%) and 38% (95% quantiles 35-40%). PVE attributable to interruption of exposure pathways was 54-57%. CONCLUSIONS Our model predicts significant reduction in future pertussis cases in infants due to maternal vaccination, with immunological blunting slightly moderating its effectiveness. The model is most sensitive to maternal vaccination coverage. The interruption of exposure pathways plays a role in the reduction of pertussis burden in infants due to maternal immunization. The effect of maternal immunization on population other than infants remains to be elucidated.
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Affiliation(s)
- Karsten Hempel
- Department of Medicine, Division of Preventive Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Wade McDonald
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Nathaniel D Osgood
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Scott A Halperin
- Departments of Pediatrics, Microbiology and Immunology, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Natasha Crowcroft
- World Health Organization, Geneva, Switzerland; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Pejman Rohani
- Department of Infectious Diseases, University of Georgia, Athens, GA, USA; Odum School of Ecology, University of Georgia, Athens, GA, USA.
| | - Alexander Doroshenko
- Department of Medicine, Division of Preventive Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Konstantinova YE, Babachenko IV, Kharit SM, Bobova EI, Ioffe MY. The clinical case of a combined new coronavirus infection and whooping cough in an unvaccinated child. JOURNAL INFECTOLOGY 2023. [DOI: 10.22625/2072-6732-2022-14-5-109-115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Whooping cough remains a life-threatening infection, especially for unvaccinated young children. The article describes a case of severe and non-smooth course of whooping cough in an unvaccinated girl of 4 months of life from the family hearth of whooping cough and COVID-19. There were cases of COVID-19 and whooping cough in adults in the family, occurring under the mask of a mild respiratory infection, not verified before they were detected in a child and did not require hospitalization. The combined course of two infectious diseases COVID-19 and whooping cough in a 4-monthold unvaccinated girl contributed to the prolongation of the duration of whooping cough, prolonged release of SARS-COV-2 RNA, the late appearance of hematological changes typical of whooping cough, the development of respiratory delays and re-hospitalization of a patient with prolonged respiratory support. In the context of the COVID-19 pandemic, the coverage of routine vaccination has significantly decreased, as a result of which children of the first years of life have become more vulnerable to vaccine-controlled infections, which causes the risk of combined infections.
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Affiliation(s)
| | - I. V. Babachenko
- Pediatric Research and Clinical Center for Infectious Disease; Saint-Petersburg State Pediatric Medical University
| | - S. M. Kharit
- Pediatric Research and Clinical Center for Infectious Disease; Saint-Petersburg State Pediatric Medical University
| | - E. I. Bobova
- Pediatric Research and Clinical Center for Infectious Disease
| | - M. Ya. Ioffe
- Pediatric Research and Clinical Center for Infectious Disease
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Gunning CE, Rohani P, Mwananyanda L, Kwenda G, Mupila Z, Gill CJ. Young Zambian infants with symptomatic RSV and pertussis infections are frequently prescribed inappropriate antibiotics: a retrospective analysis. PeerJ 2023; 11:e15175. [PMID: 37193027 PMCID: PMC10183159 DOI: 10.7717/peerj.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/13/2023] [Indexed: 05/18/2023] Open
Abstract
Pediatric community-acquired pneumonia (CAP) remains a pressing global health concern, particularly in low-resource settings where diagnosis and treatment rely on empiric, symptoms-based guidelines such as the WHO's Integrated Management of Childhood Illness (IMCI). This study details the delivery of IMCI-based health care to 1,320 young infants and their mothers in a low-resource urban community in Lusaka, Zambia during 2015. Our Southern Africa Mother Infant Pertussis Study (SAMIPS) prospectively monitored a cohort of mother/infant pairs across infants' first four months of life, recording symptoms of respiratory infection and antibiotics prescriptions (predominantly penicillins), and tested nasopharyngeal (NP) samples for respiratory syncytial virus (RSV) and Bordetella pertussis. Our retrospective analysis of the SAMIPS cohort found that symptoms and antibiotics use were more common in infants (43% and 15.7%) than in mothers (16.6% and 8%), while RSV and B. pertussis were observed at similar rates in infants (2.7% and 32.5%) and mothers (2% and 35.5%), albeit frequently at very low levels. In infants, we observed strong associations between symptoms, pathogen detection, and antibiotics use. Critically, we demonstrate that non-macrolide antibiotics were commonly prescribed for pertussis infections, some of which persisted across many weeks. We speculate that improved diagnostic specificity and/or clinician education paired with timely, appropriate treatment of pertussis could substantially reduce the burden of this disease while reducing the off-target use of penicillins.
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Affiliation(s)
- Christian E. Gunning
- Odum School of Ecology, University of Georgia, Athens, GA, United States of America
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA, United States of America
- Center for the Ecology of Infectious Diseases; Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
| | - Lawrence Mwananyanda
- School of Public Health, Department of Global Health, Boston University, Boston, MA, United States of America
- Right to Care Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- School of Health Sciences, Department of Biomedical Science, University of Zambia, Lusaka, Zambia
| | | | - Christopher J. Gill
- School of Public Health, Department of Global Health, Boston University, Boston, MA, United States of America
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He Y, Ma C, Guo X, Pan J, Xu W, Liu S. Collateral Impact of COVID-19 Prevention Measures on Re-Emergence of Scarlet Fever and Pertussis in Mainland China and Hong Kong China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9909. [PMID: 36011545 PMCID: PMC9407746 DOI: 10.3390/ijerph19169909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The incidence of scarlet fever and pertussis has increased significantly in China in recent years. During the COVID-19 pandemic, stringent non-pharmaceutical intervention measures were widely adopted to contain the spread of the virus, which may also have essential collateral impacts on other infectious diseases, such as scarlet fever and pertussis. We compared the incidence data of scarlet fever and pertussis in Mainland China and Hong Kong from 2004 to 2021 before and after the COVID-19 pandemic. The results show that the incidence of both diseases decreased significantly in 2020-2021 compared to the after-re-emergence stage in these two locations. Specifically, in 2020, scarlet fever decreased by 73.13% and pertussis by 76.63% in Mainland China, and 83.70% and 76.10%, respectively, in Hong Kong. In the absence of COVID-19, the predicted incidence of both diseases was much higher than the actual incidence in Mainland China and Hong Kong in 2020-2021. This study demonstrates that non-pharmaceutical measures implemented during the COVID-19 pandemic can partially reduce scarlet fever and pertussis re-emergence in Mainland China and Hong Kong.
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Affiliation(s)
- Yiran He
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing 100872, China
| | - Chenjin Ma
- College of Statistics and Data Science, Faculty of Science, Beijing University of Technology, Beijing 100124, China
| | - Xiangyu Guo
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing 100872, China
| | - Jinren Pan
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Wangli Xu
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing 100872, China
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
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11
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Burden of pertussis among young infants in Malaysia: A hospital-based surveillance study. Vaccine 2022; 40:5241-5247. [PMID: 35927133 DOI: 10.1016/j.vaccine.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The case fatality rate and the risk of complications due to pertussis is very high in infants. Asia has the second highest childhood pertussis burden. The study aimed to assess the prevalence, clinical complications, and mortality rates of pertussis disease requiring hospitalization among young infants in Malaysia. METHODS The study was a one-year, hospital-based, multi-site surveillance of infants less than six months of age with symptoms consistent with pertussis and a cross-sectional analysis of their mothers for recent pertussis infection. Information was obtained from medical records and interviews with the parents. Pertussis diagnosis was confirmed for all infants through serum anti-PT titration test or PCR test. RESULTS 441 possible cases of pertussis were included in this study. Of these, 12.7 % had laboratory confirmation of pertussis. Infants with confirmed pertussis had significantly higher rates of cyanosis (37.5 % vs 8.6 %; p < 0.0001) and apnea (12.5 % vs 3.9 %; p = 0.027) than test-negative infants. Most infants from both groups were in recovery/recovered at discharge. Those with confirmed pertussis had higher case fatality rate than test-negative cases (5.4 % vs 1.0 %; p = 0.094), but the difference did not reach significance. The majority of confirmed pertussis cases (89.3 %) occurred in infants too young to be fully vaccinated or under-vaccinated for their age. Both test-negative and confirmed pertussis resulted in work-day losses and incurred costs for both parents. CONCLUSIONS A high pertussis disease burden persists in infants less than six months of age, especially among those un- and under-vaccinated. Maternal and complete, on-time infant vaccination is important to reduce disease burden.
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Raihan MO, Espelien BM, Hanson C, McGregor BA, Velaris NA, Alvine TD, Al Golovko S, Bradley DS, Nilles M, Glovko MY, Hur J, Porter JE. Characterization of prostanoids response to Bordetella pertussis antigen BscF and Tdap in LPS-challenged monocytes. Prostaglandins Leukot Essent Fatty Acids 2022; 182:102452. [PMID: 35690004 DOI: 10.1016/j.plefa.2022.102452] [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] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 12/29/2022]
Abstract
Prostanoids are potent inflammatory mediators that play a regulatory role in the innate immune activation of the adaptive immune response to determine the duration of protection against infection. We aim to quantify the modulation of prostanoids profiles in lipopolysaccharide (LPS)-stimulated THP-1 cells treated with the novel pertussis antigen BscF. We compared the effect with pertussis antigens present in the current Tdap vaccine to understand the immunomodulatory effect that might contribute to the diminished Tdap vaccine effectiveness. The inflammatory challenge with LPS induced a robust elevation of most prostanoid family members compared to the control treatment. Treatment with BscF and Tdap significantly reduced the LPS-stimulated elevation of prostaglandins (PGs) D2, E2, and F2α, as well as thromboxane (TX) A2 levels. An opposite trend was observed for PGI2, as both antigens accelerated the LPS-stimulated upregulation. Further, we quantified cyclooxygenases (COXs) that catalyze the biosynthesis of prostanoids and found that both antigens significantly reduced LPS-stimulated COX-1 and COX-2, demonstrating that the waning of acellular pertussis vaccines' protective immunity may be due to other downstream enzymes not related to COXs. Our present study validates the potential role of BscF as an adjuvant, resulting in the next-generation pertussis vaccine discovery.
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Affiliation(s)
- Md Obayed Raihan
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Brenna M Espelien
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Courtney Hanson
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Brett A McGregor
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Nathan A Velaris
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Travis D Alvine
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Svetlana Al Golovko
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - David S Bradley
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Matthew Nilles
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Mikhail Y Glovko
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - Junguk Hur
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States
| | - James E Porter
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, United States.
