1
|
Domenech de Cellès M, Rohani P. Pertussis vaccines, epidemiology and evolution. Nat Rev Microbiol 2024; 22:722-735. [PMID: 38907021 DOI: 10.1038/s41579-024-01064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
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.
| |
Collapse
|
2
|
Gini R, Dodd CN, Bollaerts K, Bartolini C, Roberto G, Huerta-Alvarez C, Martín-Merino E, Duarte-Salles T, Picelli G, Tramontan L, Danieli G, Correa A, McGee C, Becker BFH, Switzer C, Gandhi-Banga S, Bauwens J, van der Maas NAT, Spiteri G, Sdona E, Weibel D, Sturkenboom M. Quantifying outcome misclassification in multi-database studies: The case study of pertussis in the ADVANCE project. Vaccine 2019; 38 Suppl 2:B56-B64. [PMID: 31677950 DOI: 10.1016/j.vaccine.2019.07.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/28/2019] [Accepted: 07/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines using European healthcare databases. Event misclassification can result in biased estimates. Using different algorithms for identifying cases of Bordetella pertussis (BorPer) infection as a test case, we aimed to describe a strategy to quantify event misclassification, when manual chart review is not feasible. METHODS Four participating databases retrieved data from primary care (PC) setting: BIFAP: (Spain), THIN and RCGP RSC (UK) and PEDIANET (Italy); SIDIAP (Spain) retrieved data from both PC and hospital settings. BorPer algorithms were defined by healthcare setting, data domain (diagnoses, drugs, or laboratory tests) and concept sets (specific or unspecified pertussis). Algorithm- and database-specific BorPer incidence rates (IRs) were estimated in children aged 0-14 years enrolled in 2012 and 2014 and followed up until the end of each calendar year and compared with IRs of confirmed pertussis from the ECDC surveillance system (TESSy). Novel formulas were used to approximate validity indices, based on a small set of assumptions. They were applied to approximately estimate positive predictive value (PPV) and sensitivity in SIDIAP. RESULTS The number of cases and the estimated BorPer IRs per 100,000 person-years in PC, using data representing 3,173,268 person-years, were 0 (IR = 0.0), 21 (IR = 4.3), 21 (IR = 5.1), 79 (IR = 5.7), and 2 (IR = 2.3) in BIFAP, SIDIAP, THIN, RCGP RSC and PEDIANET respectively. The IRs for combined specific/unspecified pertussis were higher than TESSy, suggesting that some false positives had been included. In SIDIAP the estimated IR was 45.0 when discharge diagnoses were included. The sensitivity and PPV of combined PC specific and unspecific diagnoses for BorPer cases in SIDIAP were approximately 85% and 72%, respectively. CONCLUSION Retrieving BorPer cases using only specific concepts has low sensitivity in PC databases, while including cases retrieved by unspecified concepts introduces false positives, which were approximately estimated to be 28% in one database. The share of cases that cannot be retrieved from a PC database because they are only seen in hospital was approximately estimated to be 15% in one database. This study demonstrated that quantifying the impact of different event-finding algorithms across databases and benchmarking with disease surveillance data can provide approximate estimates of algorithm validity.
Collapse
Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Caitlin N Dodd
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands; Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium.
| | - Claudia Bartolini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | | | - Elisa Martín-Merino
- BIFAP Database, Spanish Agency of Medicines and Medical Devices, Madrid, Spain.
| | - Talita Duarte-Salles
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy.
| | - Lara Tramontan
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy.
| | - Giorgia Danieli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy
| | - Ana Correa
- University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Chris McGee
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK.
| | - Benedikt F H Becker
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | | | | | - Jorgen Bauwens
- University Children's Hospital, Basel, Switzerland; University of Basel, Switzerland; Brighton Collaboration Foundation, Switzerland.
| | | | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden.
| | - Emmanouela Sdona
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden
| | - Daniel Weibel
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands; P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium; VACCINE.GRID Foundation, Spitalstrasse 33, Basel, Switzerland.
| |
Collapse
|
3
|
Heil J, Ter Waarbeek HLG, Hoebe CJPA, Jacobs PHA, van Dam DW, Trienekens TAM, Cals JWL, van Loo IHM, Dukers-Muijrers NHTM. Pertussis surveillance and control: exploring variations and delays in testing, laboratory diagnostics and public health service notifications, the Netherlands, 2010 to 2013. ACTA ACUST UNITED AC 2018; 22:30571. [PMID: 28749331 PMCID: PMC5545763 DOI: 10.2807/1560-7917.es.2017.22.28.30571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022]
Abstract
Pertussis is most severe among unvaccinated infants (< 1 year of age), and still leads to several reported deaths in the Netherlands every year. In order to avoid pertussis-related infant morbidity and mortality, pertussis surveillance data are used to guide pertussis control measures. However, more insight into the accuracy of pertussis surveillance and control, and into the range of healthcare and public health-related factors that impede this are needed. We analysed a unique combination of data sources from one Dutch region of 1.1 million residents, including data from laboratory databases and local public health notifications between 2010 and 2013. This large study (n = 12,090 pertussis tests) reveals possible misdiagnoses, substantial under-notification (18%, 412/2,301 laboratory positive episodes) and a delay between patient symptoms and notification to the local public health services (median 34 days, interquartile range (IQR): 27–54). It is likely that the misdiagnoses, under-notification and overall delay in surveillance data are not unique to this area of the Netherlands, and are generalisable to other countries in Europe. In addition to preventive measures such as maternal immunisation, based on current findings, we further recommend greater adherence to testing guidelines, standardisation of test interpretation guidelines, use of automatic notification systems and earlier preventive measures.
