Update on Epidemiology, Diagnosis, and Treatment of Pertussis

Pertussis, commonly known as whooping cough, is one of the most common vaccine-preventable infections. In adolescents and adults, infection may result in a protracted cough and is occasionally associated with substantial morbidity. In children and particularly infants, morbidity is more often substantial and the disease may be fatal. Two types of vaccines against pertussis exist: whole-cell vaccines (wP), developed in the 1940s, containing the entire inactivated Bordetella pertussis organism, and acellular vaccines (aP) constituting of 1–5 purified bacterial proteins. The aPs were developed in the 1970s in order to diminish the adverse effects that could occur in the wP vaccinations. In many industrialized countries, aP replaced the wP formulations; however, wPs are still used for primary vaccination doses in developing countries. The massive use of both types of vaccines significantly reduced the morbidity and mortality associated with the disease; nevertheless, pertussis is still an important public health problem. In fact, pertussis incidence has increased in many countries, with large sustained epidemics occurring most notably in developed countries that only use acellular vaccine for all the doses included in the calendar. This chapter focuses on some recent developments in the areas of epidemiology, diagnosis, and treatment of pertussis

Increase in pertussis cases along with high prevalence of two emerging genotypes of Bordetella pertussis in Perú, 2012

As has occurred in many regions worldwide, in 2012 the incidence of pertussis increased in Perú. This epidemiologic situation has been associated with a waning vaccine-induced immunity and the adaptation of Bordetella pertussis to vaccine-induced immunity along with improved diagnostic methods. Methods: The study comprised a total of 840 pertussis-suspected cases reported in Perú during 2012. We summarize here the distribution of pertussis cases according to age and immunization status along with the immunization-coverage rate. Laboratory diagnosis was performed by culture test and real-time polymerase-chain reaction (PCR). B. pertussis bacteria recovered from infected patients were characterized by pulsed-field gel electrophoresis (PFGE), and the DNA sequencing of the pertussis-toxin (promoter and subunit A), pertactin, and fimbriae (fim2 and fim3) genes. Results: From the total pertussis-suspected cases, 191 (22.7 %) infections were confirmed by real-time PCR and 18 through cultivation of B. pertussis (2.1 %), while one infection of B. parapertussis (0.11 %) was also detected by culture. Pertussis was significantly higher in patients that had had 0-3 vaccine doses (pentavalent vaccine alone) than in those who had had 4-5 vaccine doses (pentavalent plus DwPT boosters) at 94.3 vs. 5.7 %, respectively (p < 0.00001). The relative risk (RR) for patients with 4-5 doses compared to those with fewer than 4 doses or no dose was 0.23 (95 % Confidence Interval: 0.11-0.44), while the vaccine effectiveness was 77 % and coverage 50.5 %. Genetic analysis of B. pertussis isolates from different Peruvian regions detected two clonal groups as identified by PFGE. Those two groups corresponded to the B. pertussis genotypes emerging worldwide ptxP3-ptxA1-prn2 or 9-fim3-1 and ptxP3-ptxA1-prn2 or 9-fim3-2. Conclusions: Two emerging B. pertussis genotypes similar to isolates involved in worldwide epidemics were detected in Perú. Low vaccine coverage (<50 %) and genetic divergence between the vaccine-producing strain and the local isolates could contribute to this pertussal epidemic.Fil: Bailon, H. Instituto Nacional de Salud; PerúFil: León-Janampa, N. Instituto Nacional de Salud; PerúFil: Padilla, C.. Instituto Nacional de Salud; PerúFil: Hozbor, Daniela Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; Argentin

Outer membrane vesicles: an attractive candidate for pertussis vaccines

Pertussis is a current public-health problem and major cause of death in children, even in countries with high vaccination coverage . This bacterial respiratory disease is caused by Bordetella pertussis, but other Bordetella species such as B. parapertussis, B. bronchiseptica, and B. holmesii can provoke symptomatology similar to pertussis. The World Health Organization (WHO) estimated that in 2008, about 16 million cases of pertussis occurred worldwide with about 195,000 deaths, 95% in developing countries.Instituto de Biotecnologia y Biologia Molecula

Letter to the Editor : Bordetella pertussis Polymorphism and Pertussis Vaccines

First, I want to clarify for Dr. Guiso that in no part of our paper did we state that “the vaccines are not protecting against new circulating isolates.” Therefore, I recommend a more careful reading of our work in order to determine the true subject under discussion. My colleagues and I will not argue about what is not stated in the article. On the other hand, it is important to point out that all protection results presented in our paper were obtained using mice, and thus, care in making extrapolations to humans must be taken.Facultad de Ciencias Exacta