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13
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Matczak S, Levy C, Fortas C, Cohen JF, Béchet S, Aït El Belghiti F, Guillot S, Trombert-Paolantoni S, Jacomo V, Savitch Y, Paireau J, Brisse S, Guiso N, Lévy-Bruhl D, Cohen R, Toubiana J. Association between the COVID-19 pandemic and pertussis derived from multiple nationwide data sources, France, 2013 to 2020. Euro Surveill 2022; 27:2100933. [PMID: 35748301 PMCID: PMC9229195 DOI: 10.2807/1560-7917.es.2022.27.25.2100933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/18/2022] [Indexed: 05/22/2023] Open
Abstract
BackgroundInterventions to mitigate the COVID-19 pandemic may impact other respiratory diseases.AimsWe aimed to study the course of pertussis in France over an 8-year period including the beginning of the COVID-19 pandemic and its association with COVID-19 mitigation strategies, using multiple nationwide data sources and regression models.MethodsWe analysed the number of French pertussis cases between 2013 and 2020, using PCR test results from nationwide outpatient laboratories (Source 1) and a network of the paediatric wards from 41 hospitals (Source 2). We also used reports of a national primary care paediatric network (Source 3). We conducted a quasi-experimental interrupted time series analysis, relying on negative binomial regression models. The models accounted for seasonality, long-term cycles and secular trend, and included a binary variable for the first national lockdown (start 16 March 2020).ResultsWe identified 19,039 pertussis cases from these data sources. Pertussis cases decreased significantly following the implementation of mitigation measures, with adjusted incidence rate ratios of 0.10 (95% CI: 0.04-0.26) and 0.22 (95% CI: 0.07-0.66) for Source 1 and Source 2, respectively. The association was confirmed in Source 3 with a median of, respectively, one (IQR: 0-2) and 0 cases (IQR: 0-0) per month before and after lockdown (p = 0.0048).ConclusionsThe strong reduction in outpatient and hospitalised pertussis cases suggests an impact of COVID-19 mitigation measures on pertussis epidemiology. Pertussis vaccination recommendations should be followed carefully, and disease monitoring should be continued to detect any resurgence after relaxation of mitigation measures.
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Affiliation(s)
- Soraya Matczak
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
- AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Camille Fortas
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Jérémie F Cohen
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, INSERM UMR 1153, Université Paris Cité, Paris, France
| | - Stéphane Béchet
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Sophie Guillot
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
| | | | | | - Yann Savitch
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Juliette Paireau
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Mathematical Modelling of Infectious Diseases Unit, Paris, France
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
| | | | - Daniel Lévy-Bruhl
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
- AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Julie Toubiana
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for Whooping Cough and other Bordetella infections, Institut Pasteur, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
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14
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Choe YJ, Vidor E, Manson C. Post-Marketing Surveillance of Tetravalent Diphtheria-Tetanus-Acellular Pertussis and Inactivated Poliovirus (DTaP-IPV) Vaccine in South Korea, 2009 to 2015. Infect Dis Ther 2022; 11:1479-1492. [PMID: 35575974 PMCID: PMC9334467 DOI: 10.1007/s40121-022-00650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction TETRAXIM™ (Sanofi), a combined diphtheria, tetanus, acellular pertussis, and inactivated poliovirus (DTaP-IPV) vaccine, has been licensed in South Korea since 2009. In accordance with the Ministry of Food and Drug Safety regulations, this post-marketing surveillance (PMS) study evaluated the safety of the DTaP-IPV vaccine in real-world clinical practice in infants and children who received it as either a part of the three-dose primary series dose at 2, 4, and 6 months or school entry booster between 4 and 6 years of age. Methods This multicenter, observational, PMS study was conducted in real-world practice in South Korea for 6 years (2009–2015) in participants aged between 2 months and 6 years. The study outcomes included solicited reactions, unsolicited adverse events (AEs)/adverse drug reactions (ADRs), unexpected AEs/ADRs, and serious AEs (SAEs)/ADRs. Results Data from 647 participants was included in the safety analysis. Overall, 268 AEs were reported by 181 (28%) participants: 47 (17.5%) solicited reactions, 220 (82.1%) unsolicited AEs, and 1 (0.4%) unsolicited ADR. A total of 48 AEs (including 47 solicited reactions) were reported to have a causal relationship with the DTaP-IPV vaccine and were reported by 36 (5.6%) participants. A total of 212 unexpected AEs were reported by 152 (23.5%) participants, none of which had a causal relationship with the DTaP-IPV vaccine. Neither immediate AEs nor SAEs were reported during the study. Among the participants who reported AEs, 220 (34%) were on concomitant medications. Most AEs were of mild intensity, and all participants recovered. Conclusion No safety concerns related to the DTaP-IPV vaccine in a real-world setting were raised in participants aged 2–6 months for the primary series and 4–6 years for the school-entry booster dose in the Korean population. The DTaP-IPV vaccine was well tolerated and can be continued as part of routine immunization programs in infants and children. Trial Registration: NCT01437423.
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15
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Holubova J, Stanek O, Juhasz A, Hamidou Soumana I, Makovicky P, Sebo P. The Fim and FhaB adhesins play a crucial role in nasal cavity infection and Bordetella pertussis transmission in a novel mouse catarrhal infection model. PLoS Pathog 2022; 18:e1010402. [PMID: 35395059 PMCID: PMC9020735 DOI: 10.1371/journal.ppat.1010402] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/20/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023] Open
Abstract
Pulmonary infections caused by Bordetella pertussis used to be the prime cause of infant mortality in the pre-vaccine era and mouse models of pertussis pneumonia served in characterization of B. pertussis virulence mechanisms. However, the biologically most relevant catarrhal disease stage and B. pertussis transmission has not been adequately reproduced in adult mice due to limited proliferation of the human-adapted pathogen on murine nasopharyngeal mucosa. We used immunodeficient C57BL/6J MyD88 KO mice to achieve B. pertussis proliferation to human-like high counts of 108 viable bacteria per nasal cavity to elicit rhinosinusitis accompanied by robust shedding and transmission of B. pertussis bacteria to adult co-housed MyD88 KO mice. Experiments with a comprehensive set of B. pertussis mutants revealed that pertussis toxin, adenylate cyclase toxin-hemolysin, the T3SS effector BteA/BopC and several other known virulence factors were dispensable for nasal cavity infection and B. pertussis transmission in the immunocompromised MyD88 KO mice. In contrast, mutants lacking the filamentous hemagglutinin (FhaB) or fimbriae (Fim) adhesins infected the nasal cavity poorly, shed at low levels and failed to productively infect co-housed MyD88 KO or C57BL/6J mice. FhaB and fimbriae thus appear to play a critical role in B. pertussis transmission. The here-described novel murine model of B. pertussis-induced nasal catarrh opens the way to genetic dissection of host mechanisms involved in B. pertussis shedding and to validation of key bacterial transmission factors that ought to be targeted by future pertussis vaccines.
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Affiliation(s)
- Jana Holubova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ondrej Stanek
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Attila Juhasz
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Illiassou Hamidou Soumana
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Peter Makovicky
- Institute of Molecular Genetics of the Czech Academy of Sciences, Czech Centre for Phenogenomics, Vestec, Czech Republic
| | - Peter Sebo
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
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16
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Ernst K. Novel Strategies to Inhibit Pertussis Toxin. Toxins (Basel) 2022; 14:187. [PMID: 35324684 PMCID: PMC8951090 DOI: 10.3390/toxins14030187] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
Pertussis, also known as whooping cough, is a respiratory disease caused by infection with Bordetella pertussis, which releases several virulence factors, including the AB-type pertussis toxin (PT). The characteristic symptom is severe, long-lasting paroxysmal coughing. Especially in newborns and infants, pertussis symptoms, such as leukocytosis, can become life-threatening. Despite an available vaccination, increasing case numbers have been reported worldwide, including Western countries such as Germany and the USA. Antibiotic treatment is available and important to prevent further transmission. However, antibiotics only reduce symptoms if administered in early stages, which rarely occurs due to a late diagnosis. Thus, no causative treatments against symptoms of whooping cough are currently available. The AB-type protein toxin PT is a main virulence factor and consists of a binding subunit that facilitates transport of an enzyme subunit into the cytosol of target cells. There, the enzyme subunit ADP-ribosylates inhibitory α-subunits of G-protein coupled receptors resulting in disturbed cAMP signaling. As an important virulence factor associated with severe symptoms, such as leukocytosis, and poor outcomes, PT represents an attractive drug target to develop novel therapeutic strategies. In this review, chaperone inhibitors, human peptides, small molecule inhibitors, and humanized antibodies are discussed as novel strategies to inhibit PT.
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Affiliation(s)
- Katharina Ernst
- Institute of Pharmacology and Toxicology, Ulm University Medical Center, 89081 Ulm, Germany
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17
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Bbvac: A Live Vaccine Candidate That Provides Long-Lasting Anamnestic and Th17-Mediated Immunity against the Three Classical Bordetella spp. mSphere 2022; 7:e0089221. [PMID: 35196124 PMCID: PMC8865921 DOI: 10.1128/msphere.00892-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acute pathogens such as Bordetella pertussis can cause severe disease but are ultimately cleared by the immune response. This has led to the accepted paradigm that convalescent immunity is optimal and therefore broadly accepted as the “gold standard” against which vaccine candidates should be compared. However, successful pathogens like B. pertussis have evolved multiple mechanisms for suppressing and evading host immunity, raising the possibility that disruption of these mechanisms could result in substantially stronger or better immunity. Current acellular B. pertussis vaccines, delivered in a 5-dose regimen, induce only short-term immunity against disease and even less against colonization and transmission. Importantly, they provide modest protection against other Bordetella species that cause substantial human disease. A universal vaccine that protects against the three classical Bordetella spp. could decrease the burden of whooping cough-like disease in humans and other animals. Our recent work demonstrated that Bordetella spp. suppress host inflammatory responses and that disrupting the regulation of immunosuppressive mechanisms can allow the host to generate substantially stronger sterilizing immunity against the three classical Bordetella spp. Here, we identify immune parameters impacted by Bordetella species immunomodulation, including the generation of robust Th17 and B cell memory responses. Disrupting immunomodulation augmented the immune response, providing strong protection against the prototypes of all three classical Bordetella spp. as well as recent clinical isolates. Importantly, the protection in mice lasted for at least 15 months and was associated with recruitment of high numbers of B and T cells in the lungs as well as enhanced Th17 mucosal responses and persistently high titers of antibodies. These findings demonstrate that disrupting bacterial immunomodulatory pathways can generate much stronger and more protective immune responses to infection, with important implications for the development of better vaccines. IMPORTANCE Infectious diseases are a major cause of morbidity and mortality in the United States, accounting for over 40 million hospitalizations since 1998. Therefore, novel vaccine strategies are imperative, which can be improved with a better understanding of the mechanisms that bacteria utilize to suppress host immunity, a key mechanism for establishing colonization. Bordetella spp., the causative agents of whooping cough, suppress host immunity, which allows for persistent colonization. We discovered a regulator of a bacterial immunosuppressive pathway, which, when mutated in Bordetella spp., allows for rapid clearance of infection and subsequent generation of protective immunity for at least 15 months. After infection with the mutant strain, mice exhibited sterilizing immunity against the three classical Bordetella spp., suggesting that the immune response can be both stronger and cross-protective. This work presents a strategy for vaccine development that can be applied to other immunomodulatory pathogens.
