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Yılmaz Çolak Ç. Microfluidic point-of-care testing for the detection of Bordetella pertussis: A mini-review. Diagn Microbiol Infect Dis 2024; 109:116239. [PMID: 38552444 DOI: 10.1016/j.diagmicrobio.2024.116239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/30/2024]
Abstract
Bordetella pertussis is a bacterial pathogen responsible for pertussis, which is a highly contagious respiratory disease. Despite the relatively high vaccination coverage, pertussis is considered a reemerging disease that necessitates enhanced strategies for identification, prevention, and control. The diagnosis of pertussis typically involves a combination of clinical evaluation, laboratory tests, and a thorough medical history. The current technologies for pertussis diagnosis have their own limitations, prompting the exploration of alternative diagnostic approaches that offer enhanced sensitivity, specificity, and speed. Microfluidic technology is considered a very promising tool for the diagnosis of infectious diseases, as it offers more rapid and accurate outputs. It allows point-of-care testing (POCT) at or near the patient site, which can be critical, especially for an outbreak or pandemic. In this paper, current pertussis diagnostic tools with their limitations were discussed, and microfluidic approaches for the diagnosis of pertussis were highlighted.
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Bennai RM, Zouaki A, El Amin G, Rahani A, Zirar J, Seffar M, Soully K, Mahraoui C, Kabbaj H. Pertussis outbreak in children hospitalized in Rabat (Morocco). Diagn Microbiol Infect Dis 2024; 109:116225. [PMID: 38492491 DOI: 10.1016/j.diagmicrobio.2024.116225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Cyclical pertussis epidemics primarily affect young infants. This study aims to estimate pertussis prevalence during the ongoing 2023 outbreak at our institution, focusing on affected age groups and clinical presentations. MATERIEL AND METHODS This retrospective study includes patients admitted to Rabat University Hospital Center from 1st January 2021 to 30th June 2023. Symptomatic patients underwent Multiplex Respiratory Panel PCR testing for respiratory infections. The analysis included cases where RT-PCR identified Bordetella spp., with data analysed using SPSS 15.0. RESULTS Pertussis cases sharply increased from December 2022, constituting 85.4 % of positive samples. Most cases (78.2 %) occurred in infants under 3 months, presenting symptoms such as coughing (94.5 %) and dyspnoea (94.5 %). Pertussis was suspected in 60 % of RT-PCR confirmed cases. B. pertussis DNA was identified in 81.8 % of cases and B. parapertussis DNA in 18.2 % of cases. CONCLUSION The study exposes a significant pertussis outbreak affecting predominantly young infants.
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Affiliation(s)
- Redouane Mammar Bennai
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco.
| | - Amal Zouaki
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Ghizlane El Amin
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Abdeljalil Rahani
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Jalila Zirar
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Myriam Seffar
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
| | - Karim Soully
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Central Laboratory of Bacteriology, Rabat, Morocco
| | - Chafik Mahraoui
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Children Hospital, Rabat, Morocco
| | - Hakima Kabbaj
- Mohamed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco; Ibn Sina University Hospital Center, Specialties Hospital, Central Laboratory of Virology, Rabat, Morocco
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Martini H, Soetens O, Demuyser T, Van Honacker E, Piérard D, Wybo I. Evaluation of the ELITe InGenius and Bordetella ELITe MGB Kit for the detection and identification of B. pertussis, B. parapertussis and B. holmesii. Diagn Microbiol Infect Dis 2024; 109:116348. [PMID: 38759432 DOI: 10.1016/j.diagmicrobio.2024.116348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Bordetella pertussis is the causative pathogen of whooping cough or pertussis, a contagious respiratory disease. Aside from serodiagnosis, laboratory confirmation of pertussis is done through PCR, as B. pertussis is difficult to culture. The ELITe InGenius instrument (ELITechGroup, France) with accompanying Bordetella ELITe MGB Kit was evaluated against a laboratory-developed assay. Both assays combine two screening (IS481, IS1001) and two confirmation targets (recA, ptxA-Pr or IS1002) for optimal sensitivity and specificity. The company's stated claims on sensitivity and reproducibility were confirmed. Accuracy testing showed full concordance between both assays for the screening targets. Minor discrepancies were seen for the B. pertussis confirmation target. Some cross-reactivity with other Bordetella species was observed for the IS481-target, however, none of these were confirmed in the ptxA-Pr target. These results show the suitability of the Bordetella ELITe MGB Kit for the detection and differentiation of B. pertussis, B. parapertussis and B. holmesii.
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Affiliation(s)
- Helena Martini
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium.
| | - Oriane Soetens
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium
| | - Thomas Demuyser
- Department of Microbiology, University Hospital Antwerp, Edegem, Belgium
| | - Eveline Van Honacker
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium
| | - Denis Piérard
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium
| | - Ingrid Wybo
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium
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Merdrignac L, Aït El Belghiti F, Pandolfi E, Acosta L, Fabiánová K, Habington A, García Cenoz M, Bøås H, Toubiana J, Tozzi AE, Jordan I, Zavadilová J, O'Sullivan N, Navascués A, Flem E, Croci I, Jané M, Křížová P, Cotter S, Fernandino L, Bekkevold T, Muñoz-Almagro C, Bacci S, Kramarz P, Kissling E, Savulescu C. Effectiveness of one and two doses of acellular pertussis vaccines against laboratory-confirmed pertussis requiring hospitalisation in infants: Results of the PERTINENT sentinel surveillance system in six EU/EEA countries, December 2015 - December 2019. Vaccine 2024; 42:2370-2379. [PMID: 38472070 PMCID: PMC11007387 DOI: 10.1016/j.vaccine.2024.02.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Monitoring effectiveness of pertussis vaccines is necessary to adapt vaccination strategies. PERTINENT, Pertussis in Infants European Network, is an active sentinel surveillance system implemented in 35 hospitals across six EU/EEA countries. We aim to measure pertussis vaccines effectiveness (VE) by dose against hospitalisation in infants aged <1 year. METHODS From December 2015 to December 2019, participating hospitals recruited all infants with pertussis-like symptoms. Cases were vaccine-eligible infants testing positive for Bordetella pertussis by PCR or culture; controls were those testing negative to all Bordetella spp. For each vaccine dose, we defined an infant as vaccinated if she/he received the corresponding dose >14 days before symptoms. Unvaccinated were those who did not receive any dose. We calculated (one-stage model) pooled VE as 100*(1-odds ratio of vaccination) adjusted for country, onset date (in 3-month categories) and age-group (when sample allowed it). RESULTS Of 1,393 infants eligible for vaccination, we included 259 cases and 746 controls. Median age was 16 weeks for cases and 19 weeks for controls (p < 0.001). Median birth weight and gestational age were 3,235 g and week 39 for cases, 3,113 g and week 39 for controls. Among cases, 119 (46 %) were vaccinated: 74 with one dose, 37 two doses, 8 three doses. Among controls, 469 (63 %) were vaccinated: 233 with one dose, 206 two doses, 30 three doses. Adjusted VE after at least one dose was 59 % (95 %CI: 36-73). Adjusted VE was 48 % (95 %CI: 5-71) for dose one (416 eligible infants) and 76 % (95 %CI: 43-90) for dose two (258 eligible infants). Only 42 infants were eligible for the third dose. CONCLUSIONS Our results suggest moderate one-dose and two-dose VE in infants. Larger sample size would allow more precise estimates for dose one, two and three.
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Affiliation(s)
| | | | - Elisabetta Pandolfi
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Lesly Acosta
- Public Health Agency of Catalonia (ASPCAT), Barcelona, Spain; Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya- BarcelonaTech (UPC), Barcelona, Spain
| | | | | | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Håkon Bøås
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Julie Toubiana
- Biodiversité et Epidémiologie des bactéries et pathogènes, Institut Pasteur, Paris, France; National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Alberto E Tozzi
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Iolanda Jordan
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | | | | | | | - Elmira Flem
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Ilena Croci
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Mireia Jané
- Public Health Agency of Catalonia (ASPCAT), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Pavla Křížová
- National Institute of Public Health, Prague, Czech Republic
| | | | - Leticia Fernandino
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Terese Bekkevold
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sabrina Bacci
- European Centre for Diseases Control and Prevention, Stockholm, Sweden
| | - Piotr Kramarz
- European Centre for Diseases Control and Prevention, Stockholm, Sweden
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Singh V, S B, Lalwani S, Singh R, Singh P, Datta K, Mohanty N, Poddar S, Sodani R, Saha M, Mitra M. Evaluation of Pertussis Disease in Young Infants in India: A Hospital-Based Multicentric Observational Study. Indian J Pediatr 2024; 91:358-365. [PMID: 37378885 DOI: 10.1007/s12098-023-04700-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/19/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To evaluate the incidence of laboratory-confirmed pertussis (LCP) among infants hospitalized with acute respiratory infections (ARIs) and meeting the Centers for Disease Control and Prevention (CDC)-recommended clinical case definition. METHODS An investigator-initiated active surveillance for clinically suspected cases (CSCs) of pertussis screened infants aged ≤6 mo hospitalized with ARIs during January 2020-April 2022 at seven centers across India. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect Bordetella pertussis in nasopharyngeal swabs. Infants were classified as having 'LCP' or 'probable pertussis' (PP). RESULTS Among 1102 screened infants, 400 participants met the CDC-2020 clinical case definition for pertussis. Of these, 34/400 (8.5%) had LCP and 46/400 (11.5%) had PP. The proportion of participants with LCP and PP was similar among infants aged 0-3 and 4-6 mo [LCP: 0-3 mo, 21/248 (~9%); 4-6 mo, 13/152 (~9%); PP: 0-3 mo, 30/248 (~12%); 4-6 mo, 16/152 (~11%)]. Cough illness lasted ≥2 wk in 3/34 (~9%) and 34/46 (~74%) participants with LCP and PP, respectively. Notably, 80% CSCs had neither LCP nor PP, and a respiratory pathogen apart from B. pertussis was detected in ~32%. Ventilation was required in 12 participants with LCP/PP. CONCLUSIONS In this first study from India based on revised CDC guidelines, the incidence of LCP was 8.5%; cough illness was not a predominant feature. Infants below the age appropriate for vaccination are prone to pertussis-related hospital admissions, ICU care, and ventilation. Maternal immunization may be evaluated for neonatal protection, in addition to other strategies, to decrease disease burden in this highly vulnerable group. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2019/12/022449.
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Affiliation(s)
- Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Balasubramanian S
- Department of Pediatrics, Kanchi Kamakoti Childs Trust Hospital, Chennai, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharathi Vidyapeeth Hospital, Pune, India
| | - Raghvendra Singh
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Priti Singh
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Kalpana Datta
- Department of Pediatrics, Medical College & Hospital, Kolkata, India
| | - Nimain Mohanty
- Department of Pediatrics, MGM Medical College, Mumbai, India
| | - Sumon Poddar
- Department of Microbiology, Institute of Child Health, Kolkata, India
| | - Ravitanaya Sodani
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Manipa Saha
- Department of Medical Affairs, Medclin Research Private Limited, Kolkata, India
| | - Monjori Mitra
- Department of Pediatrics, Institute of Child Health, 11 Biresh Guha Street, Kolkata, 700017, India.