Collapse
Affiliation(s)
- Jeanne Heil
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Henriëtte L G Ter Waarbeek
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Peter H A Jacobs
- Department of Infectious Diseases Control, North Limburg Public Health Service, Venlo, the Netherlands
| | - Dirk W van Dam
- Department of Medical Microbiology and Infection Prevention, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Thera A M Trienekens
- Department of Medical Microbiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Jochen W L Cals
- Department of General Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Inge H M van Loo
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| |
Collapse
|
4
|
Nunes MC, Downs S, Jones S, van Niekerk N, Cutland CL, Madhi SA. Bordetella pertussis Infection in South African HIV-Infected and HIV-Uninfected Mother-Infant Dyads: A Longitudinal Cohort Study. Clin Infect Dis 2017; 63:S174-S180. [PMID: 27838670 PMCID: PMC5106617 DOI: 10.1093/cid/ciw527] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background. There is a paucity of data regarding the burden of Bordetella pertussis in African women and young infants, and particularly the impact of maternal human immunodeficiency virus (HIV) infection thereon. We performed a retrospective analysis of respiratory illness samples from longitudinal cohorts of HIV-uninfected and HIV-infected women and their infants to evaluate the burden of pertussis illness in a black-African community. Methods. The women were followed up for respiratory illness from midpregnancy and together with their infants until 24 weeks postpartum. Respiratory samples obtained at the time of illness visits were tested for B. pertussis by polymerase chain reaction (PCR). Results. The study included 194 HIV-infected and 1060 HIV-uninfected women, and 188 and 1028 infant offspring, respectively. There were 7 PCR-confirmed pertussis cases in the HIV-exposed infants and 30 in HIV-unexposed infants (7.4 vs 5.5 episodes per 1000 infant-months; P = .47), at a mean age of 70.9 days. All infant pertussis cases had a history of cough (mean duration, 6.3 days). Six of 17 (35.3%) pertussis-confirmed cases in infants <2 months of age were admitted to hospital within 21 days of B. pertussis detection, whereas none of the 20 cases ≥2 months of age required hospitalization. Ten PCR-positive pertussis-associated illnesses were detected in HIV-infected women compared with 32 in the HIV-uninfected women (6.8 vs 3.9 episodes per 1000 person-months; P = .12). Conclusions. Bordetella pertussis identification was common among young infants with respiratory illness, most of whom were too young to be fully protected through direct vaccination. Vaccination of pregnant women might be a valuable strategy in a setting such us ours to prevent B. pertussis–associated illness in women and their young infants.
Collapse
Affiliation(s)
- Marta C Nunes
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Sarah Downs
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Stephanie Jones
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Nadia van Niekerk
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Clare L Cutland
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Shabir A Madhi
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand.,National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa
| |
Collapse
|
5
|
Teunis P, Figueras MJ. Reassessment of the Enteropathogenicity of Mesophilic Aeromonas Species. Front Microbiol 2016; 7:1395. [PMID: 27708621 PMCID: PMC5030306 DOI: 10.3389/fmicb.2016.01395] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022] Open
Abstract
Cases of Aeromonas diarrhea have been described all over the world. The genus Aeromonas includes ca. 30 species, of which 10 have been isolated in association with gastroenteritis. The dominating species that account for ca. 96% of the identified strains are Aeromonas caviae, A. veronii, A. dhakensis, and A. hydrophila. However, the role of Aeromonas as a true enteropathogen has been questioned on the basis of the lack of outbreaks, the non-fulfillment of Koch's postulates and the low numbers of acute illnesses in the only existing human challenge study. In the present study we reassess the enteropathogenicity of Aeromonas using dose response models for microbial infection and acute illness. The analysis uses the data from the human challenge study and additional data from selected outbreak investigations where the numbers exposed and the dose were reported, allowing their inclusion as "natural experiments". In the challenge study several cases of asymptomatic shedding were found (26.3%, 15/57), however, only 3.5% (2/57) of those challenged with Aeromonas developed acute enteric symptoms (i.e., diarrhea). The "natural experiments" showed a much higher risk of illness associated with exposure to Aeromonas, even at moderate to low doses. The median dose required for 1% illness risk, was ~1.4 × 104 times higher in the challenge study (1.24 × 104 cfu) compared to natural exposure events (0.9 cfu). The dose response assessment presented in this study shows that the combined challenge and outbreak data are consistent with high infectivity of Aeromonas, and a wide range of susceptibility to acute enteric illness. To illustrate the outcomes, we simulate the risk associated with concentrations of Aeromonas found in different water and food matrices, indicating the disease burden potentially associated with these bacteria. In conclusion this study showed that Aeromonas is highly infectious, and that human susceptibility to illness may be high, similar to undisputed enteropathogens like Campylobacter or Salmonella.
Collapse
Affiliation(s)
- Peter Teunis
- Centre for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, BilthovenNetherlands
- Center for Global Safe WASH, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GAUSA
| | - Maria J. Figueras
- Unitat de Microbiologia, Departament de Ciènces Médiques Bàsiques, Facultat de Medicina i Ciències de la Salut, Pere Virgili Institute for Health Research, Universitat Rovira i Virgili, ReusSpain
| |
Collapse
|