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18
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Binns E, Koenraads M, Hristeva L, Flamant A, Baier-Grabner S, Loi M, Lempainen J, Osterheld E, Ramly B, Chakakala-Chaziya J, Enaganthi N, Simó Nebot S, Buonsenso D. Influenza and respiratory syncytial virus during the COVID-19 pandemic: Time for a new paradigm? Pediatr Pulmonol 2022; 57:38-42. [PMID: 34644459 PMCID: PMC8662286 DOI: 10.1002/ppul.25719] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/23/2021] [Accepted: 10/02/2021] [Indexed: 01/21/2023]
Abstract
Seasonal epidemics of influenza and the respiratory syncytial virus (RSV) are the cause of substantial morbidity and mortality among children. During the global coronavirus disease 2019 (COVID-19) pandemic, the epidemiology of these viruses seems to have changed dramatically. In Australia and New Zealand, a significant decrease in both influenza and bronchiolitis have been noticed during usual peak seasons. Data from early months of winter seasons in Europe are showing similar trends. This current scenario imposes a reconsideration of the paradigm that toddlers and young schoolchildren are the main drivers of seasonal RSV outbreaks and respiratory epidemics in general. In this article, we summarize current literature, address current knowledge or role of adults in the RSV epidemiology, describe the lessons learned from pertussis epidemics and call the international community to better understand the community transmission dynamics of respiratory infections in all age groups. This can allow the establishment of better and more affordable preventive measures in the whole population level, which can ultimately save millions of child lives.
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Affiliation(s)
- Emma Binns
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
| | | | | | - Alix Flamant
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sebastian Baier-Grabner
- Department of Paediatrics and Adolescent Medicine, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Mervin Loi
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Johanna Lempainen
- Department of Paediatrics, Institute of Biomedicine and Clinical Microbiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Elise Osterheld
- Department of Paediatrics, Centre Hospitalier de Mayotte, Mayotte, France
| | - Bazlin Ramly
- Paediatric Department, Children Health Ireland, Dublin, Ireland.,Paediatric Department, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | | | - Niveditha Enaganthi
- Paediatric Department, Sri Ramachandra Medical College & RI, Chennai, Tamil Nadu, India
| | - Silvia Simó Nebot
- Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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19
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Rane MS, Rohani P, Halloran ME. Durability of protection after 5 doses of acellular pertussis vaccine among 5-9 year old children in King County, Washington. Vaccine 2021; 39:6144-6150. [PMID: 34493409 PMCID: PMC9665886 DOI: 10.1016/j.vaccine.2021.08.070] [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: 06/04/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Waning of immunity after vaccination with the acellular Pertussis (aP) vaccine has been proposed as one of the main reasons for pertussis resurgence in the US. In this study, we estimated time-varying vaccine effectiveness after 5 doses of aP vaccine. METHODS We conducted a retrospective cohort study among children 5-9 years old (born between 2008 and 2012) living in King County, Washington, USA, who participated in the Washington State Immunization Information System. We estimated time-varying vaccine effectiveness after 5 doses of aP using smoothed scaled Schoenfeld residuals obtained from fitting Cox proportional hazards models to the data as well as piecewise constant Poisson regression. RESULTS There were 55 pertussis cases in this cohort, of whom 22 (40%) were fully-vaccinated and 33 (60%) were under-vaccinated. Vaccine effectiveness (VE) remained high for up to 42 months after the fifth dose (VE(t) = 89%; 95% CI: 64%, 97%) as estimated using survival analysis methods and up to 4 years (VE(t) = 93%; 95% CI: 67%, 98%) as estimated using Poisson regression. CONCLUSION We did not find evidence for waning of vaccine effectiveness for up to four years after 5 doses of aP among 5 -9 years old children in King County, WA.
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Affiliation(s)
- Madhura S Rane
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA 30602, USA; Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - M Elizabeth Halloran
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
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20
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Jolles A, Gorsich E, Gubbins S, Beechler B, Buss P, Juleff N, de Klerk-Lorist LM, Maree F, Perez-Martin E, van Schalkwyk OL, Scott K, Zhang F, Medlock J, Charleston B. Endemic persistence of a highly contagious pathogen: Foot-and-mouth disease in its wildlife host. Science 2021; 374:104-109. [PMID: 34591637 DOI: 10.1126/science.abd2475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Extremely contagious pathogens are a global biosecurity threat because of their high burden of morbidity and mortality, as well as their capacity for fast-moving epidemics that are difficult to quell. Understanding the mechanisms enabling persistence of highly transmissible pathogens in host populations is thus a central problem in disease ecology. Through a combination of experimental and theoretical approaches, we investigated how highly contagious foot-and-mouth disease viruses persist in the African buffalo, which serves as their wildlife reservoir. We found that viral persistence through transmission among acutely infected hosts alone is unlikely. However, the inclusion of occasional transmission from persistently infected carriers reliably rescues the most infectious viral strain from fade-out. Additional mechanisms such as antigenic shift, loss of immunity, or spillover among host populations may be required for persistence of less transmissible strains.
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Affiliation(s)
- Anna Jolles
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331, USA.,Department of Integrative Biology, Oregon State University, Corvallis, OR 97331, USA
| | - Erin Gorsich
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331, USA.,Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, CV4 7AL, UK.,School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Simon Gubbins
- The Pirbright Institute, Ash Road, Pirbright, Surrey, GU24 0NF, UK
| | - Brianna Beechler
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Peter Buss
- SANParks, Veterinary Wildlife Services, Kruger National Park, 1350 Skukuza, South Africa
| | - Nick Juleff
- Bill & Melinda Gates Foundation, Livestock Program, Seattle 98109, WA, USA
| | - Lin-Mari de Klerk-Lorist
- Office of the State Veterinarian, Department of Agriculture, Land Reform and Rural Development, Government of South Africa, 1350 Skukuza, South Africa
| | - Francois Maree
- Vaccine and Diagnostic Research Programme, Onderstepoort Veterinary Institute, Agricultural Research Council, Private Bag X05, Onderstepoort 0110, South Africa.,South Africa Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, South Africa
| | - Eva Perez-Martin
- The Pirbright Institute, Ash Road, Pirbright, Surrey, GU24 0NF, UK
| | - O L van Schalkwyk
- Office of the State Veterinarian, Department of Agriculture, Land Reform and Rural Development, Government of South Africa, 1350 Skukuza, South Africa.,Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.,Department of Migration, Max Planck Institute of Animal Behavior, Am Obstberg 1 Radolfzell, 78315, Germany
| | - Katherine Scott
- Vaccine and Diagnostic Research Programme, Onderstepoort Veterinary Institute, Agricultural Research Council, Private Bag X05, Onderstepoort 0110, South Africa
| | - Fuquan Zhang
- Institute of Prion Diseases, University College London, London, WC1E 6BT, UK
| | - Jan Medlock
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Bryan Charleston
- The Pirbright Institute, Ash Road, Pirbright, Surrey, GU24 0NF, UK
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21
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Carriquiriborde F, Martin Aispuro P, Ambrosis N, Zurita E, Bottero D, Gaillard ME, Castuma C, Rudi E, Lodeiro A, Hozbor DF. Pertussis Vaccine Candidate Based on Outer Membrane Vesicles Derived From Biofilm Culture. Front Immunol 2021; 12:730434. [PMID: 34603306 PMCID: PMC8479151 DOI: 10.3389/fimmu.2021.730434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023] Open
Abstract
Outer membrane vesicles (OMV) derived from Bordetella pertussis-the etiologic agent of the resurgent disease called pertussis-are safe and effective in preventing bacterial colonization in the lungs of immunized mice. Vaccine formulations containing those OMV are capable of inducing a mixed Th1/Th2/Th17 profile, but even more interestingly, they may induce a tissue-resident memory immune response. This immune response is recommended for the new generation of pertussis-vaccines that must be developed to overcome the weaknesses of current commercial acellular vaccines (second-generation of pertussis vaccine). The third-generation of pertussis vaccine should also deal with infections caused by bacteria that currently circulate in the population and are phenotypically and genotypically different [in particular those deficient in the expression of pertactin antigen, PRN(-)] from those that circulated in the past. Here we evaluated the protective capacity of OMV derived from bacteria grown in biofilm, since it was observed that, by difference with older culture collection vaccine strains, circulating clinical B. pertussis isolates possess higher capacity for this lifestyle. Therefore, we performed studies with a clinical isolate with good biofilm-forming capacity. Biofilm lifestyle was confirmed by both scanning electron microscopy and proteomics. While scanning electron microscopy revealed typical biofilm structures in these cultures, BipA, fimbria, and other adhesins described as typical of the biofilm lifestyle were overexpressed in the biofilm culture in comparison with planktonic culture. OMV derived from biofilm (OMVbiof) or planktonic lifestyle (OMVplank) were used to formulate vaccines to compare their immunogenicity and protective capacities against infection with PRN(+) or PRN(-) B. pertussis clinical isolates. Using the mouse protection model, we detected that OMVbiof-vaccine was more immunogenic than OMVplank-vaccine in terms of both specific antibody titers and quality, since OMVbiof-vaccine induced antibodies with higher avidity. Moreover, when OMV were administered at suboptimal quantity for protection, OMVbiof-vaccine exhibited a significantly adequate and higher protective capacity against PRN(+) or PRN(-) than OMVplank-vaccine. Our findings indicate that the vaccine based on B. pertussis biofilm-derived OMV induces high protection also against pertactin-deficient strains, with a robust immune response.
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Affiliation(s)
- Francisco Carriquiriborde
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Pablo Martin Aispuro
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Nicolás Ambrosis
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Eugenia Zurita
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Daniela Bottero
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - María Emilia Gaillard
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Celina Castuma
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Erika Rudi
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Aníbal Lodeiro
- Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
| | - Daniela F. Hozbor
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, La Plata, Argentina
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Bordetella Adenylate Cyclase Toxin Elicits Airway Mucin Secretion through Activation of the cAMP Response Element Binding Protein. Int J Mol Sci 2021; 22:ijms22169064. [PMID: 34445770 PMCID: PMC8396599 DOI: 10.3390/ijms22169064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 12/30/2022] Open
Abstract
The mucus layer protects airway epithelia from damage by noxious agents. Intriguingly, Bordetella pertussis bacteria provoke massive mucus production by nasopharyngeal epithelia during the initial coryza-like catarrhal stage of human pertussis and the pathogen transmits in mucus-containing aerosol droplets expelled by sneezing and post-nasal drip-triggered cough. We investigated the role of the cAMP-elevating adenylate cyclase (CyaA) and pertussis (PT) toxins in the upregulation of mucin production in B. pertussis-infected airway epithelia. Using human pseudostratified airway epithelial cell layers cultured at air–liquid interface (ALI), we show that purified CyaA and PT toxins (100 ng/mL) can trigger production of the major airway mucins Muc5AC and Muc5B. Upregulation of mucin secretion involved activation of the cAMP response element binding protein (CREB) and was blocked by the 666-15-Calbiochem inhibitor of CREB-mediated gene transcription. Intriguingly, a B. pertussis mutant strain secreting only active PT and producing the enzymatically inactive CyaA-AC– toxoid failed to trigger any important mucus production in infected epithelial cell layers in vitro or in vivo in the tracheal epithelia of intranasally infected mice. In contrast, the PT– toxoid-producing B. pertussis mutant secreting the active CyaA toxin elicited a comparable mucin production as infection of epithelial cell layers or tracheal epithelia of infected mice by the wild-type B. pertussis secreting both PT and CyaA toxins. Hence, the cAMP-elevating activity of B. pertussis-secreted CyaA was alone sufficient for activation of mucin production through a CREB-dependent mechanism in B. pertussis-infected airway epithelia in vivo.