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Monterrubio-López GP, Llamas-Monroy JL, Martínez-Gómez ÁA, Delgadillo-Gutiérrez K. Novel vaccine candidates of Bordetella pertussis identified by reverse vaccinology. Biologicals 2024; 85:101740. [PMID: 38217963 DOI: 10.1016/j.biologicals.2023.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 01/15/2024] Open
Abstract
Whooping cough is a disease caused by Bordetella pertussis, whose morbidity has increased, motivating the improvement of current vaccines. Reverse vaccinology is a strategy that helps identify proteins with good characteristics fast and with fewer resources. In this work, we applied reverse vaccinology to study the B. pertussis proteome and pangenome with several in-silico tools. We analyzed the B. pertussis Tohama I proteome with NERVE software and compared 234 proteins with B. parapertussis, B. bronchiseptica, and B. holmessi. VaxiJen was used to calculate an antigenicity value; our threshold was 0.6, selecting 84 proteins. The candidates were depurated and grouped in eight family proteins to select representative candidates, according to bibliographic information and their immunological response predicted with ABCpred, Bcepred, IgPred, and C-ImmSim. Additionally, a pangenome study was conducted with 603 B. pertussis strains and PanRV software, identifying 3421 core proteins that were analyzed to select the best candidates. Finally, we selected 15 proteins from the proteome study and seven proteins from the pangenome analysis as good vaccine candidates.
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Affiliation(s)
- Gloria Paulina Monterrubio-López
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN), Mexico City, Mexico
| | - José Luis Llamas-Monroy
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN), Mexico City, Mexico
| | - Ángel Antonio Martínez-Gómez
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN), Mexico City, Mexico
| | - Karen Delgadillo-Gutiérrez
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN), Mexico City, Mexico.
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Surmann B, Witte J, Batram M, Criée CP, Hermann C, Leischker A, Schelling J, Steinmüller M, Wahle K, Heiseke AF, Marijic P. Epidemiology of Pertussis and Pertussis-Related Complications in Adults: A German Claims Data Analysis. Infect Dis Ther 2024; 13:385-399. [PMID: 38294623 PMCID: PMC10904701 DOI: 10.1007/s40121-023-00912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Pertussis is a highly contagious respiratory infection. It affects people of all ages, yet evidence of the impact of pertussis in adults with underlying conditions (UCs) is scarce. This study investigated the incidence and complication rate of pertussis in adult patients with and without UC. METHODS A retrospective analysis was conducted using routinely collected German claims data between 2015 and 2019. Patients with and without different pneumological, cardiovascular, endocrinological, musculoskeletal, and psychological UCs were matched for incidence estimation. Logistic regression models were used to estimate the risk of pertussis depending on the presence of UCs. Negative binomial models were used to assess complication rates in patients with pertussis and with and without UC. RESULTS In total, 4383 patients were diagnosed with pertussis during the study period. Patients with any UC had an increased risk for pertussis compared to matched patients without UC (odds ratio [OR] 1.72; 95% confidence interval [CI]1.60-1.84, p < 0.0001). Underlying asthma had the highest risk of pertussis (OR 2.70; 95% CI 2.50-2.91, p < 0.0001), followed by chronic obstructive pulmonary disease (OR 2.35; 95% CI 2.10-2.60, p < 0.0001) and depression (OR 2.08; 95% CI 1.95-2.22, p < 0.0001). Severe complications occurred in 10.8% of the pertussis cohort (13.4% with UC vs. 9.5% without UC). The UC-attributable effect on the risk of severe pertussis-related complications was significantly increased for any UC (incidence rate ratio [IRR] 1.29, 95% CI 1.19-1.39). The severe complication risk was also increased for patients aged 60+ (IRR 1.59, 95% CI 1.46-1.72). CONCLUSION This study shows that adults with certain UCs have an increased risk for pertussis and are more likely to have complications. These results provide further evidence that pertussis is a relevant and impactful infectious disease in adults with and without certain UC, indicating that these patients need to be considered when developing vaccination recommendations to avoid pertussis and its associated complications. A graphical abstract is available with this article.
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Affiliation(s)
- Bastian Surmann
- Vandage GmbH, Detmolder Straße 30, 33604, Bielefeld, Germany
| | - Julian Witte
- Vandage GmbH, Detmolder Straße 30, 33604, Bielefeld, Germany.
| | - Manuel Batram
- Vandage GmbH, Detmolder Straße 30, 33604, Bielefeld, Germany
| | - Carl Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Goettingen-Weende, Bovenden, Germany
| | - Christiane Hermann
- Department of Clinical Psychology, Justus-Liebig University Giessen, Giessen, Germany
| | - Andreas Leischker
- Department for Geriatrics, Working Group "Vaccination", German Geriatric Society, Cologne, Germany
- Asklepios Hospital Wandsbek, Hamburg, Germany
| | - Jörg Schelling
- Medizinische Klinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Klaus Wahle
- Department of General Medicine, University of Muenster, Muenster, Germany
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Slaoui B, Saidi H, Kamal M, Kafty K, Nourlil J, Diawara I, Zerouali K, Belabbes H, Elmdaghri N. [Epidemiological profile of pertussis in infants in Casablanca from 2012 to 2019]. Pan Afr Med J 2023; 46:124. [PMID: 38465012 PMCID: PMC10924602 DOI: 10.11604/pamj.2023.46.124.42073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/18/2023] [Indexed: 03/12/2024] Open
Abstract
Pertussis is a real public health problem due to high neonatal morbidity rates and resurgence despite high vaccination coverage. The purpose of this study is to analyze the epidemiological profile of pertussis in infants hospitalized from 2012 to 2019. We conducted a retrospective, descriptive study over a 7-year and 8-month period from January 2012 to July 2019. It involved 500 infants admitted with clinical suspicion of pertussis. The average age of infants was 72 days, ranging from 28 days to 18 months; 75% of infants were less than 3 months old. The peak incidence was registered in 2012 and 2016, with a summer predominance (32%); 460 infants (92%) were not or incompletely vaccinated, 42.2% of whom were too young to be vaccinated. A probable contaminant in the entourage was found in 43,6% of cases. Whooping cough and cyanosis were the main reason for hospitalization (77.6%). Chest radiography objectified bronchial disease (25,4%) and alveolar foci (22.7%). Blood count performed in 410 infants showed hyperlymphocytosis in 67.5% of cases. Polymerase chain reaction (PCR) on nasopharyngeal sample collected from 206 infants was positive for Bordetella pertussis in 64% of cases; 118 PCR performed in mothers were positive in 47.7% of cases. All infants received Clarithromycin. Pertussis is a major cause of morbidity in infants in Casablanca. The prevention strategy is based on vaccination of family members of infants. However, vaccination of pregnant women appears to be more effective.
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Affiliation(s)
- Bouchra Slaoui
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Unité de Pneumo-allergologie Pédiatrique, Service de Pédiatrie 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Hajar Saidi
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Unité de Pneumo-allergologie Pédiatrique, Service de Pédiatrie 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Meryem Kamal
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Unité de Pneumo-allergologie Pédiatrique, Service de Pédiatrie 2, Hôpital Mère-Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Khalid Kafty
- Département de Microbiologie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Service de Microbiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Jalal Nourlil
- Laboratoire de Virologie, Institut Pasteur du Maroc, Casablanca
| | - Idrissa Diawara
- Département de Microbiologie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Service de Microbiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
- Faculté des Sciences et Techniques de la Santé, Université Mohamed VI des Sciences de la Santé, Casablanca, Maroc
| | - Khalid Zerouali
- Département de Microbiologie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Service de Microbiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Houria Belabbes
- Département de Microbiologie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Service de Microbiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Naima Elmdaghri
- Département de Microbiologie, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
- Service de Microbiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
- Laboratoire de Virologie, Institut Pasteur du Maroc, Casablanca
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McCarron SA, Bradley DT, Hart ND. A scoping review of the reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnant women in the United Kingdom and Ireland. BMC Pregnancy Childbirth 2023; 23:857. [PMID: 38087222 PMCID: PMC10717507 DOI: 10.1186/s12884-023-06171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pertussis and influenza cause significant morbidity and mortality in pregnancy and the neonatal period. Maternal vaccination in pregnancy would reduce harm, but low vaccine uptake is a concern. This scoping review aimed to understand the reasons for, and approaches, to non-uptake of pertussis and influenza vaccinations in pregnant women in the UK and Ireland. METHODS The inclusion criteria of this scoping review consist of pregnant women who avail of pertussis and influenza vaccines in the UK and Ireland. MEDLINE, EMBASE, Web of Science and CINAHL databases were searched in June 2021 and updated in October 2022. Searches were limited to English language reports published after 2011. We followed the Joanna Briggs Institute guidance on scoping reviews. Data were extracted and charted. RESULTS Five themes emerged from the literature. Acceptability, as well as organisational and awareness issues, were overarching themes regarding reasons for and approaches to non-uptake of the vaccines respectively. Other themes included healthcare professional factors, information interpretation and pregnancy-related factors. CONCLUSIONS Women need clear, comprehensible information, ideally provided by their healthcare professionals, in a way that is meaningful and addresses their circumstances and risk perceptions. This research will serve as a base for future work that aims behaviour science interventions at the wider pregnant population as well as the target groups that have been identified in this review.
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GALASSI FRANCESCOMARIA, VAROTTO ELENA, MARTINI MARIANO. The history of pertussis: from an ancient scourge to a contemporary health burden. J Prev Med Hyg 2023; 64:E507-E511. [PMID: 38379743 PMCID: PMC10876032 DOI: 10.15167/2421-4248/jpmh2023.64.4.3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
The present article offers a historical overview on pertussis (whooping cough) by analysing the ancient epidemic manifestations of the disease and the path towards the discovery of an effective vaccine against it. The original mentions of pertussis are examined with reference to Mediaeval Afghanistan and the famous AD 1578 Paris epidemic described by the French physician Guillaume de Baillou. The historical data are then matched with information derived from analyses of phylogenetic trees of B. pertussis. Finally, this article also highlights some recent challenges posed to public health by this infectious disease.
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Affiliation(s)
- FRANCESCO MARIA GALASSI
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - ELENA VAROTTO
- Archaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, SA, Australia
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Tessier E, Newport D, Tran A, Nash SG, Mensah AA, Yun Wang T, Shantikumar S, Campbell H, Amirthalingam G, Todkill D. Pertussis immunisation strategies to optimise infant pertussis control: A narrative systematic review. Vaccine 2023; 41:5957-5964. [PMID: 37658001 DOI: 10.1016/j.vaccine.2023.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants. METHODS We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias. FINDINGS A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies. CONCLUSION Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants.
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Affiliation(s)
| | - Daniel Newport
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Anh Tran
- UK Health Security Agency, London, UK
| | | | | | | | | | | | | | - Daniel Todkill
- UK Health Security Agency, London, UK; Warwick Medical School, University of Warwick, Coventry, UK
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Kim H, Shin JY, Chen J, Kim JH, Noh Y, Cheong HJ, Oh YM, Guignard A, Shantakumar S. Risk Factors of Pertussis Among Older Adults in South Korea: A Nationwide Health Data-Based Case-Control Study. Infect Dis Ther 2023; 12:545-561. [PMID: 36588139 PMCID: PMC9925654 DOI: 10.1007/s40121-022-00747-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION To better understand the conditions associated with pertussis diagnosis among older adults in South Korea, a matched case-control study was conducted of individuals ≥ 50 years diagnosed with pertussis between 2009 and 2018. METHODS Pertussis cases were identified using the nationwide Health Insurance Review and Assessment service (HIRA) database. Each case was then matched to up to 10 controls identified using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) by age, sex, and geographic region at index date. In the 12 months and 30 days prior to index date, the presence of clinical characteristics previously reported to be related to pertussis and pertussis-like conditions were assessed, respectively. A conditional multivariate logistic regression model was then used to calculate odds ratios (ORs) of pertussis diagnosis, adjusted for each of the characteristics. RESULTS Pertussis cases (n = 1004) generally demonstrated a higher prevalence of comorbidities compared to controls (n = 9710). Pre-existing asthma and chronic obstructive pulmonary disease (COPD) within 12 months of index date were associated with a two-fold increased risk of pertussis with adjusted ORs (95% confidence interval) of 2.08 (1.68-2.58) and 2.32 (1.59-3.39), respectively. Gastroesophageal reflux disease [GERD; 2.67 (2.23-3.19)], cancer [1.68 (1.23-2.31)], cardiovascular disease [1.62 (1.31-2.00)], renal disease [1.56 (1.12-2.16)], autoimmune disease [1.50 (1.25-1.79)], and hyperlipidemia [1.43 (1.16-1.77)] were also associated with pertussis diagnosis. Finally, acute respiratory events within 30 days prior to index date, such as pneumonia, acute bronchitis, and upper respiratory tract infection (URTI), were highly associated with increased odds of pertussis diagnosis [adjusted ORs of 8.28 (5.10-13.44), 4.86 (3.84-6.14), and 2.90 (2.30-3.67), respectively]. CONCLUSIONS This study's findings complement and expand upon previous studies on the adult pertussis population, generating real-world data to describe underlying clinical characteristics of those diagnosed with pertussis in South Korea.
