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Reicherz F, Li S, Watts AA, Goldfarb DM, Lavoie PM, Abu-Raya B. Bordetella pertussis infection following relaxation of COVID-19 non-pharmaceutical interventions in 2021-2023 in Vancouver metropolitan area, British Columbia, Canada. Vaccine 2024:S0264-410X(24)00620-0. [PMID: 38797627 DOI: 10.1016/j.vaccine.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND We recently reported a near disappearance of B. pertussis and a decline in anti-B. pertussis antibodies during the peak implementation of Coronavirus disease 2019 (COVID-19) non-pharmaceutical interventions (NPI) in 2021 in British Columbia (BC), Canada. During 2021-2023, incidence of reported B. pertussis cases remained low in BC at < 1/100,000 population. This study determined how serological evidence of B. pertussis changed after the gradual relaxation of NPI between 2021-2023. METHODS Randomly selected blood samples from school staff 25-51 years old (n = 65) were collected yearly between 2021-2023 in the Vancouver metropolitan area, BC, Canada, and tested for anti-pertussis toxin (PT) IgG levels. Serological evidence of B. pertussis infection (thereafter "seroconversion") was defined as a quantifiable anti-PT IgG levels in subjects with anti-PT IgG levels below lower limit of quantification in the preceding year or a > 4-fold increase in anti-PT IgG levels between two subsequent years. Samples were also tested for anti-diphtheria toxoid (DT) IgG, and similar seroconversion criteria were applied to exclude seroconversion due to vaccination with tetanus-diphtheria-acellular-pertussis (Tdap). RESULTS Three subjects met seroconversion criteria for anti-PT IgG between 2021 and 2022 and 9 between 2022 and 2023, yielding a seroconversion rate of 4.6 /100 person-years and 14.9/100 person-years, P = 0.127, respectively. None of the subjects met the criteria for vaccination with Tdap. The geometric mean concentration of anti-PT IgG showed a statistically significant decrease in 2022 compared with 2021, 4.8 IU/mL IU/ml (95 % confidence interval [CI], 3.8-5.9) vs. 6.4 IU/ml (95 % CI, 4.9-8.2; p = 0.001), followed by a statistically significant increase in 2023 compared with 2022 6.5 IU/ml (95 % CI, 4.9-8.5) vs. 4.8 IU/ml (95 % CI, 3.8-5.9; p = 0.0006), respectively. DISCUSSION Serological evidence of B. pertussis increased between 2022 and 2023 despite low reported cases, which suggests that B. pertussis circulation resumed after relaxing of COVID-19 NPI.
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Affiliation(s)
- Frederic Reicherz
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Department of Pediatrics, Children's Hospital Datteln, University of Witten/Herdecke, Germany
| | - Sirui Li
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Allison A Watts
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - David M Goldfarb
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Canada; Departments of Pediatrics, Dalhousie University, Nova Scotia, Canada; Microbiology and Immunology, Dalhousie University, Nova Scotia, Canada.
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Guzman-Holst A, Gomez JA, Cintra O, Van Oorschot D, Jamet N, Nieto-Guevara J. Assessing the Underestimation of Adult Pertussis Disease in Five Latin American Countries. Infect Dis Ther 2023; 12:2791-2806. [PMID: 38095808 PMCID: PMC10746655 DOI: 10.1007/s40121-023-00895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Pertussis, a contagious respiratory disease, is underreported in adults. The study objective was to quantify underestimation of pertussis cases in adults aged ≥ 50 years in five Latin American countries (Argentina, Brazil, Chile, Mexico, Peru). METHODS A previously published probabilistic model was adapted to adjust the number of pertussis cases reported to national surveillance systems by successive multiplication steps (proportion of pertussis cases seeking healthcare; proportion with a specimen collected; proportion sent for confirmatory testing; proportion positive for pertussis; proportion reported to passive surveillance). The proportions at each step were added in a random effects model to produce a pooled overall proportion, and a final multiplier was calculated as the simple inverse of this proportion. This multiplier was applied to the number of cases reported to surveillance to estimate the number of pertussis cases. Monte Carlo simulation with 10,000 iterations estimated median as well as upper and lower 90% values. Input data were obtained from surveillance systems and published sources. RESULTS The estimated median underestimation factor for pertussis cases in adults ranged from 104 (90% limits 40, 451) in Chile to 114 (90% limits 39, 419) in Argentina. In all five countries, the largest estimated number of cases was in the group aged 50-59 years. The highest number per 100,000 population was in the group aged ≥ 90 years in most countries. The estimated median underestimation factor for pertussis hospitalizations was 2.3 (90% limits 1.8, 3.3) in Brazil and 2.4 (90% limits 1.8, 3.2) in Chile (data not available for other countries). CONCLUSION This analysis indicates that the number of pertussis cases in adults aged ≥ 50 years in five Latin American countries is approximately 100 times higher than the number captured in surveillance data. These results could support decision-making in the diagnosis, management, and prevention of pertussis disease in adults.