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23
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Wu S, Hu Q, Yang C, Zhou H, Chen H, Zhang Y, Jiang M, He Y, Shi X. Molecular epidemiology of Bordetella pertussis and analysis of vaccine antigen genes from clinical isolates from Shenzhen, China. Ann Clin Microbiol Antimicrob 2021; 20:53. [PMID: 34407803 PMCID: PMC8371876 DOI: 10.1186/s12941-021-00458-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although pertussis cases globally have been controlled through the Expanded Programme on Immunization (EPI), the incidence of pertussis has increased significantly in recent years, with a “resurgence” of pertussis occurring in developed countries with high immunization coverage. Attracted by its fast-developing economy, the population of Shenzhen has reached 14 million and has become one of the top five largest cities by population size in China. The incidence of pertussis here was about 2.02/100,000, far exceeding that of the whole province and the whole country (both < 1/100,000). There are increasing numbers of reports demonstrating variation in Bordetella pertussis antigens and genes, which may be associated with the increased incidence. Fifty strains of Bordetella pertussis isolated from 387 suspected cases were collected in Shenzhen in 2018 for genotypic and molecular epidemiological analysis. Methods There were 387 suspected cases of pertussis enrolled at surveillance sites in Shenzhen from June to August 2018. Nasopharyngeal swabs from suspected pertussis cases were collected for bacterial culture and the identity of putative Bordetella pertussis isolates was confirmed by real-time PCR. The immunization history of each patient was taken. The acellular pertussis vaccine (APV) antigen genes for pertussis toxin (ptxA, ptxC), pertactin (prn) and fimbriae (fim2 and fim3) together with the pertussis toxin promoter region (ptxP) were analyzed by second-generation sequencing. Genetic and phylogenetic analysis was performed using sequences publicly available from GenBank, National Institutes of Health, Bethesda, MD, USA (https://www.ncbi.nlm.nih.gov/genbank/). The antimicrobial susceptibility was test by Kirby-Bauer disk diffusion. Results Fifty strains of Bordetella pertussis were successfully isolated from nasopharyngeal swabs of 387 suspected cases, with a positivity rate of 16.79%, including 28 males and 22 females, accounting for 56.0% and 44.0% respectively. Thirty-eight of the 50 (76%) patients were found to be positive for B. pertussis by culture. Among the positive cases with a history of vaccination, 30 of 42 (71.4%) cases had an incomplete pertussis vaccination history according to the national recommendation. Three phylogenetic groups (PG1-PG3) were identified each containing a predominant genotype. The two vaccines strains, CS and Tohama I, were distantly related to these three groups. Thirty-one out of fifty (62%) isolates belonged to genotype PG1, with the allelic profile prn2/ptxC2/ptxP3/ptxA1/fim3-1/fim2-1. Eighteen out of fifty (36%) isolates contained the A2047G mutation and were highly resistant to erythromycin, and all belonged to genotype PG3 (prn1/ptxA1/ptxP1/ptxC1/fim3-1/fim2-1), which is closely related to the recent epidemic strains found in northern China. Conclusions The positive rate of cases under one-year-old was significantly higher than that of other age groups and should be monitored. The dominant antigen genotypes of 50 Shenzhen isolates are closely related to the epidemic strains in the United States, Australia and many countries in Europe. Despite high rates of immunization with APV, epidemics of pertussis have recently occurred in these countries. Therefore, genomic analysis of circulating isolates of B. pertussis should be continued, for it will benefit the control of whooping cough and development of improved vaccines and therapeutic strategies.
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Affiliation(s)
- Shuang Wu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China
| | - Qinghua Hu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China
| | - Chao Yang
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China
| | - Haijian Zhou
- National Institute for Communicable Disease Control and Prevention (ICDC) of China CDC, Beijing, China
| | - Hongyu Chen
- Shenzhen Children's Hospital, Shenzhen, China
| | - Yanwei Zhang
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China
| | - Min Jiang
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China
| | - Yuxiang He
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China
| | - Xiaolu Shi
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Nanshan District, Shenzhen, China.
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24
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Kang L, Cui X, Fu J, Wang W, Li L, Li T, Wang X, Xiao F, Jia H, Mi R, Hou X. Clinical characteristics of 967 children with pertussis: a single-center analysis over an 8-year period in Beijing, China. Eur J Clin Microbiol Infect Dis 2021; 41:9-20. [PMID: 34398346 PMCID: PMC8365282 DOI: 10.1007/s10096-021-04336-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to understand children’s clinical characteristics with pertussis and analyze risk factors on critical pertussis patients. Demographic data from patients with pertussis at Children’s Hospital affiliated to the Capital Institute of Pediatrics between March 2011 and December 2018 were collected. We retrospectively gathered more information with the positive exposure, vaccination, antibiotic usage before diagnosis, clinical manifestation, laboratory tests, therapy, and complications for hospitalized children. We divided the patients into severe and non-severe groups, comparing related factors and clinical characteristics among each group. In particular, we summarize the clinical features of the severe patients before aggravation. A total of 967 pertussis cases were diagnosed, of which 227 were hospitalized. The onset age younger than 3 months old accounted for the highest proportion, and 126 patients received hospitalization. For those patients, the incidence of post-tussive vomiting, paroxysmal cyanosis, post-tussive heart rate decrease, hypoxemia, severe pneumonia, and mechanical ventilation was significantly higher than that in the ≥ 3-month-old group (p < 0.05). Among 227 hospitalized patients, 54 suffered from severe pertussis. Risk factors for severe patients included early age of onset, pathogen exposure, and unvaccinated status. Cough paroxysms, post-tussive vomiting, paroxysmal cyanosis, facial flushing/cyanosis/fever during cough, increased WBC, and chest X-ray revealing pneumonia/consolidation/atelectasis were important indications of severe pertussis. Unvaccinated status was an independent risk factor for severe pertussis. The most vulnerable population was infants < 3 months old to pertussis, and may be on the severe end of the disease. Pediatricians must detect and treat severe cases promptly and recommend timely vaccination for all eligible children.
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Affiliation(s)
- Limin Kang
- Department of Neonatal Medicine, Peking University First Hospital, Beijing, China
- Department of Neonatal Medicine, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xiaodai Cui
- Central Lab, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Jin Fu
- Central Lab, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wenpeng Wang
- Department of Epidemiology, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Li Li
- Department of Neonatal Medicine, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Tiegeng Li
- Department of Neonatal Medicine, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoying Wang
- Department of Neonatal Medicine, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Fei Xiao
- Central Lab, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Huixue Jia
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Rong Mi
- Department of Neonatal Medicine, Affiliated Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xinlin Hou
- Department of Neonatal Medicine, Peking University First Hospital, Beijing, China
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25
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Gill CJ, Gunning CE, MacLeod WB, Mwananyanda L, Thea DM, Pieciak RC, Kwenda G, Mupila Z, Rohani P. Asymptomatic Bordetella pertussis infections in a longitudinal cohort of young African infants and their mothers. eLife 2021; 10:65663. [PMID: 34097599 PMCID: PMC8184211 DOI: 10.7554/elife.65663] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/26/2021] [Indexed: 12/17/2022] Open
Abstract
Recent pertussis resurgence in numerous countries may be driven by asymptomatic infections. Most pertussis surveillance studies are cross-sectional and cannot distinguish asymptomatic from pre-symptomatic infections. Longitudinal surveillance could overcome this barrier, providing more information about the true burden of pertussis at the population level. Here we analyze 17,442 nasopharyngeal samples from a longitudinal cohort of 1320 Zambian mother/infant pairs. Our analysis has two elements. First, we demonstrate that the full range of IS481 qPCR CT values provides insight into pertussis epidemiology, showing concordance of low and high CT results over time, within mother/infant pairs, and in relation to symptomatology. Second, we exploit these full-range qPCR data to demonstrate a high incidence of asymptomatic pertussis, including among infants. Our results demonstrate a wider burden of pertussis infection than we anticipated in this population, and expose key limitations of threshold-based interpretation of qPCR results in infectious disease surveillance.
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Affiliation(s)
- Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, United States
| | | | - William B MacLeod
- Boston University School of Public Health, Department of Global Health, Boston, United States
| | - Lawrence Mwananyanda
- Boston University School of Public Health, Department of Global Health, Boston, United States.,Right to Care, Lusaka, Zambia
| | - Donald M Thea
- Boston University School of Public Health, Department of Global Health, Boston, United States
| | - Rachel C Pieciak
- Boston University School of Public Health, Department of Global Health, Boston, United States
| | - Geoffrey Kwenda
- University of Zambia, School of Health Sciences, Department of Biomedical Science, Lusaka, Zambia
| | | | - Pejman Rohani
- University of Georgia, Odum School of Ecology, Athens, Georgia.,University of Georgia, Center for the Ecology of Infectious Diseases, Athens, Georgia.,University of Georgia, Department of Infectious Diseases, Athens, Georgia
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26
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Macina D, Evans KE. Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in Asia. Infect Dis Ther 2021; 10:1115-1140. [PMID: 33928533 PMCID: PMC8322225 DOI: 10.1007/s40121-021-00439-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
Cyclic epidemics of pertussis (whooping cough) have been observed globally over the past twenty years despite high infant vaccine coverage. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity in older children and adults, as well as better surveillance and diagnostics. Moreover, in adolescents and adults, pertussis symptoms are mild and similar to common cough syndromes, meaning that it is 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, burden of illness, and mortality in school-aged children, adolescents, and adults in Asia. Studies identified for inclusion were reviewed narratively because a statistical comparison was not possible due to the mix of methodologies used. The results showed that in East Asia, including Japan, South Korea, China, and Taiwan, pertussis is circulating in older children and adults. Diphtheria-tetanus-pertussis (DTP4) coverage is high in East Asia, yet outbreaks observed in Japan and South Korea suggest that vaccine-acquired immunity had waned in adolescents and adults. Several school outbreaks in China show that pertussis is circulating in young children, with continued circulation in adolescents and adults. There was a lack of information from Southeast/South Asian countries, although pan-Asian serosurveys showed that recent pertussis infection was common in adolescents and in adults with persistent cough. To conclude, the circulation of pertussis in Asian countries with high DTP4 coverage supports the expansion of routine vaccination to include booster doses for children at school entry and adolescents. However, surveillance is weak or absent in many countries, meaning that the true burden of pertussis, particularly among older populations, is unknown.