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Affiliation(s)
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Seobu-ro 2066, Jangan-gu, Suwon, Gyeonggi-do, 440-746, South Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea.
| | | | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Seobu-ro 2066, Jangan-gu, Suwon, Gyeonggi-do, 440-746, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Seobu-ro 2066, Jangan-gu, Suwon, Gyeonggi-do, 440-746, South Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeon-Mok Oh
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Hebballi NB, Parker T, Garcia EI, Ferguson DM, Lesser S, Tsao K, Broussard M, Wootton SH. Pertussis and influenza immunization: perceived attitude and decision of postpartum patients. BMC Pregnancy Childbirth 2022; 22:975. [PMID: 36577947 PMCID: PMC9795743 DOI: 10.1186/s12884-022-05296-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Vaccination of pregnant patients with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccine during influenza season can reduce maternal and fetal morbidity and mortality; nevertheless, vaccination rates remain suboptimal in this patient population. To investigate the effect of a brief educational counseling session on maternal Tdap and influenza vaccination and determine factors influencing women's decision in regards to receiving Tdap and or influenza vaccine during their pregnancy. METHODS A face-to-face semi-structured cross-sectional survey was administered to postpartum patients on their anticipated day of discharge (June 11-August 21, 2018). A brief educational counseling session about maternal pertussis and Tdap vaccine was provided to interested patients after which the Tdap vaccine was offered to eligible patients who did not receive it during their pregnancy or upon hospital admission. Medical records were reviewed to determine if surveyed patients were vaccinated prior to discharge. RESULTS Two hundred postpartum patients were surveyed on their day of anticipated discharge. Of those who were surveyed, 103 (51.5%) had received Tdap and 80 (40.0%) had received influenza vaccinations prior to hospitalization. Among immunized patients, the common facilitators were doctor's recommendation (Tdap: 68, 54.4%; influenza: 3, 6.0%), to protect their baby (Tdap: 57, 45.6%; influenza: 17, 34.0%) and for self-protection (Tdap: 17, 13.6%; Influenza: 17, 34.0%). Of the 119 participants who had not received either Tdap or influenza vaccine prior to the survey, the barriers cited were that the vaccine was not offered by the provider (Tdap: 36, 52.2%; influenza: 29, 27.6%), belief that vaccination was unnecessary (Tdap: 5, 7.2%; influenza: 9, 8.5%), safety concerns for baby (Tdap: 4, 5.8%; influenza: 2, 1.9%). Of 97 patients who were not immunized with Tdap prior to admission but were eligible to receive vaccine, 24 (25%) were vaccinated prior to survey as part of routine hospital-based screening and vaccination program, 29 (38.2%) after our survey. CONCLUSION Interventions to educate pregnant patients about the benefits of vaccination for their baby, addressing patient safety concerns, and vaccine administration in obstetricians' offices may significantly improve maternal vaccination rates.
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Affiliation(s)
- Nutan B. Hebballi
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Tayler Parker
- grid.267308.80000 0000 9206 2401Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Elisa I. Garcia
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Dalya M. Ferguson
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Susan Lesser
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - KuoJen Tsao
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA ,grid.430695.d0000 0004 0444 5322Children’s Memorial Hermann Hospital, Houston, TX USA
| | - Maryam Broussard
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Susan H. Wootton
- grid.430695.d0000 0004 0444 5322Children’s Memorial Hermann Hospital, Houston, TX USA ,grid.267308.80000 0000 9206 2401Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX USA
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Ruiz-Botia I, Riera-Bosch MT, Rodríguez-Losada O, Soler-Palacín P, Melendo S, Moraga-Llop F, Balcells-Ramírez J, Otero-Romero S, Armadans-Gil L. Impact of vaccinating pregnant women against pertussis on hospitalizations of children under one year of age in a tertiary hospital in Catalonia. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:473-478. [PMID: 35752569 DOI: 10.1016/j.eimce.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The recommendation for pertussis vaccination in pregnancy was established in Catalonia in February 2014. The objective of this study was to compare the hospitalisation rate for pertussis in children under one year of age before and after the implementation of the vaccination programme. METHODS Observational and retrospective study of patients under one year of age admitted to hospital with a diagnosis of pertussis. The hospitalisation rate of patients under one year of age of the period prior to the vaccination programme (2008-2013) was compared with the period with vaccination programme (2014-2019) in the total of children under one year of age and in 2 subgroups: children under 3 months and between 3-11 months. RESULTS Hospitalization rate was significantly lower in the period with vaccination programme in children under one year of age and specifically in children under 3 months (2.43 vs. 4.72 per 1000 person-years and 6.47 vs. 13.11 per 1000 person-years, respectively). The rate ratios were: 0.51 (95% CI 0.36-0.73) for children under one year of age; 0.49 (95% CI 0.32-0.75) for those younger than 3 months and 0.56 (95% CI 0.30-1.03) for those with 3-11 months. No statistically significant differences were observed in the clinical severity between both periods. CONCLUSION The introduction of the pertussis vaccination programme in pregnancy was associated with a global lower hospitalisation rate for pertussis in children under one year of age and specifically in those under 3 months of age.
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Affiliation(s)
- Irene Ruiz-Botia
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | | | - Olalla Rodríguez-Losada
- Unidad de Urgencias Pediátricas, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Pere Soler-Palacín
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Susana Melendo
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Moraga-Llop
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Balcells-Ramírez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Susana Otero-Romero
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Lluís Armadans-Gil
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
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Merdrignac L, Acosta L, Habington A, Garcìa Cenoz M, Pandolfi E, Fabiánová K, Jordan I, O'Sullivan N, Navasués A, Tozzi AE, Zavadilová J, Jané M, Cotter S, Pitillas NI, Rizzo C, Křížová P, Hanslik T, Muñoz Almagro C, Pastore L, Bacci S, Moren A, Valenciano M; PERTINENT Group. Effectiveness of pertussis vaccination in pregnancy to prevent hospitalisation in infants aged <2 months and effectiveness of both primary vaccination and mother's vaccination in pregnancy in infants aged 2-11 months. Vaccine 2022; 40:6374-82. [PMID: 36182617 DOI: 10.1016/j.vaccine.2022.09.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND PERTINENT is an active hospital-based surveillance system for pertussis in infants. In 2019, four of the six participating European countries recommended pertussis vaccination in pregnancy. Among infants aged <2 months, we measured the vaccine effectiveness (VE) in pregnancy; among infants aged 2-11 months, VE of vaccination in pregnancy and of primary vaccination (PV). METHODS From December 2015 to 2019, we included all infants aged <1 year presenting with pertussis-like symptoms. Using a test-negative-design, cases were infants testing positive for Bordetella pertussis by PCR or culture. Controls were those testing negative for all Bordetella species. Vaccinated mothers were those who received vaccine in pregnancy. Vaccinated infants were those who received ≥1 dose of PV > 14 days before symptom onset. We excluded infants with unknown maternal or PV status or with mothers vaccinated ≤14 days before delivery. We calculated pooled VE as 100 * (1-odds ratio of vaccination) adjusted for study site, onset date in quarters and infants' age group. RESULTS Of 829 infants presenting with pertussis-like symptoms, 336 (41%) were too young for PV. For the VE in pregnancy analysis, we included 75 cases and 201 controls. Vaccination in pregnancy was recorded for 9 cases (12%) and 92 controls (46%), adjusted VE was between 75% [95%CI: 35-91%] and 88% [95%CI: 57-96%]. Of 493 infants eligible for PV, we included 123 cases and 253 controls. Thirty-one cases and 98 controls recorded both PV with ≥ 1 dose and vaccination in pregnancy, adjusted VE was between 74% [95%CI: 33-90] and 95% [95%CI: 69-99]; 27 cases and 53 controls recorded PV only, adjusted VE was between 68% [95%CI: 27-86] and 94% [95%CI: 59-99]. CONCLUSION Our findings suggest that vaccination in pregnancy reduces pertussis incidence in infants too young for PV. In infants aged 2-11 months, PV only and both PV and vaccination in pregnancy provide significant protection against severe pertussis.
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Rodríguez Arranz C, Albañil Ballesteros MªR, García Vera C, Blasco Alberdi M, Gil de Gómez MJ. Diagnostic study of pertussis using PCR in primary care clinics. An Pediatr (Barc) 2022; 97:262-269. [PMID: 35995698 DOI: 10.1016/j.anpede.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Pertussis is a respiratory infection caused by bacteria of the genus Bordetella, mainly pertussis and parapertussis species. Despite the high vaccination coverage in developed countries, it is considered a re-emerging disease that is also underreported and underdiagnosed, especially in patients who do not require hospital referral. MATERIAL AND METHODS Descriptive, prospective and multicentre study of pertussis diagnosis and contact investigation in 17 primary care paediatric clinics through collection of samples for polymerase chain reaction (PCR) testing over a period of 4 years and after the implementation of routine vaccination against pertussis during pregnancy. RESULTS Pertussis was diagnosed in a total of 50 patients; the estimated incidence in these years was higher compared to previous rates in the paediatric age group. Fourteen percent of the cases occurred in children aged less than 1 year. The mean age was 6.7 years. Cough was present in 100% of cases, followed in frequency by vomiting and rhinorrhoea. Only 1 patient required hospital admission, and none died or developed complications. B. pertussis was the predominant causative agent. Only 40% knew the source of infection. In 26% of the cases, pertussis was confirmed in contacts of the patient by PCR, and in 46% it was suspected based on the clinical presentation but without microbiological confirmation. CONCLUSIONS Access to diagnostic tests (PCR) for pertussis in primary care allows us to optimise its diagnosis and treatment, to break the chain of transmission, to know the real incidence rates and to assess the impact of routine vaccination of pregnant women on this disease.
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DeJong MA, Wolf MA, Bitzer GJ, Hall JM, Sen-Kilic E, Blake JM, Petty JE, Wong TY, Barbier M, Campbell JD, Bevere JR, Damron FH. CpG 1018® adjuvant enhances Tdap immune responses against Bordetella pertussis in mice. Vaccine 2022; 40:5229-5240. [PMID: 35927132 DOI: 10.1016/j.vaccine.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Bordetella pertussis is the causative agent of whooping cough (pertussis), a severe respiratory disease that can be fatal, particularly in infants. Despite high vaccine coverage, pertussis remains a problem because the currently used DTaP and Tdap vaccines do not completely prevent infection or transmission. It is well established that the alum adjuvant is a potential weakness of the acellular vaccines because the immunity provided by it is short-term. We aimed to evaluate the potential of CpG 1018® adjuvant to improve antibody responses and enhance protection against B. pertussis challenge in a murine model. A titrated range of Tdap vaccine doses were evaluated in order to best identify the adjuvant capability of CpG 1018. Antibody responses to pertussis toxin (PT), filamentous hemagglutinin (FHA), or the whole bacterium were increased due to the inclusion of CpG 1018. In B. pertussis intranasal challenge studies, we observed improved protection and bacterial clearance from the lower respiratory tract due to adding CpG 1018 to 1/20th the human dose of Tdap. Further, we determined that Tdap and Tdap + CpG 1018 were both capable of facilitating clearance of strains that do not express pertactin (PRN-), which are rising in prevalence. Functional phenotyping of antibodies revealed that the inclusion of CpG 1018 induced more bacterial opsonization and antibodies of the Th1 phenotype (IgG2a and IgG2b). This study demonstrates the potential of adding CpG 1018 to Tdap to improve immunogenicity and protection against B. pertussis compared to the conventional, alum-only adjuvanted Tdap vaccine.