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Affiliation(s)
| | | | | | | | | | - Javier Nieto-Guevara
- GSK, Oceania Business Plaza, Punta Pacifica, Torre 1000 Piso 34, Panama City, Panama.
- SNI-Senacyt Panama, Panama City, Panama.
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Zhang C, Hu W, Wang R, Wang Y, Li Y, Lv Y, Li W, Si Y, Zhang S. Seroepidemiology of pertussis and diphtheria among healthy adults in Shaanxi Province, northwest China: A large - scale cross-sectional study. Hum Vaccin Immunother 2022; 18:2133913. [PMID: 36255248 DOI: 10.1080/21645515.2022.2133913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To determine the estimated pertussis incidence in adults and the need for a booster dose by detecting pertussis and diphtheria antibody levels in adults in Shaanxi province, China. Blood samples were collected from healthy individuals aged 18-59 years in Shaanxi province in 2017. Serum immunoglobulin G (IgG) antibodies against pertussis toxin (PT) and diphtheria toxin (DT) were determined using enzyme-linked immunosorbent assay. The data on reported pertussis cases in Shaanxi province were collected from the China Information System for Disease Control and Prevention and compared with the results of this study. A total of 4307 subjects were enrolled. The mean concentration of anti-PT IgG was 19.6 IU/mL (95% CI = 18.9-20.3), and the positive rate (≥40 IU/mL) was 11.0% (474/4307), of which recent infections (≥100 IU/mL) accounted for 1.2% (53/4307). Only one adult case of pertussis was reported in 2017, which is much lower than the results of this study. The mean concentration of anti-DT IgG was 0.04 IU/mL (95% CI = 0.04-0.05), and the positive rate (≥0.01 IU/mL) was 82.3% (3543/4307). The mean concentration of anti-DT IgG decreased from 0.07 IU/mL in the 18-29 year-old group to 0.03 IU/mL in the 50-59 year-old-group, and the positivity rate decreased from 86.7% to 78.7%. Our study suggests that pertussis is not uncommon among adults. The existing surveillance system might have underestimated the true incidence of pertussis. The diphtheria antibody levels decreased with age. Booster vaccination against pertussis should be considered for adolescents and young adults.
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Affiliation(s)
- Chao Zhang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Weijun Hu
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Ruize Wang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yinan Wang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yajun Li
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yake Lv
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Weixuan Li
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yuan Si
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Shaobai Zhang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
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Gabutti G, Cetin I, Conversano M, Costantino C, Durando P, Giuffrida S. Experts' Opinion for Improving Pertussis Vaccination Rates in Adolescents and Adults: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074412. [PMID: 35410091 PMCID: PMC8998413 DOI: 10.3390/ijerph19074412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
This article highlights the importance of diphtheria-tetanus-acellular pertussis (with reduced antigen content, dTap) vaccination in preventing pertussis, a respiratory infection that is still widespread and easily transmitted. In particular, it highlights the need to receive a booster vaccination throughout life to maintain high antibody levels, which decrease through time. This document collects the opinions that emerged from the comparison between major Italian experts in the field of vaccination. This working group was created to promote a "call to action", aimed at raising awareness among all institutions, public health authorities, and health workers involved in the vaccination process, about the importance of dTap vaccine administration and with the mindset of implementing the strategic vaccination plan provided by the National Vaccine Plan (NVP). In fact, despite this vaccine being included in the NVP, there are some issues attributable to the practice of vaccination (local health authorities, vaccination centers, occupational health services, gynecology centers, societies of work). Therefore, it is necessary that the Ministry defines the vaccination coverage objectives, identifies the groups of subjects who should receive the booster vaccine (subjects exposed to greater risk of infection, subjects over 60, pregnant women), and applies all the necessary measures to encourage the implementation of this practice.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, Section of Public Health Medicine, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-34-7888-9342
| | - Irene Cetin
- Obstetrics and Gynecology, Department “Woman, Mother and Child”—ASST Fatebenefratelli Sacco, Buzzi Children’ Hospital, University of Milan, 20157 Milan, Italy;
| | | | - Claudio Costantino
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Excellence Specialties, University of Palermo, 90133 Palermo, Italy;
| | - Paolo Durando
- Occupational Medicine, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Sandro Giuffrida
- Department of Prevention, Azienda Sanitaria Provinciale of Reggio Calabria, 89124 Reggio Calabria, Italy;
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Cherry JD, Doustmohammadi S. Pertussis vaccines. Curr Opin Pediatr 2022; 34:126-131. [PMID: 35081553 DOI: 10.1097/mop.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Pertussis is a vaccine preventable cough illness. It can be controlled by universal pertussis vaccination. RECENT FINDINGS Pertussis cases and deaths in children are at a record low number. More complete use of adolescent/adult vaccine can further reduce morbidity and mortality. SUMMARY Considerable progress in the control of pertussis has occurred over the last 75 years. The universal use of Tdap vaccines in all pregnant women will prevent virtually all pertussis deaths.