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Affiliation(s)
- Denis Macina
- Global Medical, Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
| | - Keith E Evans
- InScience Communications, Chowley Oak Business Park, Chowley Oak Lane, Tattenhall, Cheshire, UK
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27
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Macina D, Evans KE. Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in the Middle East. Infect Dis Ther 2021; 10:719-738. [PMID: 33905101 PMCID: PMC8116454 DOI: 10.1007/s40121-021-00440-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/24/2021] [Indexed: 10/13/2023] Open
Abstract
Despite modern diphtheria-tetanus-pertussis (DTP) vaccines and high vaccine coverage, a resurgence of pertussis (whooping cough) has been observed globally. In North America and Europe, high vaccine coverage in children has led to a shift in the age-specific peak incidence of infection away from infants and towards older children and adolescents. However, much less is known about the prevalence of pertussis in older children and adults in the Middle East. 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, burden of illness, and mortality in school-aged children, adolescents, and adults in the Middle East. Studies identified for inclusion were reviewed narratively because a statistical comparison was not possible because of the mix of methodologies used. The results showed that surveillance data are weak or missing in most Middle Eastern countries, and among 24 epidemiological studies identified, most were from Iran (14), Israel (4), and Turkey (3), with single studies from the United Arab Emirates and Iraq. Despite various surveillance periods, clinical definitions, and antibody cut-off values used across the studies, the reported seroprevalence of pertussis antibodies suggested that adolescents and adults are commonly exposed to pertussis in the community and that vaccine-acquired immunity from childhood wanes. Few countries in the Middle East include a diphtheria-tetanus-acellular pertussis (Tdap) booster for adolescents on the national schedule. Israel was the only country with epidemiological data in a population that received Tdap, and the study showed that after the introduction of the adolescent booster dose, there was decrease in pertussis among children aged 5–14 years. To conclude, results from the Middle East suggest that in common with other regions, pertussis is widely circulating and that it might be shifting towards older age groups.
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Affiliation(s)
- Denis Macina
- Global Medical, Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
| | - Keith E Evans
- inScience Communications, Chowley Oak Business Park, Chowley Oak Lane, Tattenhall, Cheshire, UK
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28
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Rane MS, Halloran ME. Estimating population-level effects of the acellular pertussis vaccine using routinely collected immunization data. Clin Infect Dis 2021; 73:2101-2107. [PMID: 33881527 DOI: 10.1093/cid/ciab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measuring and reporting the different population-level effects of the acellular pertussis vaccine on pertussis disease in addition to direct effects can increase the cost-effectiveness of a vaccine. METHODS We conducted a retrospective cohort study of children born between January 1, 2008, and December 31, 2017, in King County, Washington, who were enrolled in the Washington State Immunization Information System. Diphtheria-Tetanus-acellular-Pertussis (DTaP) vaccination data from WA-IIS was linked with pertussis case data from Public Health Seattle and King County. Census-level vaccination coverage was estimated as proportion of age-appropriately vaccinated children residing in it. Direct vaccine effectiveness was estimated by comparing pertussis risk in fully-vaccinated and under-vaccinated children. Population-level vaccine effects were estimated by comparing pertussis risk in census tracts in the highest vaccination coverage quartile to that in the lowest vaccination coverage quartile. RESULTS For direct protection, estimated vaccine effectiveness was 76% (95% CI: 63% - 84%) in low vaccination coverage clusters and it decreased to 47% (95% CI: 13% - 68%) in high vaccination coverage clusters, after adjusting for potential confounders. The estimated indirect effect was 45.0% (95% CI: 1%, 70%), total effect was 93.9% (95% CI: 91%, 96%), and overall effect was 42.2% (95% CI: 19%, 60%). CONCLUSION Our findings suggest that DTaP vaccination provided direct as well as indirect protection in the highly immunized King County, WA. Routine DTaP vaccination programs may have the potential to provide not only protection for vaccinated individuals but also for the under-vaccinated individuals living in the same area.
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Affiliation(s)
- Madhura S Rane
- Department of Epidemiology, University of Washington, Seattle USA
| | - M Elizabeth Halloran
- Department of Epidemiology, University of Washington, Seattle USA.,Department of Biostatistics University of Washington, Seattle USA.,Biostatistics, Bioinformatics, and Epidemiology Program, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, USA
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29
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Ernst K, Mittler AK, Winkelmann V, Kling C, Eberhardt N, Anastasia A, Sonnabend M, Lochbaum R, Wirsching J, Sakari M, Pulliainen AT, Skerry C, Carbonetti NH, Frick M, Barth H. Pharmacological targeting of host chaperones protects from pertussis toxin in vitro and in vivo. Sci Rep 2021; 11:5429. [PMID: 33686161 PMCID: PMC7940712 DOI: 10.1038/s41598-021-84817-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/16/2021] [Indexed: 01/05/2023] Open
Abstract
Whooping cough is caused by Bordetella pertussis that releases pertussis toxin (PT) which comprises enzyme A-subunit PTS1 and binding/transport B-subunit. After receptor-mediated endocytosis, PT reaches the endoplasmic reticulum from where unfolded PTS1 is transported to the cytosol. PTS1 ADP-ribosylates G-protein α-subunits resulting in increased cAMP signaling. Here, a role of target cell chaperones Hsp90, Hsp70, cyclophilins and FK506-binding proteins for cytosolic PTS1-uptake is demonstrated. PTS1 specifically and directly interacts with chaperones in vitro and in cells. Specific pharmacological chaperone inhibition protects CHO-K1, human primary airway basal cells and a fully differentiated airway epithelium from PT-intoxication by reducing intracellular PTS1-amounts without affecting cell binding or enzyme activity. PT is internalized by human airway epithelium secretory but not ciliated cells and leads to increase of apical surface liquid. Cyclophilin-inhibitors reduced leukocytosis in infant mouse model of pertussis, indicating their promising potential for developing novel therapeutic strategies against whooping cough.
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Affiliation(s)
- Katharina Ernst
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany.
| | - Ann-Katrin Mittler
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | | | - Carolin Kling
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Nina Eberhardt
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Anna Anastasia
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Michael Sonnabend
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Robin Lochbaum
- Institute of General Physiology, University of Ulm, Ulm, Germany
| | - Jan Wirsching
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Moona Sakari
- Institute of Biomedicine, Research Unit for Infection and Immunity, University of Turku, Turku, Finland
| | - Arto T Pulliainen
- Institute of Biomedicine, Research Unit for Infection and Immunity, University of Turku, Turku, Finland
| | - Ciaran Skerry
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicholas H Carbonetti
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Manfred Frick
- Institute of General Physiology, University of Ulm, Ulm, Germany
| | - Holger Barth
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany.
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30
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Emerging macrolide resistance in Bordetella pertussis in mainland China: Findings and warning from the global pertussis initiative. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 8:100098. [PMID: 34327426 PMCID: PMC8315362 DOI: 10.1016/j.lanwpc.2021.100098] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
Whooping cough, or pertussis, is a highly communicable infectious disease caused by the bacterium Bordetella pertussis. Vaccination once reduced the incidence of the disease, but a global resurgence of the infection happened during the past two decades, likely due to the waning immunity of vaccination. Macrolides such as erythromycin and azithromycin are the drugs of primary choice for treatment. In this personal view, we call for attention to macrolide-resistant B. pertussis (MRBP), which has emerged and prevailed in mainland China for years and are exclusively mediated by mutations in the 23S rRNA gene. Whether the prevalence of MRBP in China results from overuse of azithromycin in clinical medicine remains unknown. The incidence of MRBP is low in other countries, but this could be a technical illusion since China employs culture as the mainstream diagnostic method whereas nucleic-acid amplification test being widely used in other countries fail to test antimicrobial susceptibility. Given the increasingly frequent global travel that facilitates microbial transmission worldwide, there is a pressing need to perform international surveillance on MRBP to prevent the potential circulation of the organism. Finding alternative agents that possess good activity against B. pertussis is also urgently required.
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Cinicola B, Conti MG, Terrin G, Sgrulletti M, Elfeky R, Carsetti R, Fernandez Salinas A, Piano Mortari E, Brindisi G, De Curtis M, Zicari AM, Moschese V, Duse M. The Protective Role of Maternal Immunization in Early Life. Front Pediatr 2021; 9:638871. [PMID: 33996688 PMCID: PMC8113393 DOI: 10.3389/fped.2021.638871] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/26/2021] [Indexed: 12/16/2022] Open
Abstract
With birth, the newborn is transferred from a quasi-sterile environment to the outside world. At this time, the neonatal immune system is inexperienced and continuously subject to a process of development as it encounters different antigenic stimuli after birth. It is initially characterized by a bias toward T helper 2 phenotype, reduced T helper 1, and cytotoxic responses to microbial stimuli, low levels of memory, and effector T and B cells and a high production of suppressive T regulatory cells. The aim of this setting, during fetal life, is to maintain an anti-inflammatory state and immune-tolerance. Maternal antibodies are transferred during pregnancy through the placenta and, in the first weeks of life of the newborn, they represent a powerful tool for protection. Thus, optimization of vaccination in pregnancy represents an important strategy to reduce the burden of neonatal infections and sepsis. Beneficial effects of maternal immunization are universally recognized, although the optimal timing of vaccination in pregnancy remains to be defined. Interestingly, the dynamic exchange that takes place at the fetal-maternal interface allows the transfer not only of antibodies, but also of maternal antigen presenting cells, probably in order to stimulate the developing fetal immune system in a harmless way. There are still controversial effects related to maternal immunization including the so called "immunology blunting," i.e., a dampened antibody production following infant's vaccination in those infants who received placentally transferred maternal immunity. However, clinical relevance of this phenomenon is still not clear. This review will provide an overview of the evolution of the immune system in early life and discuss the benefits of maternal vaccination. Current maternal vaccination policies and their rationale will be summarized on the road to promising approaches to enhance immunity in the neonate.
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Affiliation(s)
- Bianca Cinicola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy.,Ph.D. Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Reem Elfeky
- Department of Clinical Immunology, Royal Free Hospital, London, United Kingdom.,Infection, Immunity & Inflammation Department, Institute of Child Health, University College London (UCL), London, United Kingdom
| | - Rita Carsetti
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ane Fernandez Salinas
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eva Piano Mortari
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Brindisi
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mario De Curtis
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy.,Department Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Marzia Duse
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Cole LE, Zhang J, Pacheco KM, Lhéritier P, Anosova NG, Piolat J, Zheng L, Reveneau N. Immunological Distinctions between Acellular and Whole-Cell Pertussis Immunizations of Baboons Persist for at Least One Year after Acellular Vaccine Boosting. Vaccines (Basel) 2020; 8:vaccines8040729. [PMID: 33276673 PMCID: PMC7761625 DOI: 10.3390/vaccines8040729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 01/17/2023] Open
Abstract
While both whole-cell (wP) and acellular pertussis (aP) vaccines have been highly effective at reducing the global pertussis disease burden, there are concerns that compared to wP vaccination, the immune responses to aP vaccination may wane more rapidly. To gain insights into the vaccine elicited immune responses, pre-adult baboons were immunized with either aP or wP vaccines, boosted with an aP vaccine, and observed over a nearly two-year period. Priming with a wP vaccine elicited a more Th17-biased response than priming with aP, whereas priming with an aP vaccine led to a more Th2-biased response than priming with wP. These differences were maintained after aP vaccine boost immunizations. Compared to aP, animals primed with a wP vaccine exhibited greater numbers of pertussis specific memory B cells. While aP and wP vaccine priming initially elicited similar levels of anti-pertussis toxin antibody, titers declined more rapidly in aP vaccine primed animals leading to a 4-fold difference. Both wP and aP vaccine immunization could induce serum bactericidal activity (SBA); however, only one wP vaccine immunization was required to elicit SBA while multiple aP vaccine immunizations were required to elicit lower, less durable SBA titers. In conclusion, when compared to aP vaccine, priming with wP vaccine elicits distinct cellular and humoral immune responses that persist after aP vaccine boosting.