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Affiliation(s)
- Megan A DeJong
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - M Allison Wolf
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Graham J Bitzer
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jesse M Hall
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Emel Sen-Kilic
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jeanna M Blake
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jonathan E Petty
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Ting Y Wong
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Mariette Barbier
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | | | - Justin R Bevere
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - F Heath Damron
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, USA; Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, WV, USA.
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Brandal LT, Vestrheim DF, Bruvik T, Roness RB, Bjørnstad ML, Greve-Isdahl M, Steens A, Brynildsrud OB. Evolution of Bordetella pertussis in the acellular vaccine era in Norway, 1996 to 2019. Eur J Clin Microbiol Infect Dis 2022; 41:913-24. [PMID: 35543837 DOI: 10.1007/s10096-022-04453-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/28/2022] [Indexed: 01/16/2023]
Abstract
We described the population structure of Bordetella pertussis (B. pertussis) in Norway from 1996 to 2019 and determined if there were evolutionary shifts and whether these correlated with changes in the childhood immunization program. We selected 180 B. pertussis isolates, 22 from the whole cell vaccine (WCV) era (1996–1997) and 158 from the acellular vaccine (ACV) era (1998–2019). We conducted whole genome sequencing and determined the distribution and frequency of allelic variants and temporal changes of ACV genes. Norwegian B. pertussis isolates were evenly distributed across a phylogenetic tree that included global strains. We identified seven different allelic profiles of ACV genes (A–F), in which profiles A1, A2, and B dominated (89%), all having pertussis toxin (ptxA) allele 1, pertussis toxin promoter (ptxP) allele 3, and pertactin (prn) allele 2 present. Isolates with ptxP1 and prn1 were not detected after 2007, whereas the prn2 allele likely emerged prior to 1972, and ptxP3 before the early 1980s. Allele conversions of ACV genes all occurred prior to the introduction of ACV. Sixteen percent of our isolates showed mutations within the prn gene. ACV and its booster doses (implemented for children in 2007 and adolescents in 2013) might have contributed to evolvement of a more uniform B. pertussis population, with recent circulating strains having ptxA1, ptxP3, and prn2 present, and an increasing number of prn mutations. These strains clearly deviate from ACV strains (ptxA1, ptxP1, prn1), and this could have implications for vaccine efficiency and, therefore, prevention and control of pertussis.
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Zhang C, Zong Y, Wang Z, Wang L, Li Y, Yang Y. Risk factors and prediction model of severe pertussis in infants < 12 months of age in Tianjin, China. BMC Infect Dis 2022; 22:24. [PMID: 34983413 PMCID: PMC8725437 DOI: 10.1186/s12879-021-07001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background To identify risk factors associated with the prognosis of pertussis in infants (< 12 months). Methods A retrospective study on infants hospitalized with pertussis January 2017 to June 2019. The infants were divided into two groups according to the severity of disease: severe pertussis and non-severe pertussis groups. We collected all case data from medical records including socio-demographics, clinical manifestations, and auxiliary examinations. Univariate analysis and Logistic regression were used. Results Finally, a total of 84 infants with severe pertussis and 586 infants with non-severe pertussis were admitted. The data of 75% of the cases (severe pertussis group, n = 63; non-severe pertussis group, n = 189) were randomly selected for univariate and multivariate logistic regression analysis. The results showed rural area [P = 0.002, OR = 6.831, 95% CI (2.013–23.175)], hospital stay (days) [P = 0.002, OR = 1.304, 95% CI (1.107–1.536)], fever [P = 0.040, OR = 2.965, 95% CI (1.050–8.375)], cyanosis [P = 0.008, OR = 3.799, 95% CI (1.419–10.174)], pulmonary rales [P = 0.021, OR = 4.022, 95% CI (1.228–13.168)], breathing heavily [P = 0.001, OR = 58.811, 95% CI (5.503–628.507)] and abnormal liver function [P < 0.001, OR = 9.164, 95% CI (2.840–29.565)] were independent risk factors, and higher birth weight [P = 0.006, OR = 0.380, 95% CI (0.191–0.755)] was protective factor for severe pertussis in infants. The sensitivity and specificity of logistic regression model for remaining 25% data of severe group and common group were 76.2% and 81.0%, respectively, and the consistency rate was 79.8%. Conclusions The findings indicated risk factor prediction models may be useful for the early identification of severe pertussis in infants.
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Affiliation(s)
- Cui Zhang
- Department of Infectious Disease, Tianjin Second People's Hospital, No. 7 Sudinan Road, Nankai District, Tianjin, 300192, China
| | - Yanmei Zong
- Department of Infectious Disease, Tianjin Second People's Hospital, No. 7 Sudinan Road, Nankai District, Tianjin, 300192, China
| | - Zhe Wang
- Department of Infectious Disease, Tianjin Second People's Hospital, No. 7 Sudinan Road, Nankai District, Tianjin, 300192, China
| | - Li Wang
- Department of Pharmacy, Tianjin Second People's Hospital, Tianjin, 300192, China
| | - Ying Li
- Department of Infectious Disease, Tianjin Second People's Hospital, No. 7 Sudinan Road, Nankai District, Tianjin, 300192, China.
| | - Yuejie Yang
- Department of Infectious Disease, Tianjin Second People's Hospital, No. 7 Sudinan Road, Nankai District, Tianjin, 300192, China.
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Naninck T, Contreras V, Coutte L, Langlois S, Hébert-Ribon A, Pelletier M, Reveneau N, Locht C, Chapon C, Le Grand R. Intranasal inoculation with Bordetella pertussis confers protection without inducing classical whooping cough in baboons. Curr Res Microb Sci 2021; 2:100072. [PMID: 34841362 PMCID: PMC8610340 DOI: 10.1016/j.crmicr.2021.100072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
In this manuscript, we describe the impact of Bordetella pertussis exposure route on whooping cough pathogenesis in baboons. We demonstrate in this paper that intranasal exposure of animals with a clinical isolate (or its fluorescent derivative) of B. pertussis induced classical nasopharyngeal and tracheal colonization but without inducing pertussis symptoms (cough and leukocytosis) compared to animals exposed to the classical combined intranasal and intra-tracheal routes with the same bacterial strains. Moreover, this intranasal exposure induces good B. pertussis specific seroconversion and provides protection from further infection.
Background The resurgence of whooping cough in many countries highlights the crucial need for a better understanding of the pathogenesis of respiratory infection by Bordetella pertussis. Exposure of baboons to B. pertussis by the intranasal and intra-tracheal routes is a recently described preclinical model that reproduces both B. pertussis infection of humans and whooping cough disease. Here, we tested both intranasal and intranasal+intra-tracheal exposure routes and assessed their impact on disease development and immunity. Methods Young baboons were intranasally exposed to the B1917 clinical isolate, representative of circulating strains in Europe, or its green-fluorescent protein expressing derivative. Animals were followed for pertussis symptoms and bacterial colonization and by in vivo probe-based confocal laser endomicroscopy (pCLE) imaging. Sero-conversion and protection against subsequent infection were then evaluated. Results Seroconversion and bacterial colonization of both the nasopharynx and trachea was observed in baboons exposed to B. pertussis by the intranasal route only, and also in those animals challenged by both the intranasal and intra-tracheal routes together. However, baboons exposed solely by the intranasal route developed only mild clinical symptoms, with no paroxysmal cough. These animals were protected against re-infection by B. pertussis. Conclusions Intranasal exposure of baboons to B. pertussis does not induce disease but elicits immune mechanisms that protect them from subsequent exposure to the bacteria. These findings suggest that the intranasal route of inoculation in this non-human primate model could be used in the pre-clinical evaluation of nasal candidate vaccines against pertussis.
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Affiliation(s)
- Thibaut Naninck
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Vanessa Contreras
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Loïc Coutte
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Sébastien Langlois
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | | | | | | | - Camille Locht
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Catherine Chapon
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Roger Le Grand
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
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21
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Saedi S, Safarchi A, Moghadam FT, Heidarzadeh S, Nikbin VS, Shahcheraghi F. Fha Deficient Bordetella pertussis Isolates in Iran with 50 Years Whole Cell Pertussis Vaccination. Iran J Public Health 2021; 50:1454-1462. [PMID: 34568185 PMCID: PMC8426785 DOI: 10.18502/ijph.v50i7.6636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022]
Abstract
Background: Bordetella pertussis, a highly contagious respiratory. Notably, the resurgence of pertussis has recently been associated with the lacking production of vaccine virulence factors. This study aimed to screen pertactin (Prn) and filamentous hemagglutinin (Fha) production in Iran with 50 years’ whole cell vaccine (WCV) immunization program. Methods: Overall, 130 B. pertussis isolates collected from Pertussis Reference Laboratory of Iran during 2005–2018. Real-time PCR was performed by targeting IS481, ptxP, IS1001 and IS1002 for species confirmation of B. pertussis. Western-blot was used to evaluate the expression of virulence factors (pertactin and filamentous hemagglutinin). Results: All tested B. pertussis isolates expressed Prn and all except two isolates expressed Fha. We have sequenced genomes of these strains and identified differences compared with genome reference B. pertussis Tohama I. Conclusion: Many countries reporting Prn and Fha-deficiency due to acellular vaccine (ACV) pressure. Our results demonstrate in a country with WCV history, Fha-deficient isolates may rise independently. However, Prn-deficient isolates are more under the ACV pressure in B. pertussis isolates. Continues surveillance will provide a better understanding of the effect of WCV on the evolution of the pathogen deficiency.
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Affiliation(s)
- Samaneh Saedi
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Azadeh Safarchi
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | | | - Siamak Heidarzadeh
- Department of Microbiology and Virology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Fereshteh Shahcheraghi
- Pertussis Reference Laboratory, Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
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22
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Macina D, Evans KE. Bordetella pertussis in School-Age Children, Adolescents and Adults: A Systematic Review of Epidemiology and Mortality in Europe. Infect Dis Ther 2021; 10:2071-118. [PMID: 34435338 DOI: 10.1007/s40121-021-00520-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Pertussis (whooping cough) epidemics persist globally despite high vaccine coverage among infants and young children. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity, resulting in a pool of unprotected adolescents and adults. However, pertussis is generally less severe in adolescents and adults, and this difference in presentation means it can often be unrecognised by healthcare professionals, meaning that it is largely under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology and mortality in school-aged children, adolescents and adults in Europe. A formal statistical comparison (e.g. using meta-analyses) was not possible because of the mix of methodologies reported. There were 69 epidemiological studies and 19 mortality studies identified for review. Over the past decade, the reported incidence of notified pertussis cases varied widely between European countries, which is likely associated with differences in surveillance systems, diagnostic techniques and reporting regulations. However, several studies show that pertussis is circulating among adolescents and adults in Europe, and although pertussis-related morbidity and mortality are highest in infants, there is evidence that adults aged > 50 years are at increased risk. For example, in a hospital-based surveillance study in Portugal, between 2000 and 2015, 94% of hospitalised pertussis cases were infants aged < 1 year, with a case fatality rate (CFR) of 0.8%; however, among hospitalised adult cases of pertussis, the CFRs were 11.5% (aged 18–64 years) and 17.4% (aged > 65 years). Very few European countries currently include pertussis boosters for adults in the national immunisation strategy. In addition to increasing pertussis vaccination coverage in adolescents and adults, mitigation strategies in European countries should include improved diagnosis and treatment in these populations.
