Prevention of pertussis: from clinical trials to Real World Evidence

Structure and Immunogenicity of the Bordetella pertussis LOS-Derived Oligosaccharides in the Endosomal-Like Pre-Processing Mice Model

Glycoproteins are processed endosomally prior to presentation to T cells and subsequent induction of specific antibodies. The sugar part of glycoconjugate may be degraded while the type of the process depends on the features of the particular structure. The generated carbohydrate epitopes may differ from native structures and influence immunogenicity of the antigens. We have devised a model of endosomal-like pre-processing of Bordetella pertussis 186 oligosaccharides (OSs) to verify how it affects the immunogenicity of their conjugates. The glycoconjugates of structurally defined forms of the dodecasaccharide OS were synthesized and their immunogenicity was assessed using immunochemical methods. The structural features of the oligosaccharides and their sensitivity to deamination were analyzed by NMR spectroscopy. The distal trisaccharide-comprising pentasaccharide conjugated to a protein was the most effective in inducing immune response against the B. pertussis 186 LOS and the immune response to the complete OS conjugates was significantly lower. This could be explained by the loss of the distal trisaccharide during the in-cell deamination process suggesting that the native structure is not optimal for a vaccine antigen. Consequently, our research has shown that designing of new glycoconjugate vaccines requires the antigen structures to be verified in context of possible endosomal reactions beforehand.

Anti-FIM and Anti-FHA Antibodies Inhibit Bordetella pertussis Growth and Reduce Epithelial Cell Inflammation Through Bacterial Aggregation

The pertussis vaccination is highly recommended for infants, children, and pregnant women. Despite a high coverage of vaccination, pertussis continues to be of public health concern as a re-emerging infectious disease. The mechanism by which vaccine-elicited anti-pertussis antibodies mediate direct bactericidal effects is poorly understood. In this study, we showed that the interaction of B. pertussis with A549 epithelial cells induce release of biological factors which enhance bacteria growth. Complement-depleted antisera from vaccine-immunized guinea pigs or monoclonal antibodies targeting FHA and FIM mediate bacteria aggregation and elicit bactericidal effects. Our in vitro results indicated that aggregation of bacteria through anti-FIM and anti-FHA specific antibodies is one of the major biological mechanisms to clear bacterial infections and restore epithelial cell survival in vitro. Our data also indicates that the anti-pertussis antibodies reduce secretion of proinflammatory chemokines and cytokines by preventing interaction of B. pertussis with host cells. The results of this study not only demonstrate mechanism of action of anti-FIM and anti-FHA antibodies, but also opens translational applications for potential therapeutic approaches or development of analytical assays such as in vitro potency assays.

Clinical Findings and Management of Pertussis

Pertussis is an endemic highly infectious vaccine-preventable disease. The disease is a major cause of childhood morbidity and mortality. In the most recent years, the re-emergence of pertussis occurred, and many efforts were done to identify the possible causes. Certainly, more effective laboratory methods have a role in making the diagnosis easier. However, sub-optimal efficacy of available vaccines as well as their limited duration of protection could explain the resurgence of the disease. Many forms and clinical features of the disease, ranging from the most classical to atypical and very nuanced forms, have been reported. There are many aspects that influence the clinical features of the pathology, such as a previous immunization or infection, patient's age, gender and antibiotic treatment. A prompt suspect and a rapid diagnosis of pertussis is fundamental for an appropriate clinical management and for preventing pertussis complications, especially in children. However, under a clinical point of view, pertussis is often difficult to be diagnosed. A prompt treatment may decrease the duration and severity of cough; the cornerstone drugs are the macrolides. Although prompt diagnosis and effective therapy are important for pertussis control, only with a broad vaccination coverage will be possible to reduce circulation of Bordetella pertussis.

Trends in Hospital Admissions for Pertussis Infection: A Nationwide Retrospective Observational Study in Italy, 2002-2016

Background: Pertussis is a highly contagious infectious disease which continues to be an important public-health issue despite the high immunization coverage rates achieved. However, evidence of increased circulation of pertussis among adolescents and adults due to waning immunity and atypical clinical manifestations seem to be the main reasons for its resurgence. The aim of this study was the analysis of the epidemiological trend for pertussis-related hospitalizations in Italy, in relation with vaccination coverage and information from laboratory confirmed cases of pertussis. Methods: A retrospective observational study investigating hospitalizations for pertussis from 2002 to 2016 in Italy was conducted. Frequencies and rates of hospitalization were analyzed and hospitalization data were compared with a series of already published laboratory confirmed data. Results: This study highlighted a rising trend for pertussis hospitalizations in Italy since 2008. Infants aged <1 year showed the highest frequencies (63.39%) and average rates (74.60 × 100000 infants) of hospitalization despite an extremely high vaccination coverage (95.89%). An increasing trend of hospitalization frequency emerged for the age group with levels of IgG antibodies to pertussis toxin compatible with pertussis infection within the last year (20–29 years old age group). Conclusions: The rising trend for pertussis hospitalizations and the greater involvement of infants aged <1 year require an integrated approach, including the implementation of booster doses administration in adolescence and adulthood, the vaccination of pregnant women and the cocoon strategy.