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Affiliation(s)
- Leah E. Cole
- Sanofi Pasteur, Cambridge, MA 02139, USA; (J.Z.); (K.M.P.); (N.G.A.)
- Correspondence: (L.E.C.); (N.R.); Tel.: +1-617-866-4473 (L.E.C.); +33-4-37-66-8510 (N.R.)
| | - Jinrong Zhang
- Sanofi Pasteur, Cambridge, MA 02139, USA; (J.Z.); (K.M.P.); (N.G.A.)
| | - Kristl M. Pacheco
- Sanofi Pasteur, Cambridge, MA 02139, USA; (J.Z.); (K.M.P.); (N.G.A.)
| | | | | | - Julie Piolat
- Sanofi Pasteur, 69280 Marcy L’Etoile, France; (P.L.); (J.P.)
| | | | - Nathalie Reveneau
- Sanofi Pasteur, 69280 Marcy L’Etoile, France; (P.L.); (J.P.)
- Correspondence: (L.E.C.); (N.R.); Tel.: +1-617-866-4473 (L.E.C.); +33-4-37-66-8510 (N.R.)
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Thommes E, Wu J, Xiao Y, Tomovici A, Lee J, Chit A. Revisiting the epidemiology of pertussis in Canada, 1924-2015: a literature review, evidence synthesis, and modeling study. BMC Public Health 2020; 20:1749. [PMID: 33218317 PMCID: PMC7678223 DOI: 10.1186/s12889-020-09854-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Disease surveillance is central to the public health understanding of pertussis epidemiology. In Canada, public reporting practices have significantly changed over time, creating challenges in accurately characterizing pertussis epidemiology. Debate has emerged over whether pertussis resurged after the introduction of adsorbed pertussis vaccines (1981-1985), and if the incidence fell to its pre-1985 after the introduction of acellular pertussis vaccines (1997-1998). Here, we aim to assemble a unified picture of pertussis disease incidence in Canada. METHODS Using publicly available pertussis surveillance reports, we collected, analyzed and presented Canadian pertussis data for the period (1924-2015), encompassing the pre-vaccine era, introduction of vaccine, changes to vaccine technology, and the introduction of booster doses. Information on age began to be reported since 1952, but age reporting practices (full, partial or no ages) have evolved over time, and varied across provinces/territories. For those cases reported without age each year, we impute an age distribution by assuming it follows that of the age-reported cases. RESULTS Below the age of 20 years, the adjusted age-specific incidence from 1969 to 1988 is substantially higher than existing estimates. In children < 1 year, the incidence in some years was comparable to that during the 1988-1999 resurgence. CONCLUSIONS The results presented here suggest that the surge in the average yearly incidence of pertussis that began in 1988 was weaker than previously inferred, and in contrary to the past findings, below age 5, the average yearly incidence of pertussis from 1999 to 2015 (when the incidence dropped again) has been lower than it was from 1969 to 1988.
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Affiliation(s)
- Edward Thommes
- Sanofi Pasteur, Toronto, ON, Canada.
- University of Guelph, Guelph, Ontario, Canada.
- York University, Toronto, Ontario, Canada.
| | | | - Yanyu Xiao
- University of Cincinnati, Cincinnati, OH, USA
| | | | - Jason Lee
- Sanofi Pasteur, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Ayman Chit
- Sanofi Pasteur, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Gill CJ, Gunning CE, MacLeod W, Mwananyanda L, Thea D, Pieciak R, Kwenda G, Mupila Z, Rohani P. Asymptomatic Bordetella pertussis infections in young African infants and their mothers identified within a longitudinal cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.18.20231423. [PMID: 33236026 PMCID: PMC7685339 DOI: 10.1101/2020.11.18.20231423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite long-standing vaccination programs, pertussis incidence has increased in numerous countries; transmission by asymptomatic individuals is a suspected driver of this resurgence. However, unequivocal evidence documenting asymptomatic infections in adults and children is lacking due, in part, to the cross-sectional nature of most pertussis surveillance studies. In addition, modern pertussis surveillance relies on quantitative PCR (qPCR) using fixed diagnostic thresholds to identify cases. To address this gap, we present a longitudinal analysis of 17,442 nasopharyngeal samples collected from a cohort of 1,320 Zambian mother/infant pairs. Using full-range cycle threshold (CT) values from IS481 qPCR assays, we document widespread asymptomatic infections among mothers and also, surprisingly, among young infants. From an initial group of eight symptomatic infants who tested positive by qPCR, we identify frequent contemporaneous subclinical infections in mothers. Within the full cohort, we observe strong temporal correlation between low- and high-intensity qPCR signals. We compute a single time-averaged score for each individual summarizing the evidence for pertussis infection (EFI), and show that EFI strongly clusters within mother/infant pairs, and is strongly associated with clinical symptomatology and antibiotic use. Overall, the burden of pertussis here is substantially underestimated when restricting diagnostic criteria to IS481 CT≤35. Rather, we find that full-range CT values provide valuable insights into pertussis epidemiology in this population, and illuminate the infection arc within individuals. These findings have significant implications for quantifying asymptomatic pertussis prevalence and its contribution to overall transmission. Our results also expose limitations of threshold-based interpretations of qPCR assays in infectious disease surveillance.
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Affiliation(s)
- C J Gill
- Boston University School of Public Health, Deptartment of Global Health
| | - C E Gunning
- University of Georgia, Odum School of Ecology
| | - W MacLeod
- Boston University School of Public Health, Deptartment of Global Health
| | - L Mwananyanda
- Boston University School of Public Health, Deptartment of Global Health
- Right to Care - Zambia
| | - D Thea
- Boston University School of Public Health, Deptartment of Global Health
| | - R Pieciak
- Boston University School of Public Health, Deptartment of Global Health
| | - G Kwenda
- University of Zambia, School of Health Sciences, Department of Biomedical Science
| | | | - P Rohani
- University of Georgia, Odum School of Ecology
- University of Georgia, Center for the Ecology of Infectious Diseases
- University of Georgia, Department of Infectious Diseases
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35
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O'Regan SM, O'Dea EB, Rohani P, Drake JM. Transient indicators of tipping points in infectious diseases. J R Soc Interface 2020; 17:20200094. [PMID: 32933375 DOI: 10.1098/rsif.2020.0094] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The majority of known early warning indicators of critical transitions rely on asymptotic resilience and critical slowing down. In continuous systems, critical slowing down is mathematically described by a decrease in magnitude of the dominant eigenvalue of the Jacobian matrix on the approach to a critical transition. Here, we show that measures of transient dynamics, specifically, reactivity and the maximum of the amplification envelope, also change systematically as a bifurcation is approached in an important class of models for epidemics of infectious diseases. Furthermore, we introduce indicators designed to detect trends in these measures and find that they reliably classify time series of case notifications simulated from stochastic models according to levels of vaccine uptake. Greater attention should be focused on the potential for systems to exhibit transient amplification of perturbations as a critical threshold is approached, and should be considered when searching for generic leading indicators of tipping points. Awareness of this phenomenon will enrich understanding of the dynamics of complex systems on the verge of a critical transition.
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Affiliation(s)
- Suzanne M O'Regan
- Department of Mathematics and Statistics, Marteena Hall, 1601 E. Market St., North Carolina A&T State University, Greensboro, NC 27411 USA
| | - Eamon B O'Dea
- Odum School of Ecology, University of Georgia, Athens, GA 30602, USA.,Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA 30602, USA.,Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, USA.,Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - John M Drake
- Odum School of Ecology, University of Georgia, Athens, GA 30602, USA.,Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
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36
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Abstract
Pertussis wird durch das gramnegative Bakterium Bordetella pertussis verursacht. Die Krankheitsmanifestationen reichen von unspezifischem Husten bis zu lebensbedrohlichen Verläufen mit Hyperleukozytose und respiratorischer Insuffizienz, v.a. bei jungen Säuglingen. Die Diagnose basiert auf klinischer Symptomatik und mikrobiologischen Nachweisverfahren. Die Therapie besteht aus Makrolidantibiotika; bei Apnoen kann Koffein versucht werden. Die Inzidenz beträgt 10–40 Fälle/100.000 Bevölkerung und Jahr, bei Säuglingen ist sie am höchsten (ca. 50), gefolgt von Jugendlichen (30–35). Mehr als 50 % der in den ersten 5 Lebensmonaten an Pertussis erkrankten Kinder werden hospitalisiert. Die Impfprävention umfasst Grundimmunisierung und regelmäßige Auffrischimpfungen mit azellulären Impfstoffen. Um schwere Verläufe bei jungen Säuglingen zu verhindern, ist die Impfung schwangerer Frauen am erfolgversprechendsten. Säuglinge geimpfter Mütter sollen zeitgerecht ab dem Alter von 2 Monaten für den Eigenschutz immunisiert werden.
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Affiliation(s)
- Ulrich Heininger
- Universitäts-Kinderspital beider Basel, Spitalstr. 33, 4056 Basel, Schweiz.,Medizinische Fakultät, Universität Basel, Basel, Schweiz
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Cao J, Xu L, Pan J. Analysis of Multiple Factors Involved in Pertussis-Like Coughing. Clin Pediatr (Phila) 2020; 59:641-646. [PMID: 32075427 DOI: 10.1177/0009922820905871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. To identify risk factors associated with the prognosis of pertussis-like coughing. Methods. A retrospective study on children hospitalized with pertussis-like coughing from 2018 to 2019. We collected all the case data from medical records including age, gender, vaccination, clinical symptoms, complication, pathogens, white blood cell (WBC) count, lymphocyte ratio, application of macrolide antibiotics, usage of sulfamethoxazole, and usage of inhaled glucocorticoids. Logistic regression was used in this study. Results. A total of 213 hospitalized children with pertussis-like coughing were included in this study. About 70 children were cured within 2 weeks. One120 children were cured from 2 weeks to 3 months, including cases of initial attack and relapse. Symptoms lasting longer than 3 months accounts for 10.8%. Bordetella pertussis, WBC count >20 × 109/L and lymphocyte ratio >60% were associated with poor prognosis (P < .05). Conclusions. Bordetella pertussis, WBC count, and lymphocyte ratio are independent risk factors for poor prognosis.
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Affiliation(s)
- Jiaying Cao
- Anhui Medical University, Hefei, China.,Anhui Provincial Hospital, Hefei, China
| | - Lu Xu
- Anhui Medical University, Hefei, China
| | - Jiahua Pan
- Anhui Medical University, Hefei, China.,Anhui Provincial Hospital, Hefei, China
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Dewan KK, Linz B, DeRocco SE, Harvill ET. Acellular Pertussis Vaccine Components: Today and Tomorrow. Vaccines (Basel) 2020; 8:vaccines8020217. [PMID: 32414005 PMCID: PMC7349526 DOI: 10.3390/vaccines8020217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
Pertussis is a highly communicable acute respiratory infection caused by Bordetella pertussis. Immunity is not lifelong after natural infection or vaccination. Pertussis outbreaks occur cyclically worldwide and effective vaccination strategies are needed to control disease. Whole-cell pertussis (wP) vaccines became available in the 1940s but have been replaced in many countries with acellular pertussis (aP) vaccines. This review summarizes disease epidemiology before and after the introduction of wP and aP vaccines, discusses the rationale and clinical implications for antigen inclusion in aP vaccines, and provides an overview of novel vaccine strategies aimed at better combating pertussis in the future.