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McAlister SM, van den Biggelaar AHJ, Thornton RB, Richmond PC. Optimising a 6-plex tetanus-diphtheria-pertussis fluorescent bead-based immunoassay. MethodsX 2021; 8:101360. [PMID: 34430260 DOI: 10.1016/j.mex.2021.101360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
Small volume assays are required for large-scale research studies and in particular paediatric trials, where multiple measures are required from a single sample. Fluorescent bead-based technology (Bioplex/Luminex) allows high through-put and simultaneous quantification of multiple analytes in a single test. This technology uses sets of microspheres, each with a unique spectral address that can be coated with a different antigen of interest. Following the addition of a detector antibody, specific for the isotype of interest and labelled with R-Phycoerythrin, the bioplex reader determines the amounts of antigen-specific antibodies in each test sample relative to a reference standard. Here we outline the optimisations undertaken to establish a 6-plex fluorescent bead-based immunoassay that can accurately measure human IgG to individual tetanus-diphtheria-acellular pertussis (Tdap) antigens from 2 to 4 ul of human serum/ plasma. This protocol was adapted from previously published methods and aligns with current recommendations for developing pertussis-serological assays. To our knowledge, this is the first Tdap-specific multiplex immunoassay (MIA) established in Australia. All components were optimised and validated in-house including: microsphere preparation conditions, reference serum and QC development, and assay running.Determining optimal antigen coating dose and conjugation method. Optimising an in-house reference serum with clinically relevant titres. Determining assay specificity and reproducibility.
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24
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Hughes SL, Kwong JC, Schwartz KL, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Mahmud SM, Crowcroft NS. Exploring the reasons for low pertussis vaccine effectiveness in Ontario, Canada, 2006-2008: a Canadian Immunization Research Network study. Can J Public Health 2021; 113:155-164. [PMID: 34424508 DOI: 10.17269/s41997-021-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although pertussis vaccines have been widely used for many decades, a burden of illness persists. Resurgences in Ontario, Canada, have not been substantial in the past decade, but an outbreak of pertussis occurred in Toronto between 1 October 2005 and 31 March 2006. Previous Ontario studies found high vaccine effectiveness (VE) in the initial years post-immunization. In order to explore the impact of outbreaks and external factors on VE, we investigated pertussis VE during the period 2006-2008. METHODS We assessed pertussis VE using a frequency-matched case-control study for the period 1 March 2006 to 31 December 2008. We used logistic regression to estimate VE by age, time since last vaccination, and vaccination status according to the Ontario recommended schedule. We compared analyses including and excluding cases from Toronto, and to two recent Ontario pertussis VE studies. RESULTS We included 1797 confirmed cases and 7188 matched controls. Most cases were under 4 years of age during the study period. Pertussis VE was 3.8% (95% CI: - 21.0, 24.0) in the period 15-364 days following the last pertussis vaccine dose, and increased with increasing time since vaccination. Pertussis VE in the first 15-364 days excluding Toronto increased to 57.1% (95% CI: 26.0, 75.1), but the trend of increasing VE with time since vaccination persisted. Although VE was higher in older (6-11 years) than younger (0-5 years) children, it was lower at 12-13 years than after 14 years. CONCLUSION VE was lower in comparison with other studies conducted in Ontario, particularly in younger children. Various factors occurring during the study period may have influenced the results, including clinical testing of asymptomatic contacts, laboratory testing and methods and reporting practice, and a sensitive case definition. Further studies are needed to optimize methods for measuring VE to inform pertussis vaccine policy.
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Affiliation(s)
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,ICES, Toronto, ON, Canada
| | - Cynthia Chen
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Frances B Jamieson
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Canadian Blood Services, Ottawa, ON, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health, Edmonton, AB, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.
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Leite D, Camargo CH, Kashino SS, Polatto R, Martins LM, Pereira JC, Pawloski L, Tondella ML, Oliveira RSD, Vaz de Lima LRDA. Prevalence and characterization of pertactin deficient Bordetella pertussis strains in Brazil, a whole-cell vaccine country. Vaccine X 2021; 8:100103. [PMID: 34179765 PMCID: PMC8213957 DOI: 10.1016/j.jvacx.2021.100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Many countries have reported antigenic divergence among circulating Bordetella pertussis strains, mainly in those countries which introduced the acellular pertussis (aP) vaccine. This phenomenon can be seen, for example, with the recent rise of pertactin (Prn)-deficient B. pertussis strains, one of the antigens included in aP vaccine formulas. The whole cell pertussis (wP) vaccine has been used in Brazil since 1977 for the primary pertussis, diphtheria and tetanus immunization series. In 2014, the aP vaccine was recommended for women during pregnancy to protect infants in the first months of life. Our objective was to determine the prevalence of Prn-deficiency in 511 isolates of B. pertussis collected in Brazil during 2010-2016. All isolates were characterized, through PFGE and serotyping, and screened for the loss of Prn by ELISA. Prn-deficiency was confirmed by immunoblotting, and identification of the possible genetic markers was performed with PCR and Sanger sequencing. Results indicate that 110 PFGE profiles are currently circulating, with five profiles representing the majority, and the predominant serotype 3, has been gradually replaced by serotype 2 and serotype 2,3. ELISA screening and immunoblotting identified three Prn-deficient isolates. Genotypic characterization by PCR and sequencing indicated that one isolate had a promoter mutation in prn, while the other two did not have an obvious genetic explanation for their deficiency. While the lack of Prn was identified in a few isolates, this study did not detect a relevant occurrence of Prn-deficiency, until 2016, confirming previous observations that Prn-deficiency is likely aP vaccine-driven.
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Affiliation(s)
- Daniela Leite
- Department of Bacteriology, National Reference Laboratory for Pertussis, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Carlos Henrique Camargo
- Department of Bacteriology, National Reference Laboratory for Pertussis, Instituto Adolfo Lutz, São Paulo, Brazil
| | | | - Ricardo Polatto
- Department of Bacteriology, National Reference Laboratory for Pertussis, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Luciano Moura Martins
- Department of Bacteriology, National Reference Laboratory for Pertussis, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Juliana Cristina Pereira
- Department of Bacteriology, National Reference Laboratory for Pertussis, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Lucia Pawloski
- Pertussis and Diphtheria Laboratory, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Maria Lucia Tondella
- Pertussis and Diphtheria Laboratory, Centers for Diseases Control and Prevention, Atlanta, GA, USA
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Ruiz-Botia I, Riera-Bosch MT, Rodríguez-Losada O, Soler-Palacín P, Melendo S, Moraga-Llop F, Balcells-Ramírez J, Otero-Romero S, Armadans-Gil L. Impact of vaccinating pregnant women against pertussis on hospitalizations of children under one year of age in a tertiary hospital in Catalonia. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00088-4. [PMID: 34020822 DOI: 10.1016/j.eimc.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The recommendation for pertussis vaccination in pregnancy was established in Catalonia in February 2014. The objective of this study was to compare the hospitalization rate for pertussis in children under one year of age before and after the implementation of the vaccination program. METHODS Observational and retrospective study of patients under one year of age admitted to hospital with a diagnosis of pertussis. The hospitalization rate of patients under one year of age of the period prior to the vaccination program (2008-2013) was compared with the period with vaccination program (2014-2019) in the total of children under one year of age and in 2subgroups: children under 3 months and between 3-11 months. RESULTS Hospitalization rate was significantly lower in the period with vaccination program in children under one year of age and specifically in children under 3 months (2.43 vs. 4.72 per 1,000 person-years and 6.47 vs. 13.11 per 1,000 person-years, respectively). The rate ratios were: 0.51 (95% CI 0.36-0.73) for children under one year of age; 0.49 (95% CI 0.32-0.75) for those younger than 3 months and 0.56 (95% CI 0.30-1.03) for those with 3-11 months. No statistically significant differences were observed in the clinical severity between both periods. CONCLUSION The introduction of the pertussis vaccination program in pregnancy was associated with a global lower hospitalization rate for pertussis in children under one year of age and specifically in those under 3 months of age.
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Affiliation(s)
- Irene Ruiz-Botia
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | | | - Olalla Rodríguez-Losada
- Unidad de Urgencias Pediátricas, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, España
| | - Pere Soler-Palacín
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Susana Melendo
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, España
| | - Fernando Moraga-Llop
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, España
| | - Joan Balcells-Ramírez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, España
| | - Susana Otero-Romero
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, España
| | - Lluís Armadans-Gil
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, España
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Wilkinson K, Righolt CH, Elliott LJ, Fanella S, Mahmud SM. Pertussis vaccine effectiveness and duration of protection - A systematic review and meta-analysis. Vaccine 2021; 39:3120-3130. [PMID: 33934917 DOI: 10.1016/j.vaccine.2021.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
A comprehensive review of observational pertussis vaccine effectiveness (VE) studies is needed to update gaps from previous reviews. We conducted a systematic review of VE and duration of protection studies for the whole-cell (wP) and acellular (aP) pertussis vaccines and conducted a formal meta-analysis using random effects models. Evidence continues to suggest that receipt of any pertussis vaccine confers protection in the short-term against disease although this protection wanes rapidly for aP vaccine. We detected significant heterogeneity in pooled estimates due, in part, to factors such as bias and confounding which may be mitigated by study design. Our review of possible sources of heterogeneity may help interpretation of other VE studies and aid design decisions in future pertussis VE research.
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Affiliation(s)
- Krista Wilkinson
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence J Elliott
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sergio Fanella
- Department of Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Solans L, Debrie AS, Coutte L, Locht C. Construction and evaluation of a pertactin-deficient live attenuated pertussis vaccine candidate BPZE1 derivative. Vaccine 2021; 39:2843-2849. [PMID: 33896662 DOI: 10.1016/j.vaccine.2021.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
Pertussis, mainly caused by Bordetella pertussis, is a severe respiratory disease that can be fatal, especially in young infants. Vaccines, massively implemented since the middle of the last century, have substantially reduced the pertussis incidence, but have not been able to fully control the disease. One of the shortcomings of current pertussis vaccines is their inability to prevent infection by and transmission of B. pertussis, in contrast to immunity following natural infection. We have developed the live attenuated nasal vaccine BPZE1 and have shown that it prevents both disease and B. pertussis infection in preclinical models. This vaccine is now in clinical development. However, the initial clinical studies have suggested that vaccine take is hampered by pre-existing antibodies to pertactin. Here, we have constructed a pertactin-deficient BPZE1 derivative called BPZE1P in order to overcome this limitation. BPZE1P colonized the murine respiratory tract as efficiently as BPZE1 and induced antibodies at levels similar to those elicited by BPZE1. In the presence of pre-existing antibodies induced by acellular pertussis vaccination, BPZE1P colonized the mouse respiratory tract more efficiently than BPZE1. Both vaccines protected equally well the murine lungs and noses from challenge with laboratory and clinical strains of B. pertussis, including pertactin-deficient strains, against which current acellular pertussis vaccines are less efficient. BPZE1P may thus be an interesting alternative to BPZE1 to overcome vaccine take limitations due to pre-existing antibodies to pertactin.
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Affiliation(s)
- Luis Solans
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Anne-Sophie Debrie
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Loïc Coutte
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Camille Locht
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.