Membrane vesicles derived from Bordetella bronchiseptica: Active constituent of a new vaccine against infections caused by this pathogen

Bordetella bronchiseptica, a Gram-negative bacterium, causes chronic respiratory tract infections in a wide variety of mammalian hosts, including humans (albeit rarely). We recently designed Bordetella pertussis and Bordetella parapertussis experimental vaccines based on outer membrane vesicles (OMVs) derived from each pathogen, and we obtained protection against the respective infections in mice. Here, we demonstrated that OMVs derived from virulent-phase B. bronchiseptica (OMVBbvir+) protected mice against sublethal infections with different B. bronchiseptica strains, two isolated from farm animals and one isolated from a human patient. In all infections, we observed that the B. bronchiseptica loads were significantly reduced in the lungs of vaccinated animals; the lung-recovered CFU were decreased by ≥4 log units, compared with those detected in the lungs of nonimmunized animals (P < 0.001). In the OMVBbvir+-immunized mice, we detected IgG antibody titers against B. bronchiseptica whole-cell lysates, along with an immune serum having bacterial killing activity that both recognized B. bronchiseptica lipopolysaccharides and polypeptides such as GroEL and outer membrane protein C (OMPc) and demonstrated an essential protective capacity against B. bronchiseptica infection, as detected by passive in vivo transfer experiments. Stimulation of cultured splenocytes from immunized mice with OMVBbvir+ resulted in interleukin 5 (IL-5), gamma interferon (IFN-γ), and IL-17 production, indicating that the vesicles induced mixed Th2, Th1, and Th17 T-cell immune responses. We detected, by adoptive transfer assays, that spleen cells from OMVBbvir+-immunized mice also contributed to the observed protection against B. bronchiseptica infection. OMVs from avirulent-phase B. bronchiseptica and the resulting induced immune sera were also able to protect mice against B. bronchiseptica infection.Fil: Bottero, Daniela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; ArgentinaFil: Zurita, Maria Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; ArgentinaFil: Gaillard, María Emilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; ArgentinaFil: Bartel, Erika Belén. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; ArgentinaFil: Vercellini, María Clara. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Estudios Inmunológicos y Fisiopatológicos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Estudios Inmunológicos y Fisiopatológicos; ArgentinaFil: Hozbor, Daniela Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; Argentin

Modelling the effect of changes in vaccine effectiveness and transmission contact rates on pertussis epidemiology

AbstractThe incidence of the highly infectious respiratory disease named pertussis or whooping cough has been increasing for the past two decades in different countries, as in much of the highly vaccinated world. A decrease in vaccine effectiveness over time, especially when acellular vaccines were used for primary doses and boosters, and pathogen adaptation to the immunity conferred by vaccines have been proposed as possible causes of the resurgence. The contributions of these factors are not expected to be the same in different communities, and this could lead to different epidemiological trends. In fact, differences in the magnitude and dynamics of pertussis outbreaks as well as in the distribution of notified cases by age have been reported in various regions.Using an age-structured mathematical model designed by us, we evaluated how the changes in some of the parameters that could be related to the above proposed causes of disease resurgence – vaccine effectiveness and effective transmission rates – may impact on pertussis transmission.When a linear decrease in vaccine effectiveness (VE) was assayed, a sustained increase in pertussis incidence was detected mainly in infants and children. On the other hand, when changes in effective transmission rates (βij) were made, a dynamic effect evidenced by the presence of large peaks followed by deep valleys was detected. In this case, greater incidence in adolescents than in children was observed. These different trends in the disease dynamics due to modifications in VE or βij were verified in 18 possible scenarios that represent different epidemiological situations. Interestingly we found that both incidence trends produced by the model and their age distribution resemble the profiles obtained from data reported in several regions. The implications of these correlations are discussed

Global population structure and evolution of Bordetella pertussis and their relationship with vaccination