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Affiliation(s)
- Kalyan K. Dewan
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (K.K.D.); (B.L.)
| | - Bodo Linz
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (K.K.D.); (B.L.)
| | | | - Eric T. Harvill
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (K.K.D.); (B.L.)
- Correspondence:
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Li YT, Luo XQ, Zhong XB, Cai LM, Zhu LP, Chen XQ, Wang KC, Chen ZG. Seroprevalences of antibodies against pertussis, diphtheria, tetanus, measles, mumps and rubella: A cross-sectional study in children following vaccination procedure in Guangzhou, China. Vaccine 2020; 38:3960-3967. [PMID: 32321685 DOI: 10.1016/j.vaccine.2020.03.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/01/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
This study investigated the concentrations and seroprevalence of immunoglobulin G (IgG) antibodies against pertussis, diphtheria, tetanus, measles, mumps and rubella among children in Guangzhou, China. We conducted a cross-sectional study focusing on the post-vaccination immune statuses of children on scheduled immunisation. Human IgG antibody against six diseases were measured using commercial enzyme-linked immunosorbent assay kits. Of 620 subjects, the male-to-female ratio was 2.04 (416/204). Seroprevalence (81.97% vs 90.20%) and IgG concentrations (686.55 IU/mL vs 884.26 IU/mL, P < 0.05) for measles, tetanus (0.94 IU/mL vs 1.21 IU/mL) and rubella (34.33 IU/mL vs 47.37 IU/mL) were all higher in females. No differences based on sex were observed in the seroprevalence and IgG concentrations for anti-pertussis antibodies, anti-diphtheria antibodies and anti-mumps. Slight increase in seroprevalence and IgG concentration occurred with anti-pertussis antibodies after primary and booster vaccinations (from 0.00% [1 m], 5.45% [6 m], to 17.14% [1.5 yr]; and from 8.57% [5 yr] to 15.79% [6 yr]). Although no booster vaccination was given after age 6 yr, the seroprevalence and IgG concentration for anti-pertussis antibodies remained relatively stable. For diphtheria, tetanus, measles and rubella, seroprevalence reached their peaks after the primary and first booster vaccination. A plateau occurred after age 1.5 yr with a declining trend in subjects >8-10 yr. The IgG concentrations of these 4 pathogens showed a dramatic increase after primary vaccination, with steadily declining trends thereafter. For mumps, subjects showed increased seroprevalence and IgG concentration after the primary mumps-containing vaccination in 1.5-yr-olds (from 7.14% to 57.14%; 52.13 IU/mL to 214.18 IU/mL); however, following that low seroprevalence levels (from 42.86% to 80.00%) were observed. The post-vaccination immune statuses against diphtheria, tetanus, measles and rubella were relatively satisfactory, compared to those against pertussis and mumps. Booster vaccination against pertussis and mumps at appropriate time should be considered.
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Affiliation(s)
- Ya-Ting Li
- Department of Pediatrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Xiang-Qin Luo
- Department of Pediatrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Xiao-Bing Zhong
- Department of Pediatrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Liang-Ming Cai
- Department of Pediatrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China; Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, PR China
| | - Ling-Ping Zhu
- Department of Pediatrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Xiao-Qian Chen
- Department of Pediatrics, the First People's Hospital of Foshan, Foshan, PR China
| | - Kun-Cheng Wang
- Department of Clinical Laboratory, Nanhai Hospital Affiliated to Southern Medical University, Foshan, PR China
| | - Zhuang-Gui Chen
- Department of Pediatrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
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40
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Alai S, Ghattargi VC, Gautam M, Patel K, Pawar SP, Dhotre DP, Shaligram U, Gairola S. Comparative genomics of whole-cell pertussis vaccine strains from India. BMC Genomics 2020; 21:345. [PMID: 32381023 PMCID: PMC7204287 DOI: 10.1186/s12864-020-6724-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite high vaccination coverage using acellular (ACV) and whole-cell pertussis (WCV) vaccines, the resurgence of pertussis is observed globally. Genetic divergence in circulating strains of Bordetella pertussis has been reported as one of the contributing factors for the resurgence of the disease. Our current knowledge of B. pertussis genetic evolution in circulating strains is mostly based on studies conducted in countries using ACVs targeting only a few antigens used in the production of ACVs. To better understand the adaptation to vaccine-induced selection pressure, it will be essential to study B. pertussis populations in developing countries which are using WCVs. India is a significant user and global supplier of WCVs. We report here comparative genome analyses of vaccine and clinical isolates reported from India. Whole-genome sequences obtained from vaccine strains: WCV (J445, J446, J447 and J448), ACV (BP165) were compared with Tohama-I reference strain and recently reported clinical isolates from India (BPD1, BPD2). Core genome-based phylogenetic analysis was also performed using 166 isolates reported from countries using ACV. RESULTS Whole-genome analysis of vaccine and clinical isolates reported from India revealed high genetic similarity and conserved genome among strains. Phylogenetic analysis showed that clinical and vaccine strains share genetic closeness with reference strain Tohama-I. The allelic profile of vaccine strains (J445:ptxP1/ptxA2/prn1/fim2-1/fim3-1; J446: ptxP2/ptxA4/prn7/fim2-2/fim3-1; J447 and J448: ptxP1/ptxA1/ prn1/fim2-1/fim3-1), which matched entirely with clinical isolates (BPD1:ptxP1/ptxA1/prn1/fim2-1 and BPD2: ptxP1/ptxA1/prn1/fim2-1) reported from India. Multi-locus sequence typing (MLST) demonstrated the presence of dominant sequence types ST2 and primitive ST1 in vaccine strains which will allow better coverage against circulating strains of B. pertussis. CONCLUSIONS The study provides a detailed characterization of vaccine and clinical strains reported from India, which will further facilitate epidemiological studies on genetic shifts in countries which are using WCVs in their immunization programs.
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Affiliation(s)
- Shweta Alai
- Department of Health and Biological Sciences, Symbiosis International University, Pune, Maharashtra, 412115, India
| | - Vikas C Ghattargi
- National Centre for Microbial Resource, National Centre for Cell Science, Pune, Maharashtra, 411021, India
| | - Manish Gautam
- Serum Institute of India Pvt. Ltd, Pune, Maharashtra, 411028, India
| | - Krunal Patel
- Serum Institute of India Pvt. Ltd, Pune, Maharashtra, 411028, India
| | - Shrikant P Pawar
- National Centre for Microbial Resource, National Centre for Cell Science, Pune, Maharashtra, 411021, India
| | - Dhiraj P Dhotre
- National Centre for Microbial Resource, National Centre for Cell Science, Pune, Maharashtra, 411021, India
| | - Umesh Shaligram
- Serum Institute of India Pvt. Ltd, Pune, Maharashtra, 411028, India
| | - Sunil Gairola
- Serum Institute of India Pvt. Ltd, Pune, Maharashtra, 411028, India.
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41
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Jenkins VA, Savic M, Kandeil W. Pertussis in high-risk groups: an overview of the past quarter-century. Hum Vaccin Immunother 2020; 16:2609-2617. [PMID: 32298213 PMCID: PMC7746252 DOI: 10.1080/21645515.2020.1738168] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Infectious diseases can impact chronic medical conditions. However, it is currently not clear how pertussis correlates with preexisting or underlying disorders. We reviewed literature from the last 25 years to describe the burden and impact of pertussis infection in specific risk groups in individuals aged ≥11 years. Our literature search returned 543 hits, of which 18 were eligible for this review. Adolescents and adults with underlying conditions, such as asthma, chronic obstructive pulmonary disease (COPD), or obesity are potentially at increased risk of pertussis infection. Immunodeficiency and smoking have also been associated with worsened pertussis symptoms and an increased pertussis-related hospitalization rate. In patients with pertussis and preexisting asthma or COPD, symptoms were worsened, and health-care costs were consequently increased. Further efforts are needed to close the knowledge gap and to understand the burden of pertussis in at-risk adolescent and adult populations to help inform vaccination strategies and recommendations.
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Evaluation of immunisation strategies for pertussis vaccines in Jinan, China - an interrupted time-series study. Epidemiol Infect 2020; 148:e26. [PMID: 32046804 PMCID: PMC7026899 DOI: 10.1017/s0950268820000102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Studies in countries with high immunisation coverage suggest that the re-emergence of pertussis may be caused by a decreased duration of protection resulting from the replacement of whole-cell pertussis vaccine (WPV) with the acellular pertussis vaccine (APV). In China, WPV was introduced in 1978. The pertussis vaccination schedule advanced from an all-WPV schedule (1978-2007), to a mixed WPV/APV schedule (2008-2009), then to an all-APV schedule (2010-2016). Increases in the incidence of pertussis have been reported in recent years in Jinan and other cities in China. However, there have been few Chinese-population-based studies focused on the impact of schedule changes. We obtained annual pertussis incidences from 1956 to 2016 from the Jinan Notifiable Conditions Database. We used interrupted time series and segmented regression analyses to assess changes in pertussis incidence at the beginning of each year, and average annual changes during the intervention. Pertussis incidence decreased by 1.11 cases per 100 000 population (P = 0.743) immediately following WPV introduction in 1978 and declined significantly by 1.21 cases per 100 000 population per year (P < 0.0001) between 1978 and 2001. Immediately after APV replaced the fourth dose of WPV in 2008, the second and third doses in 2009, then replaced all four doses in 2010, pertussis incidence declined by 1.98, 1.98 and 1.08 cases per 100 000 population, respectively. However, the results were not statistically significant. There were significant increasing trends in pertussis incidence after APV replacements: 1.63, 1.77 and 1.78 cases/year in 2008-2016, 2009-2016 and 2010-2016, respectively. Our study shows that the impact of an all-WPV schedule may be less than the impacts of the sequential WPV/APV schedules. The short-term impact of APV was better than that of WPV; however, the duration of APV-induced protection was not ideal. The impact and duration of protective immunity resulting from APVs produced in China need further evaluation. Further research on the effectiveness of pertussis vaccination programme in Jinan, China is also necessary.
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Wong A, Opinel A, Combes SJB, Toubiana J, Brisse S. Determining Factors for Pertussis Vaccination Policy: A Study in Five EU Countries. Vaccines (Basel) 2020; 8:vaccines8010046. [PMID: 31991855 PMCID: PMC7158661 DOI: 10.3390/vaccines8010046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/26/2023] Open
Abstract
Pertussis vaccination policy varies across Europe, not only in the type of vaccine-whole cell (wP) vs. acellular (aP1/2/3/5)-but also in the schedule and recommendation for parents. This study aims to investigate the determining factors for the type of vaccine, immunization schedule and maternal immunization recommendation. From March to May 2019, experts in national health agencies and major academic or research institutions from Denmark, France, Poland, Sweden and the UK were invited to a semi-structured interview. Thematic analysis was performed on the transcripts using a codebook formulated by three coders. Inter-coder agreement was assessed. Fifteen expert interviews were conducted. The identified driving factors for pertussis vaccine policy were classified into three domains: scientific factors, sociological factors, and pragmatic factors. The determining factors for the type of vaccine were prescriber's preference, concern of adverse events following immunization (AEFI), effectiveness, and consideration of other vaccine components in combined vaccines. The determining factors for infant schedule were immunity response and the potential to improve coverage and timeliness. The determining factors for maternal immunization were infant mortality and public acceptability. To conclude, socio-political and pragmatic factors were, besides scientific factors, important in determining the pertussis vaccine type, schedule of childhood immunization and recommendations for parents.