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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 Africa. Infect Dis Ther 2021; 10:1097-1113. [PMID: 33881713 PMCID: PMC8322245 DOI: 10.1007/s40121-021-00442-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/24/2021] [Indexed: 12/02/2022] Open
Abstract
The Global Pertussis Initiative recommends diphtheria–tetanus–pertussis (DTP3) vaccination of infants aged < 1 year for all African countries, and recommends the vaccination of pregnant women as a primary prevention strategy. However, the role of older children and adults in the transmission of pertussis in Africa is not clear. 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 Africa. Studies identified for inclusion were reviewed narratively because a statistical comparison was not possible because of the mix of methodologies used. Studies from North Africa (Morocco, Tunisia, and Algeria) reported that although DTP4 vaccine coverage is high, severe pertussis-related complications persist in young children, vaccine-acquired immunity wanes in adolescents, and household contacts are important transmitters of infection. A serosurvey in Gambia showed that 6% of the general population had pertussis antibody levels suggesting recent infection, and studies from Senegal showed that pertussis infection was endemic despite high DTP3 coverage. During a pertussis outbreak in Ethiopia, the case fatality rate was 3.7% overall, and 6.3% among children aged 5–9 years. In a case-surveillance study in South Africa, the incidence of pertussis among hospitalized children was 526/100,000, and infection rates were higher in HIV-exposed and -infected children compared with uninfected children. In conclusion, the highest burden of pertussis in Africa is among infants, and surveillance is lacking in many African countries meaning that the burden of pertussis among infants and infection rates among older children and adults are not well reported, and likely underestimated.
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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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Del Valle-Mendoza J, Del Valle-Vargas C, Aquino-Ortega R, Del Valle LJ, Cieza-Mora E, Silva-Caso W, Bazán-Mayra J, Zavaleta-Gavidia V, Aguilar-Luis MA, Cornejo-Pacherres H, Martins-Luna J, Cornejo-Tapia A. Clinical characteristics and molecular detection of Bordetella pertussis in hospitalized children with a clinical diagnosis of whooping cough in Peru. Iran J Microbiol 2021; 13:23-30. [PMID: 33889359 PMCID: PMC8043828 DOI: 10.18502/ijm.v13i1.5488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Pertussis is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. In Peru, actual public health programs indicate that vaccination against B. pertussis must be mandatory and generalized, besides all detected cases must be reported. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age with a presumptive diagnosis of whopping cough in Cajamarca, a region located in northern Peru. Materials and Methods The population of this cross-sectional study were children under 5 years old hospitalized as presumptive cases of pertussis during December 2017 to December 2018. The nasopharyngeal samples were analyzed by real-time PCR for the detection of B. pertussis. Results B. pertussis was identified as PCR + in 42.3% of our sample (33/78). The clinical presentation that was observed most frequently includes paroxysmal coughing (97%), difficulty breathing (69.7%), cyanosis (72.7%) and post-tussive emesis (60.6%). Additionally, pneumonia was the most observed complication (33.3%). Four of the patients with PCR+ for B. pertussis presented only lymphocytosis, five only leukocytosis, two patients with decreased leukocytosis and lymphocytes and only one patient with leukopenia and relative lymphocytosis. There was a percentage of 84.8% of unvaccinated children in the PCR+ group. Finally, the mother was the most frequent symptom carrier (18.2%). Conclusion In conclusion, in the studied population there is a high rate of PCR+ cases for B. pertussis. Laboratory values may show leukopenia or lymphopenia in patients with pertussis. It is necessary to use appropriate laboratory diagnostic tests in all infants with respiratory symptoms for B. pertussis. Since, the clinical diagnosis overestimates the diagnosis of pertussis.
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Affiliation(s)
- Juana Del Valle-Mendoza
- Molecular and Cell Biology Laboratory, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Department of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Molecular Biology Laboratory, Instituto de Investigación Nutricional, Lima, Peru
| | | | - Ronald Aquino-Ortega
- Molecular and Cell Biology Laboratory, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Molecular Biology Laboratory, Instituto de Investigación Nutricional, Lima, Peru
| | - Luis J Del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament d'Enginyeria Quıímica, EEBE, Universidad Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Erico Cieza-Mora
- Peditric Unit, Hospital Regional Docente de Cajamarca, Cajamarca, Peru
| | - Wilmer Silva-Caso
- Molecular and Cell Biology Laboratory, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Department of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Molecular Biology Laboratory, Instituto de Investigación Nutricional, Lima, Peru.,Comité del Médico Joven-Consejo Nacional, Colegio Médico del Perú, Lima, Peru
| | - Jorge Bazán-Mayra
- Molecular Biology Laboratory, Laboratorio Regional de Cajamarca, Dirección Regional de Salud de Cajamarca (DIRESA), Cajamarca, Peru
| | - Victor Zavaleta-Gavidia
- Molecular Biology Laboratory, Laboratorio Regional de Cajamarca, Dirección Regional de Salud de Cajamarca (DIRESA), Cajamarca, Peru
| | - Miguel Angel Aguilar-Luis
- Molecular and Cell Biology Laboratory, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Department of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Molecular Biology Laboratory, Instituto de Investigación Nutricional, Lima, Peru
| | - Hernán Cornejo-Pacherres
- Molecular Biology Laboratory, Laboratorio Regional de Cajamarca, Dirección Regional de Salud de Cajamarca (DIRESA), Cajamarca, Peru
| | - Johanna Martins-Luna
- Molecular and Cell Biology Laboratory, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Molecular Biology Laboratory, Instituto de Investigación Nutricional, Lima, Peru
| | - Angela Cornejo-Tapia
- Molecular and Cell Biology Laboratory, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Department of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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McAlister SM, van den Biggelaar AHJ, Woodman TL, Hutton H, Thornton RB, Richmond PC. An observational study of antibody responses to a primary or subsequent pertussis booster vaccination in Australian healthcare workers. Vaccine 2021; 39:1642-1651. [PMID: 33589299 DOI: 10.1016/j.vaccine.2021.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/23/2020] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
Adult pertussis vaccination is increasingly recommended to control pertussis in the community. However, there is little data on the duration and kinetics of immunity to pertussis boosters in adults. We compared IgG responses to vaccination with a tetanus, low-dose diphtheria, low-dose acellular pertussis (Tdap) booster at 1 week, 1 month and 1 year post-vaccination in whole-cell (wP)-primed Australian paediatric healthcare workers who had received an adult Tdap booster 5-12 years previously, to those who received their first Tdap booster. Tdap vaccination was well tolerated in both groups. Previously boosted adults had significantly higher pre-vaccination IgG concentrations for all vaccine-antigens, and more were seropositive for pertussis toxin (PT)-specific IgG (≥ 5 IU/mL) (69.5%; 95% confidence interval (CI) 59.5-79.5) than adults in the naïve group (45.2%; 95% CI 32.8-57.5). Tdap vaccination significantly increased IgG responses 1 month post-vaccination in both groups. This increase was more rapid in previously boosted than in naïve adults, with geometric mean fold-increases in PT-IgG at 1 week post vaccination of 3.6 (95% CI 2.9-4.3) and 2.6 (95% CI 2.2-3.2), respectively. Antibody waning between 1 month and 1 year post-vaccination was similar between groups for IgG specific to PT and filamentous haemagglutinin (FHA), but was faster for IgG against pertactin (PRN) in the naïve group (GMC ratio 0.36; 95% CI 0.31-0.42) than the previously boosted group (GMC ratio 0.45; 95% CI 0.39-0.50). At baseline, all but one adult had protective IgG titres against tetanus toxin (TT) (≥ 0.1 IU/mL), and 75.6% in the previously boosted and 61.3% in the naïve group had protective IgG titres against diphtheria toxoid (DT) of ≥ 0.1 IU/mL. This study shows that pertussis immune memory is maintained up to 12 years after Tdap vaccination in wP-primed Australian adults. There was no evidence that pertussis immune responses waned faster after a booster dose. These findings support current recommendations of repeating Tdap booster vaccination in paediatric healthcare workers at least every 10 years. Clinical trials registry: ACTRN12615001262594.
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Affiliation(s)
- Sonia M McAlister
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
| | - Anita H J van den Biggelaar
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Tabitha L Woodman
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Heidi Hutton
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Ruth B Thornton
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter C Richmond
- Vaccine Trials Group, Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia; Departments of Immunology and General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
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Bagattini AM, Policena G, Minamisava R, Andrade ALS, Nishioka SDA, Sinha A, Russell LB, Toscano CM. The data used to build the models: Pertussis morbidity and mortality burden considering various Brazilian data sources. Vaccine 2021; 39:137-146. [PMID: 33303181 PMCID: PMC7738753 DOI: 10.1016/j.vaccine.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/10/2020] [Accepted: 09/01/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pertussis is associated with significant disease burden in children worldwide. In addition to its cyclical nature, resurgences of pertussis cases, hospitalizations and deaths have been reported by many countries. We describe the dynamics of pertussis in Brazil, a middle-income country that has experienced a resurgence and that provides good quality data to allow building a dynamic transmission disease model. METHODS We conducted a descriptive analysis of pertussis burden considering data from the national disease surveillance system, national hospitalization information system and national mortality registry. Study period was 2000-2016. Absolute numbers and rates per 100,000 inhabitants over time, by age sub-groups and geographical regions are presented. RESULTS From 2000 to 2016, a total of 37,299 reported pertussis cases, 25,240 hospitalizations, and 601 deaths due to pertussis were reported. Although the outcomes - pertussis cases, hospitalizations, and deaths - come from independent information systems, our results document low disease burden with periodic increases every 3-4 years during the years 2000-2010, followed by a sharp increase which peaked in 2014. In both periods, disease burden is concentrated in young children, while its more serious outcomes - hospitalizations and deaths, are concentrated in infants. Pre-outbreak and outbreak disease burden as well as timing of peak during the outbreak period vary by states and within geographical regions, representing valuable resources of data for modelling purposes. CONCLUSION Consistent disease burden patterns were observed over time in Brazil using a variety of data sources. Given the scarcity of good epidemiological data on pertussis available from low- and middle-income countries, our reported data provide valuable information for the assessment of the public health impact and cost-effectiveness modelling studies of newer strategies to prevent and control pertussis. These data were used to build and calibrate a national dynamic transmission model, which was used to evaluate the cost-effectiveness of maternal immunization. Clinical Trial registry name and registration number: Not applicable.
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Affiliation(s)
- Angela M Bagattini
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Gabriela Policena
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil(1)
| | - Ana Lucia S Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil(2)
| | - Sérgio de A Nishioka
- National Coordination of Transmittable Diseases Surveillance, Secretary of Health Surveillance (SVS), Brazilian Ministry of Health, Brazil(3)
| | - Anushua Sinha
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Louise B Russell
- University of Pennsylvania, Department of Medical Ethics and Health Policy, 423 Guardian Drive, Philadelphia, PA 19104, USA(4)
| | - Cristiana M Toscano
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil(2).
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Cock IE, Van Vuuren SF. The traditional use of southern African medicinal plants for the treatment of bacterial respiratory diseases: A review of the ethnobotany and scientific evaluations. J Ethnopharmacol 2020; 263:113204. [PMID: 32730881 PMCID: PMC7383173 DOI: 10.1016/j.jep.2020.113204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 05/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Multiple plant species were used traditionally in southern Africa to treat bacterial respiratory diseases. This review summarises this usage and highlights plant species that are yet to be verified for these activities. AIM OF THE STUDY This manuscript reviews the traditional usage of southern African plant species to treat bacterial respiratory diseases with the aim of highlighting gaps in the literature and focusing future studies. MATERIALS AND METHODS An extensive review of ethnobotanical books, reviews and primary scientific studies was undertaken to identify southern African plants which are used in traditional southern African medicine to treat bacterial respiratory diseases. We also searched for southern African plants whose inhibitory activity against bacterial respiratory pathogens has been conmfirmed, to highlight gaps in the literature and focus future studies. RESULTS One hundred and eighty-seven southern African plant species are recorded as traditional therapies for bacterial respiratory infections. Scientific evaluations of 178 plant species were recorded, although only 42 of these were selected for screening on the basis of their ethnobotanical uses. Therefore, the potential of 146 species used teraditionally to treat bacterial respiratory diseases are yet to be verified. CONCLUSIONS The inhibitory properties of southern African medicinal plants against bacterial respiratory pathogens is relatively poorly explored and the antibacterial activity of most plant species remains to be verified.