Bordetella pertussis causes pertussis, a respiratory disease that is most severe for infants. Vaccination was introduced in the 1950s, and in recent years, a resurgence of disease was observed worldwide, with significant mortality in infants. Possible causes for this include the switch from whole-cell vaccines (WCVs) to less effective acellular vaccines (ACVs), waning immunity, and pathogen adaptation. Pathogen adaptation is suggested by antigenic divergence between vaccine strains and circulating strains and by the emergence of strains with increased pertussis toxin production. We applied comparative genomics to a worldwide collection of 343 B. pertussis strains isolated between 1920 and 2010. The global phylogeny showed two deep branches; the largest of these contained 98% of all strains, and its expansion correlated temporally with the first descriptions of pertussis outbreaks in Europe in the 16th century. We found little evidence of recent geographical clustering of the strains within this lineage, suggesting rapid strain flow between countries. We observed that changes in genes encoding proteins implicated in protective immunity that are included in ACVs occurred after the introduction of WCVs but before the switch to ACVs. Furthermore, our analyses consistently suggested that virulence-associated genes and genes coding for surface-exposed proteins were involved in adaptation. However, many of the putative adaptive loci identified have a physiological role, and further studies of these loci may reveal less obvious ways in which B. pertussis and the host interact. This work provides insight into ways in which pathogens may adapt to vaccination and suggests ways to improve pertussis vaccines.La lista completa de autores que integran el documento puede consultarse en el archivo.Instituto de Biotecnologia y Biologia Molecula

Non-mandatory immunization and its potential impact on pertussis epidemiology

En este trabajo, se analizan cuantitativamente las consecuenciasa corto plazo que tendría sobre coqueluche la sanción delProyecto de Ley de Consentimiento Informado en Materiade Vacunación presentado en Argentina, en 2017, el cualcontempla la no obligatoriedad de la aplicación de las vacunasdel Calendario Nacional a los menores de edad. Se utilizaun modelo matemático para la transmisión de pertusis,desarrollado previamente en nuestro grupo. Se considera quela sola presentación del proyecto provoca una disminución enlas coberturas por generar desconfianza sobre los beneficiosdel programa de vacunación. Asumiendo 5 % anual dereducción de las coberturas durante 4 años a partir de 2018,en el siguiente brote, los casos graves en menores del año seincrementarían en más del 100 % respecto del último brote, yse estiman 101 fallecidos. Con una reducción del 10 % anualpor 4 años, el siguiente brote superaría al previo en más del200 %, con 163 decesos.Fil: Bergero, Paula Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Fabricius, Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Hozbor, Daniela Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; Argentin

Outer membrane vesicles: an attractive candidate for pertussis vaccines

Pertussis is a current public-health problem and major cause of death in children, even in countries with high vaccination coverage . This bacterial respiratory disease is caused by Bordetella pertussis, but other Bordetella species such as B. parapertussis, B. bronchiseptica, and B. holmesii can provoke symptomatology similar to pertussis. The World Health Organization (WHO) estimated that in 2008, about 16 million cases of pertussis occurred worldwide with about 195,000 deaths, 95% in developing countries.Instituto de Biotecnologia y Biologia Molecula

Assessment of pertussis vaccination strategies using a mathematical model of disease transmission

La tos convulsa o coqueluche es una enfermedad respiratoria inmunoprevenible que ha resurgido en las últimas décadas. La mayor morbimortalidad se registra en los lactantes, aunque también se detectan casos en adolescentes y adultos. La situación epidemiológica de la enfermedad ha obligado a revisar e implementar nuevas estrategias para mejorar su control. Sin embargo, muchas de estas estrategias aún no cuentan con un sustento experimental que permita su universalización. En este contexto, los modelos matemáticos de transmisión de enfermedades resultan herramientas útiles en la toma de decisiones. En este trabajo se evaluó, mediante un modelo matemático para coqueluche, el impacto que tendrían distintas medidas de control en la población más vulnerable (0 a 1 año). En particular, se analizó el impacto de la inclusión de un refuerzo a los 11 años, el efecto de la mejora en las coberturas de las dosis primarias y la disminución del retraso en la aplicación de estas. También se estimó el efecto de la vacunación a embarazadas. Los resultados muestran que la inclusión de un refuerzo a los 11 años disminuye un 3% la incidencia en los menores de 1 año. Por su parte, la aplicación de las dosis primarias a tiempo calendario (sin retrasos) la reduce un 16%. Al aumentar la cobertura del 80% al 95%, la incidencia en la población vulnerable se reduce signifcativamente (38%). Cuando el porcentaje de las embarazadas inmunizadas alcanza el 50%, la reducción de los casos más graves en los infantes superaría el 43% (0 - 2 meses).Fil: Pesco, Pablo Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Bergero, Paula Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Fabricius, Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Hozbor, Daniela Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Biotecnología y Biología Molecular; Argentin