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Affiliation(s)
- Anabelle Wong
- Institut Pasteur/INSERM/University of Versailles Saint Quentin, UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France;
- EHESP French School of Public Health, F-35000 Rennes, France
- ScHARR, The University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
- Correspondence:
| | - Annick Opinel
- Institut Pasteur/INSERM/University of Versailles Saint Quentin, UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France;
| | - Simon Jean-Baptiste Combes
- Univ Rennes, EHESP, CNRS, ARENES—UMR 6051, F-35000 Rennes, France;
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
| | - Julie Toubiana
- Institut Pasteur, Unit Biodiversity and Epidemiology of Bacterial Pathogens, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France; (J.T.); (S.B.)
- National Reference Center for Whooping Cough and OtherBordetella Infections, Institut Pasteur, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France
- Department of General Paediatrics and Infectious Diseases, Necker-Enfants malades University Hospital, Université de Paris, AP-HP, 135 rue de Sevres, 75015 Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Unit Biodiversity and Epidemiology of Bacterial Pathogens, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France; (J.T.); (S.B.)
- National Reference Center for Whooping Cough and OtherBordetella Infections, Institut Pasteur, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France
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Gestal MC, Johnson HM, Harvill ET. Immunomodulation as a Novel Strategy for Prevention and Treatment of Bordetella spp. Infections. Front Immunol 2019; 10:2869. [PMID: 31921136 PMCID: PMC6923730 DOI: 10.3389/fimmu.2019.02869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022] Open
Abstract
Well-adapted pathogens have evolved to survive the many challenges of a robust immune response. Defending against all host antimicrobials simultaneously would be exceedingly difficult, if not impossible, so many co-evolved organisms utilize immunomodulatory tools to subvert, distract, and/or evade the host immune response. Bordetella spp. present many examples of the diversity of immunomodulators and an exceptional experimental system in which to study them. Recent advances in this experimental system suggest strategies for interventions that tweak immunity to disrupt bacterial immunomodulation, engaging more effective host immunity to better prevent and treat infections. Here we review advances in the understanding of respiratory pathogens, with special focus on Bordetella spp., and prospects for the use of immune-stimulatory interventions in the prevention and treatment of infection.
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Affiliation(s)
- Monica C Gestal
- Department of Infectious Diseases, College of Veterinary Sciences, University of Georgia, Athens, GA, United States
| | - Hannah M Johnson
- Department of Infectious Diseases, College of Veterinary Sciences, University of Georgia, Athens, GA, United States
| | - Eric T Harvill
- Department of Infectious Diseases, College of Veterinary Sciences, University of Georgia, Athens, GA, United States
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45
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Abundance of the nasopharyngeal microbiome effects pertussis diagnosis and explains the sensitivity difference between bacterial culture and real-time PCR. Eur J Clin Microbiol Infect Dis 2019; 39:501-507. [DOI: 10.1007/s10096-019-03750-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
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46
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Chitkara AJ, Parikh R, Mihalyi A, Kolhapure S. Hexavalent Vaccines in India: Current Status. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1651-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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47
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Domenech de Cellès M, Magpantay FMG, King AA, Rohani P. The impact of past vaccination coverage and immunity on pertussis resurgence. Sci Transl Med 2019; 10:10/434/eaaj1748. [PMID: 29593103 DOI: 10.1126/scitranslmed.aaj1748] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/20/2017] [Accepted: 10/06/2017] [Indexed: 01/01/2023]
Abstract
The resurgence of pertussis over the past decades has resulted in incidence levels not witnessed in the United States since the 1950s. The underlying causes have been the subject of much speculation, with particular attention paid to the shortcomings of the latest generation of vaccines. We formulated transmission models comprising competing hypotheses regarding vaccine failure and challenged them to explain 16 years of highly resolved incidence data from Massachusetts, United States. Our results suggest that the resurgence of pertussis is a predictable consequence of incomplete historical coverage with an imperfect vaccine that confers slowly waning immunity. We found evidence that the vaccine itself is effective at reducing overall transmission, yet that routine vaccination alone would be insufficient for elimination of the disease. Our results indicated that the core transmission group is schoolchildren. Therefore, efforts aimed at curtailing transmission in the population at large, and especially in vulnerable infants, are more likely to succeed if targeted at schoolchildren, rather than adults.
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Affiliation(s)
- Matthieu Domenech de Cellès
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA. .,Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases Unit, Institut Pasteur, Inserm U1181, University of Versailles St-Quentin-en-Yvelines, Versailles, France
| | - Felicia M G Magpantay
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Mathematics and Statistics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - 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.,Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA 30602, USA.,Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA.,Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
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48
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Kitano T, Onishi T, Takeyama M, Shima M. Questionnaire survey on maternal pertussis vaccination for pregnant women and mothers in Nara prefecture, Japan. Hum Vaccin Immunother 2019; 16:335-339. [PMID: 31368853 DOI: 10.1080/21645515.2019.1651000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Infantile pertussis is a major concern and causes a significant health burden worldwide. Maternal adult tetanus, diphtheria, and acellular pertussis (Tdap) vaccination is very effective way of preventing infantile pertussis. However, Tdap has not been approved by the Japanese government or been included in Japan's national immunization program (NIP). We carried out a questionnaire survey to investigate whether Japanese women would accept the Tdap vaccination if they were provided with appropriate information.Methods: The questionnaire survey was administered to pregnant women who visited the Obstetrics and Gynecology Department and mothers who visited the Pediatrics Department of Nara Medical University, Kashihara City, Japan, between October 2018 and May 2019. The questionnaire included information about pertussis infection and maternal vaccination, followed by seven questions.Results: A total of 943 participants answered the questionnaire (481 pregnant women and 462 mothers). Before reading the information, just 4.6% of participants knew that infantile pertussis can be prevented by maternal vaccination. After reading the information, 93.0% and 92.6% of participants thought that the maternal Tdap vaccine should be approved by the Japanese government and be included in the NIP, respectively. Although only 67.6% of participants wished to have the maternal Tdap vaccine without government financial support after reading the information, 92.5% said they would have the vaccine with government support (P < .001).Conclusion: Most Japanese mothers and pregnant women would like the maternal Tdap vaccine to be approved by the government and included in the NIP, once they have been provided with appropriate information.
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Affiliation(s)
- Taito Kitano
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
| | - Tomoko Onishi
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
| | - Masahiro Takeyama
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
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Ben Fraj I, Bouchez V, Smaoui H, Kechrid A, Brisse S. Genome characteristics of Bordetella pertussis isolates from Tunisia. J Med Microbiol 2019; 68:1320-1323. [PMID: 31329091 DOI: 10.1099/jmm.0.001042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The recent increase in pertussis cases observed in some countries may have several causes, including the evolution of Bordetella pertussis populations towards escape of vaccine-induced immunity. Most genomic studies of B. pertussis isolates performed so far are from countries that use acellular vaccines. The objective was to analyse genomic sequences of isolates collected during the 2014 whooping cough epidemic in Tunisia, a country where whole-cell vaccines are used. Ten Tunisian isolates and four vaccine strains were sequenced and compared to 169 isolates from countries where acellular vaccines are used. Phylogenetic analysis showed that Tunisian isolates are diverse, demonstrating a multi-strain 2014 epidemic peak, and are intermixed with those circulating in other world regions, showing inter-country transmission. Consistently, Tunisian isolates have antigen variant composition observed in other world regions. No pertactin-deficient strain was observed. The Tunisian B. pertussis population appears to be largely connected with populations from other countries.
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Affiliation(s)
- Ikram Ben Fraj
- University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Valérie Bouchez
- National Reference Center for Whooping Cough and other Bordetella infections, Paris, France.,Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Hanen Smaoui
- University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Amel Kechrid
- University of Tunis El Manar, Children's Hospital of Tunis, Laboratory of Microbiology, UR12ES01, Tunis, Tunisia
| | - Sylvain Brisse
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.,National Reference Center for Whooping Cough and other Bordetella infections, Paris, France
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50
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Zhang RQ, Li GX, Li XN, Shen XX, Gao Y, Wang L, Fan T, Duan QX, Wang YK, Wang J, Feng ZS, Ma XJ. A rapid and sensitive recombinase aided amplification assay incorporating competitive internal control to detect Bordetella pertussis using the DNA obtained by boiling. Int J Infect Dis 2019; 86:108-113. [PMID: 31288091 DOI: 10.1016/j.ijid.2019.06.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/22/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Pertussis is a highly transmissible acute respiratory infection caused by the bacterial pathogen Bordetella pertussis. The purpose of this study was to develop a rapid, simple and sensitive diagnostic test for detecting this pathogen. METHODS Here we present a recombinase aided amplification (RAA) assay incorporating competitive internal amplification control (IAC) to detect Bordetella pertussis using the DNA obtained by boiling. This assay was performed in a single closed tube at 39°C within 30min. A total of 115 clinical samples suspected of pertussis were collected and tested by the internally controlled RAA assay using both extracted DNA with the commercial kit and the DNA obtained by boiling. For comparison, the real-time PCR (RT-PCR) was also performed with DNA extraction in parallel. RESULTS The sensitivity of the internally controlled RAA assay was 101 copies or 10CFU/ml per reaction in detecting plasmid DNA or B. pertussis strain. The optimum concentration of the IAC plasmid was determined to be 100 copies, and the introduction of IAC effectively reduced the occurrence of false negatives. Compared to the RT-PCR, RAA results with DNA extraction obtained 100% sensitivity and specificity, and the RAA results with heat-treated DNA showed 85.96% sensitivity and 100% specificity. CONCLUSION With the advantages of 45min turn-around time and simple steps of DNA purification, this assay could become a useful diagnostic tool for Bordetella pertussis detection and is potentially suitable for point-of-care identification to guide prompt clinical treatment.
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Affiliation(s)
- Rui-Qing Zhang
- Hebei Medical University, Shijiazhuang, 050031, Hebei, China; NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
| | - Gui-Xia Li
- Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei, China.
| | - Xin-Na Li
- NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
| | - Xin-Xin Shen
- NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
| | - Yuan Gao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, National State Key Laboratory for Infectious Disease Prevention and Control, Beijing, 102206, China.
| | - Le Wang
- Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei, China.
| | - Tao Fan
- Hebei Medical University, Shijiazhuang, 050031, Hebei, China; NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
| | - Qing-Xia Duan
- Hebei Medical University, Shijiazhuang, 050031, Hebei, China; NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
| | - Ya-Kun Wang
- Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei, China.
| | - Ji Wang
- NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
| | - Zhi-Shan Feng
- Hebei General Hospital, Shijiazhuang, 050051, Hebei, China.
| | - Xue-Jun Ma
- NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Street, Changping District, Beijing 102206, China.
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