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Affiliation(s)
- Ian E Cock
- School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia; Environmental Futures Research Institute, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia.
| | - Sandy F Van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
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Vásconez Noguera S, Jaramillo K, Zabala A, Villacís JE. Bordetella pertussis, a reemerging pathogen in pediatric respiratory infections. A study in Quito, Ecuador. Rev Argent Microbiol 2021; 53:27-33. [PMID: 33243445 DOI: 10.1016/j.ram.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 05/11/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
Bordetella pertussis is the causative agent of pertussis, which mainly affects unvaccinated children, while Bordetella parapertussis causes a disease presenting clinical characteristics that are indistinguishable from whooping cough. Despite high vaccination coverage, pertussis remains a public health concern worldwide, with approximately 140000 cases reported annually. Here we determined the prevalence of B. pertussis and B. parapertussis infection among infants under one year of age by polymerase chain reaction (PCR); our aim being to identify whether the data obtained relates to the relevant sociodemographic and clinical data. The study included 86 samples of nasopharyngeal swabs from infants aged between 0-12 months, who were reported as probable cases of whooping cough by the health centers around the Ecuadorian highlands, from August 2016 to July 2017. The nasopharyngeal swabs were cultured and microbiological and molecular analyses were performed. B. pertussis was identified by PCR in 41% of the samples (30/86), more than half of which corresponded to infants aged between 0-3 months. Moreover, a statistically significant correlation (p<0.05) between the identification of bacteria in culture and the catarrhal stage of the disease was observed. The results obtained from the study highlighted the need for an active national surveillance of pertussis, in particular for laboratory testing, to provide a highly sensitive and more specific diagnosis of Bordetella infection.
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Abstract
BACKGROUND After the introduction of a vaccine against B. pertussis the seasonal pattern with the highest number of infections in the spring to summer months changed. Recent studies from around the world suggest that B. pertussis infections again follow a seasonal pattern with increased incidence in summer.The aim of this study was to investigate whether respiratory infections caused by B. pertussis in the period from January 2008 to December 2018 also seasonally spread in Germany and if so, when the B. pertussis activity peaked. METHODS We tested 19,031 samples, mainly from Southern Germany, collected in the period from January 2008 to December 2018 using a Multiplex PCR assay. We assessed the number and proportion of samples positive for B. pertussis, stratified by patient's age and month. The seasonal distribution was investigated by plotting the average proportion of positive samples for each month. RESULTS We observed a B. pertussis seasonality with the highest number of positive samples in the months from June until September. In contrast, testing of samples for B. pertussis was requested most frequently in the period from October until March. The proportion of positive samples increased earlier in adolescents (age 10 to 19) than in other age groups. CONCLUSIONS We found a seasonality of B. pertussis infections in Germany, which differs from the time when most samples are sent in for testing of B. pertussis. Our study suggests that clinicians should be more aware of B. pertussis infections in the months from June until September to prevent further transmission to vulnerable family members.
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Affiliation(s)
| | - Friedemann Tewald
- Laboratory Prof. Gisela Enders and colleagues, MVZ, Stuttgart, Germany
| | - Maren Eggers
- Laboratory Prof. Gisela Enders and colleagues, MVZ, Stuttgart, Germany.
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Arango-Granados MC, Trompa IM. Neurologic alterations in an HIV adult patient with pertussis: a case report. BMC Infect Dis 2020; 20:471. [PMID: 32615931 PMCID: PMC7330534 DOI: 10.1186/s12879-020-05198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Pertussis is a highly contagious disease of public health interest caused by the bacterium Bordetella pertussis. Although its incidence has decreased substantially after the introduction of a vaccination, the burden of the disease remains high. Although the paroxysmal phase is highly disabling, complications are uncommon and more prevalent in children than in adults. The most frequent neurological complication is encephalopathy, but seizures, paresis, paraplegia, ataxias, aphasias, and decerebration postures have also been described. The complication of decerebration postures has not been previously reported in adults. Case presentation We present a video case of an adult HIV patient with severe coughing paroxysms, post-tussive emesis and syncope, whose workup confirmed the diagnosis of a B. pertussis respiratory infection. During hospitalization, he had fluctuant encephalopathy and post-tussive decerebration postures following paroxysms. He was treated with antibiotic therapy and finally sent home without residual neurological deficits. Conclusion This case illustrates the biological plausibility of neurologic complications of pertussis in adults, which, albeit rare, can cause important morbidities. Future research should explore whether there are differences in the clinical presentation, risk factors and pathophysiology of the disease among adults or interventions aimed at preventing or treating pertussis encephalopathy.
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Affiliation(s)
- María Camila Arango-Granados
- Emergency Department, Fundación Valle del Lili, Cra 98 # 18 - 49, Cali, Valle del Cauca, Colombia. .,School of Medicine, Universidad Icesi, Cl. 18 # 122 - 135, Cali, Valle del Cauca, Colombia.
| | - Iván Mauricio Trompa
- IPS Universitaria León XIII, Infectology Service, Cl. 69 # 51C - 24, Medellín, Antioquia, Colombia.,School of Medicine, Universidad de Antioquia, Cl. 67 # 53 -108, Medellín, Antioquia, Colombia
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39
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González-Bertolín I, Ochoa-Fernández BM, Bloise I, de Ceano-Vivas-La Calle M, Ruíz-Domínguez JA. Urgent Bordetella PCR in infants under 3 months, a useful tool in the Pediatric Emergency Department. Enferm Infecc Microbiol Clin 2020; 39:174-178. [PMID: 32471689 DOI: 10.1016/j.eimc.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Whooping cough in patients aged under 3 months has higher rates of morbimortality. Hospitalization and treatment with azithromycin is generally recommended. Many patients with cough without other signs of alarm, are admitted and started antibiotic therapy until a result of Bordetella-PCR is available. This technique, when performed urgently, can provide the diagnosis in a few hours. The objective of this study is to determine if its generalisation in the Emergency Department allows to improve patient management. METHODS Retrospective cohort study of patients aged under 3 months who underwent Bordetella-PCR testing from upper respiratory tract secretions since March 2011 to December 2017. From December 2015 the test was performed urgently. RESULTS One hundred and fifty-eight PCR were performed, 16 (10%) were positive for B. pertussis. Negative results (142; 90%) were divided in 2 cohorts: conventional-PCR, with 74 cases, and urgent-PCR, with 68 cases. The 2 groups were homogeneous in terms of clinical and analytical characteristics. In the urgent-PCR group there was 18% reduction in chest X-rays performed (P=.008). There were 33 (48.5%) patients admitted in the urgent-PCR group, compared to 49 (66.2%) in the conventional-PCR (P=.042). Antibiotic treatment was initiated in 32% of the patients in the urgent-PCR group compared to 67% in the conventional-PCR group (P=.000047), without observing any significant increase in the number of visits to the Emergency Department or worse clinical performance. CONCLUSIONS The introduction of urgent PCR in the Emergency Department is a useful tool in the management of infants under 3 months of age with suspected pertussis, since it can avoid unnecessary admissions, diagnostic tests and antibiotic treatments.
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Affiliation(s)
- Isabel González-Bertolín
- Servicio de Urgencias Pediátricas, Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
| | | | - Ivan Bloise
- Servicio de Microbiología y Parasitología, Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - María de Ceano-Vivas-La Calle
- Servicio de Urgencias Pediátricas, Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Jose Antonio Ruíz-Domínguez
- Servicio de Urgencias Pediátricas, Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mazzilli S, Tavoschi L, Lopalco PL. Factors Affecting the Implementation Process of Pertussis [Tdap] Immunization in Pregnant Women in an Italian Region: A Qualitative Study. Front Public Health 2020; 8:120. [PMID: 32426313 PMCID: PMC7212430 DOI: 10.3389/fpubh.2020.00120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
Whooping cough (pertussis) represents one of the most prevalent vaccine-preventable diseases in Western countries, capable of causing disease in infants, with a high risk of severe complications. To protect new-borns from pertussis, many countries have introduced the acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids for women in the third trimester of pregnancy. Thanks to the approval of the new National Immunization Prevention Plan 2017-2019: Italy is among those countries. The Italian health-care system is a regionally based National Health Service, therefore, regions organize and implement new vaccination strategy on their own. This study focuses on Tuscany's experience in implementing the maternal pertussis vaccination. The present study had a qualitative design: we obtained information about the implementation process through interviews with relevant stakeholders involved in the planning or implementation of vaccination programme at different levels. We noticed heterogeneous implementation's status between Tuscan Health Care Departments. The most frequently reported barriers influencing the success of the implementation process of this prevention strategy included: lack of accountability, lack of enabling instruments, financial constraints, logistics barriers, training deficiencies, attitudes of health care workers, and lack of communication experts. The implementation of new vaccination programs is complex and challenging. Often the importance of education and information activities targeting health professionals are underestimated and underfunded. These elements would need to be carefully considered and adequate provisions should be made to address them when designing and implementing effective vaccine interventions.
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Affiliation(s)
- Sara Mazzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Leong RNF, Wood JG, Liu B, McIntyre PB, Newall AT. High healthcare resource utilisation due to pertussis in Australian adults aged 65 years and over. Vaccine 2020; 38:3553-9. [PMID: 32220516 DOI: 10.1016/j.vaccine.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the context of co-morbid illness and increasing age, data on excess morbidity from pertussis in older adults is crucial for immunisation policy but has been largely limited to case-series. METHODS We designed a matched case-control study nested within a population-based cohort of 267,153 adults aged ≥45 years in New South Wales, Australia (The 45 and Up Study cohort). Excess hospital bed days, emergency department (ED) admissions, general practitioner (GP) visits, and prescriptions were estimated using negative binomial regression models. An additional self-controlled analysis was also conducted to validate the main models, and to evaluate results for those with either asthma or a body mass index (BMI)≥30 compared to those without these risk factors. RESULTS Based on 524 pairs of PCR-confirmed pertussis cases and matched controls, we estimated an excess healthcare utilisation per case of 2.5 prescriptions (95% CI: 0.2-4.7), of which 1.1 (95% CI: 0.5-2.2) were antibiotics, 2.3 GP visits (95% CI: 2.0-2.6), and 0.1 ED admissions (95% CI: 0.1-0.2). Compared to those 45-64 years, cases ≥65 years had a significantly greater excess for all prescriptions (1.1 vs 4.7/case), antibiotic prescriptions (0.1 vs 2.2/case), and ED admissions (0.1 vs 0.2/case), but no significant excess of respiratory-related hospital bed days. An additional self-controlled analysis confirmed that cases with either asthma or BMI≥30 had higher overall healthcare utilisation but this was not associated with pertussis infection. CONCLUSION We found a substantial excess outpatient healthcare burden among adults aged 65 years and over with PCR-confirmed pertussis, supporting further evaluation of preventive measures.
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Cassone A. Pertussis Vaccines and Vaccination Strategies. An Ever-Challenging Health Problem. Adv Exp Med Biol 2019; 1183:161-7. [PMID: 31342457 DOI: 10.1007/5584_2019_411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Vaccines and vaccination against pertussis (whooping cough) have had one of the longest and most complex history, with alternating splendour and public disbelief, enthusiasm and concerns, overall resulting in changes in composition and replacement of vaccines, and associated vaccination strategies, including use of different vaccines in different countries, with no apparent equals for other bacterial vaccines. Of this both frustrating and exciting venue no end has been reached. In this note, I am shortly recapitulating the history of pertussis vaccines, from the inactivated, whole-cell vaccine to the acellular ones, with their merits and limitations, particularly concerning the debated issue of waning immunity, and a glimpse on a new vaccine proposal. Some reflections on the complexity and apparent peculiarity of this field are also made to the final scope of discussing aspects of the evolving strategies of disease control in a high-income country.
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Perry M, McGowan A, Roberts R, Cottrell S. Timeliness and equity of infant pertussis vaccination in wales: Analysis of the three dose primary course. Vaccine 2020; 38:1402-1407. [PMID: 31839466 DOI: 10.1016/j.vaccine.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
Infants aged under one year are at the highest risk of severe complications or death from pertussis infection. Prompt vaccination with a three dose course at two, three and four months of age decreases the amount of time they are vulnerable following waning of maternal antibodies. In Wales, uptake of all three doses of the primary course of pertussis containing vaccine is high. However, timeliness and equity at a population level have not been previously reported. This analysis included 163,733 children born from 1st January 2013 to 31st December 2017. In this cohort 87.9% received the first dose of a pertussis containing vaccine by 12 weeks of age, 87.1% had received all three doses by 24 weeks of age, and 96.3% received three doses by 52 weeks of age. Differences in uptake between those living in the most deprived and least deprived quintiles of Lower Super Output Area (LSOA) were smaller than differences in timeliness, but statistically significant. In 2017 the difference in timely uptake between those living in the most and least deprived quintiles was 4%, 5% and 7% for doses one, two and three respectively. There was a difference of 10% in the proportion of infants receiving all three primary vaccinations on time between the most and least deprived quintile of LSOAs. Consideration is needed on interventions that will help improve timeliness such as enhanced follow up of defaulters, electronic communication between primary care data systems, enhanced health visitor intervention and opportunistic vaccination in those who fail to attend scheduled vaccination appointments. There is also the need for routine monitoring of timeliness and further research into what influences delayed vaccination.
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Affiliation(s)
- Malorie Perry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Anne McGowan
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Richard Roberts
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Simon Cottrell
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
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45
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Mir-Cros A, Moreno-Mingorance A, Martín-Gómez MT, Codina G, Cornejo-Sánchez T, Rajadell M, Van Esso D, Rodrigo C, Campins M, Jané M, Pumarola T, Fàbrega A, González-López JJ. Population dynamics and antigenic drift of Bordetella pertussis following whole cell vaccine replacement, Barcelona, Spain, 1986-2015. Emerg Microbes Infect 2019; 8:1711-1720. [PMID: 31769735 PMCID: PMC6882445 DOI: 10.1080/22221751.2019.1694395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Among the factors associated with the resurgence of whooping cough, special emphasis has been given to pathogen adaptation after the introduction of the acellular vaccine (ACV). To assess the impact of the vaccine transition strategy from whole-cell vaccine (WCV) to ACV on population dynamics of Bordetella pertussis in Barcelona (Spain), we studied 339 isolates collected from 1986 to 2015 by PFGE and multi-locus variable-number tandem repeat analysis (MLVA). Additionally, allelic variants for the pertussis toxin and its promoter, pertactin, type 3 fimbriae and fimbrial serotyping were assessed to determine its antigenic drift. A shift was observed in the B. pertussis population as well as in its antigenic profile concurrently with the introduction of ACV in Barcelona. Four out of the five most prevalent PFGE profiles were replaced by new profiles following the ACV introduction. MLVA type 27 was the dominant genotype, and its frequency increased from 25% to 79.3% after WCV replacement. Antigen typing demonstrated the emergence of prn2, ptxP3, fim3-2 and a shift from the fimbriae 3 to the fimbriae 2 serotypes after the ACV introduction. Our findings support the presence of population and antigenic dynamic changes in B. pertussis likely driven by the introduction of ACV.
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Affiliation(s)
- Alba Mir-Cros
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Moreno-Mingorance
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Teresa Martín-Gómez
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gema Codina
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Thais Cornejo-Sánchez
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mireia Rajadell
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diego Van Esso
- Primary Care Health Centre Service 'Muntanya', Catalan Institute of Health, Barcelona, Spain
| | - Carlos Rodrigo
- Department of Paediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Magda Campins
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mireia Jané
- Public Health Agency of Catalonia, Barcelona, Spain
| | - Tomàs Pumarola
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Fàbrega
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Faculty of Health Sciences, University of Vic - Central University of Catalonia (UVic-UCC), Manresa, Spain
| | - Juan José González-López
- Department of Clinical Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
The WHO recommends vaccination of all children against pertussis. However, newborn infants remain vulnerable to infection. Pertussis vaccination during pregnancy has been introduced in several countries to protect newborns via transplacental transfer of maternal pertussis antibodies to the infant. We reviewed the impact of maternal pertussis vaccination on the health of pregnant women, the developing fetus, and health of the newborn. We searched PubMed/MEDLINE, EMBASE, Scopus (Elsevier), Cochrane Database of Systematic Reviews, ProQuest, and Science Direct to identify studies that assessed the safety of maternal pertussis vaccination. Twenty-seven English language publications published between January 1995 and December 2018 were included in this review. Pregnant women receiving pertussis vaccines did not have increased rates of systemic or local reactions. There were no safety concerns with repeat vaccination with other tetanus-containing vaccines or their concomitant administration with influenza vaccines. Maternal pertussis vaccination did not adversely affect pregnancy, birth or neonatal outcomes. This review confirms the safety of maternal pertussis vaccination during pregnancy. FUNDING: Sanofi Pasteur. Plain language summary available for this article.
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Affiliation(s)
| | | | - Denis Macina
- Sanofi Pasteur, Vaccines Epidemiology and Modeling, Lyon, France.
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Brousseau N, Skowronski DM, Bellemare D, Amini R, Joffres Y, Clarke Q, Quach C, Rallu F, Hoang L, De Serres G. Impact of the adolescent pertussis booster dose on the incidence of pertussis in British Columbia and Quebec, Canada. Vaccine 2019; 38:427-432. [PMID: 31685295 DOI: 10.1016/j.vaccine.2019.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/16/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
Impact of an adolescent tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine program was assessed in the provinces of British Columbia and Quebec, Canada. In both provinces, the Tdap booster has been in place since 2004, targeting Grade 9 students (14-15-years-of-age). Incidence rate ratios (IRRs) standardizing notification rates among teens 15-19-years-old to infants <1-year-old decreased following introduction of the Tdap program and were significantly halved during the 2009-2012 post-Tdap versus 2000-2003 pre-Tdap period. This program impact, however, is tempered by the observation that pertussis incidence among 15-19-year-olds was already lower than any other pediatric age group, following gradual decline from pre-teen rates even before the Tdap program. The risk of hospitalization among adolescents 15-19-years-old was also low throughout at <1/100,000. Furthermore, IRRs increased in 2013-2017 when an increasing proportion of 15-19-year-olds were primed with acellular pertussis vaccine only, suggesting short-lived Tdap booster-dose effectiveness that warrants further monitoring.
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Affiliation(s)
- Nicholas Brousseau
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada; Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada; School of Population and Public Health, Department of Medicine, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - David Bellemare
- Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada
| | - Rachid Amini
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada
| | - Yayuk Joffres
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada
| | - Quinten Clarke
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal H3T 1J4, Canada; Division of Paediatric Infectious Diseases and Department of Medical Microbiology, CHU Sainte-Justine, Montreal H3T 1C5, Canada
| | - Fabien Rallu
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal H3T 1J4, Canada; Division of Paediatric Infectious Diseases and Department of Medical Microbiology, CHU Sainte-Justine, Montreal H3T 1C5, Canada
| | - Linda Hoang
- Public Health Laboratory, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada; Department of Pathology and Laboratory Medicine, Department of Medicine, University of British Columbia, Vancouver V6T 2B5, Canada
| | - Gaston De Serres
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada; Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada
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Fernandes EG, Sartori AMC, de Soárez PC, Amaku M, de Azevedo Neto RS, Novaes HMD. Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil. Vaccine 2020; 38:46-53. [PMID: 31648911 DOI: 10.1016/j.vaccine.2019.09.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. METHODS Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. RESULTS Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. CONCLUSIONS The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
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McGirr A, Fisman DN, Tuite AR. The health and economic burden of pertussis in Canada: A microsimulation study. Vaccine 2019; 37:7240-7247. [PMID: 31585727 DOI: 10.1016/j.vaccine.2019.09.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite excellent vaccine coverage, pertussis persists in Canada, with high incidence during recent outbreaks and non-negligible incidence in non-outbreak years. While Canadian pertussis incidence is well-characterized, the full health and economic impact of pertussis have not been examined in Canada. We estimated age-specific life years (LYs) and quality-adjusted life years (QALYs) lost, and costs due to pertussis in Ontario, Canada, using a model-based approach. METHODS We developed a microsimulation model to simulate pertussis natural history. Daily probabilities of pertussis complications, hospitalizations, and disease sequelae as well as utilities and costs for health states were literature-derived. A healthcare payer perspective was used with a lifetime time horizon. Model outcomes were compared to those from a model with no pertussis health states. Probabilistic sensitivity analyses were used to generate distributions for estimates. Economic burden was estimated by multiplying case cost estimates by annual age-specific incidence. RESULTS Overall, LYs lost per pertussis case was low, with negligible LYs lost in those aged >4 years. Infants (<6 months) had the greatest mean QALY loss per case (0.58), while adults lost only 0.05 QALYs per case. Infants experienced the greatest mean cost per case of $22,768 (95% CI: 21,144-23,406). Case costs generally declined with age, but increased in seniors (aged 65+) with mean cost of $1920 (95% CI: 1800-2033). Based on historic age-specific incidence, pertussis costs the Ontario healthcare system approximately $7.6-$21.5 M annually. In total economic cost estimates with QALYs valued at 1xGDP (3xGDP) per capita, the net impact of pertussis in Ontario was estimated at $21.7-$66.5 M annually ($50.0-$156.3 M). For all of Canada, total economic costs were estimated at $79.6-$241.3 M ($187.5-$580.5 M) annually. CONCLUSION The health and economic consequences of pertussis persistence are substantial and highlight the need for improved control strategies.
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Affiliation(s)
- Ashleigh McGirr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Gil-Prieto R, Walter S, San-Román-Montero J, Marín-García P, González-Escalada A, Gil-de-Miguel A. Paediatric hospitalizations due to whooping cough in Spain (1997-2017). Vaccine 2019; 37:6342-6347. [PMID: 31526619 DOI: 10.1016/j.vaccine.2019.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
This epidemiological survey estimates the burden of whooping cough in infants up to 12 months old in Spain during a twenty-one-year period (1997-2017). The survey was conducted by reviewing data from the Spanish Surveillance System for Hospital Data. All hospitalizations due to whooping cough for infants, reported during the 1997-2017 period, were analysed. Codes were selected from the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 033.0-033.9. To explore the latest national outbreak and the implementation of vaccination in pregnant women, analyses were stratified to compare the following periods: 1997-2010, 2011-2015 and 2016-2017. A total of 13,352 hospital discharges for whooping cough in infants up to 12 months old were reported. A total of 6850 discharges in the period 1997-2010, 5271 in the period 2011-2015 and 1231 in 2016-2017 were identified. The annual hospitalization rate prior to 2011 was 131.02 cases per 100,000 infants; in 2011-2015, the rate was significantly higher (250.13 cases per 100,000 infants) and in 2016-2017 it decreased (157.69 cases per 100,000 infants). Most of the cases (n = 11,446) occurred in infants under 4 months of age, with hospitalization rates of 328.80, 670.81 and 385.84 cases per 100,000 infants up to 4 months of age in the periods 1997-2010, 2011-2015 and 2016-17, respectively. Thirty-four deaths occurred in the period 1997-2010, 36 in the period 2011-2015 and 4 in 2016-2017. All of the deaths occurred in infants under 4 months old. The case fatality rate did not vary significantly across the study periods. Whooping cough infections concentrate in infants up to 4 months of age in Spain. Public health measures such as vaccination of pregnant women, caregivers, health care professionals and relatives, especially young parents, could reduce the hospitalization burden during the current outbreak.
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Affiliation(s)
- Ruth Gil-Prieto
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain.
| | - Stefan Walter
- Fundación de Investigación, Hospital Universitario de Getafe, Madrid, Spain; Dept. of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | | | - Angel Gil-de-Miguel
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
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