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Affiliation(s)
- James D Cherry
- David Geffen School of Medicine at UCLA, Department of Pediatrics
| | - Saba Doustmohammadi
- Keck School of Medicine of USC, Department of Population and Public Health Sciences, Los Angeles, California, USA
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Lambert EE, van Twillert I, Beckers L, Poelen MCM, Han WGH, Pieren DKJ, van Els CACM. Reduced Bordetella pertussis-specific CD4+ T-Cell Responses at Older Age. FRONTIERS IN AGING 2022; 2:737870. [PMID: 35822011 PMCID: PMC9261443 DOI: 10.3389/fragi.2021.737870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022]
Abstract
Pertussis, a human-specific respiratory infectious disease caused by the Gram-negative bacterium Bordetella pertussis (Bp), remains endemic with epidemic years despite high vaccination coverage. Whereas pertussis vaccines and natural infection with Bp confer immune protection, the duration of protection varies and is not lifelong. Recent evidence indicates a considerable underestimation of the pertussis burden among older adults. Whereas the impact of increasing age on Bp-specific humoral immunity has been demonstrated, little is known on immunosenescence of CD4+ T-cell responses in the context of Bp. Here, we aimed to address whether increasing age impacts responsiveness of the Bp-specific CD4+ T-cells in the memory pool following a clinically symptomatic pertussis infection in whole cell vaccine-primed pediatric and adult cases. Cytokine and proliferative responses and phenotypical profiles of CD4+ T cells specific for Bp antigens at an early and late convalescent timepoint were compared. Responses of various Th cytokines, including IFNγ, were significantly lower in older adults at early and late timepoints post diagnosis. In addition, we found lower frequencies of Bp-specific proliferated CD4+ T cells in older adults, in the absence of differences in replication profile. Phenotyping of Bp-specific CD4+ T cells suggested reduced expression of activation markers rather than increased expression of co-inhibitory markers. Altogether, our findings show that the magnitude and functionality of the Bp-specific memory CD4+ T-cell pool decrease at older age. Declined CD4+ T-cell responsiveness to Bp is suggested to contribute to the burden of pertussis in older adults.
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Cherry JD. The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future. J Pediatric Infect Dis Soc 2019; 8:334-341. [PMID: 30793754 DOI: 10.1093/jpids/piz005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/07/2019] [Accepted: 01/22/2019] [Indexed: 12/30/2022]
Abstract
Effective diphtheria, tetanus toxoids, whole-cell pertussis (DTwP) vaccines became available in the 1930s, and they were put into routine use in the United States in the 1940s. Their use reduced the average rate of reported pertussis cases from 157 in 100 000 in the prevaccine era to <1 in 100 000 in the 1970s. Because of alleged reactions (encephalopathy and death), several countries discontinued (Sweden) or markedly decreased (United Kingdom, Germany, Japan) use of the vaccine. During the 20th century, Bordetella pertussis was studied extensively in animal model systems, and many "toxins" and protective antigens were described. A leader in B pertussis research was Margaret Pittman of the National Institutes of Health/US Food and Drug Administration. She published 2 articles suggesting that pertussis was a pertussis toxin (PT)-mediated disease. Dr Pittman's views led to the idea that less-reactogenic acellular vaccines could be produced. The first diphtheria, tetanus, pertussis (DTaP) vaccines were developed in Japan and put into routine use there. Afterward, DTaP vaccines were developed in the Western world, and definitive efficacy trials were carried out in the 1990s. These vaccines were all less reactogenic than DTwP vaccines, and despite the fact that their efficacy was less than that of DTwP vaccines, they were approved in the United States and many other countries. DTaP vaccines replaced DTwP vaccines in the United States in 1997. In the last 13 years, major pertussis epidemics have occurred in the United States, and numerous studies have shown the deficiencies of DTaP vaccines, including the small number of antigens that the vaccines contain and the type of cellular immune response that they elicit. The type of cellular response a predominantly, T2 response results in less efficacy and shorter duration of protection. Because of the small number of antigens (3-5 in DTaP vaccines vs >3000 in DTwP vaccines), linked-epitope suppression occurs. Because of linked-epitope suppression, all children who were primed by DTaP vaccines will be more susceptible to pertussis throughout their lifetimes, and there is no easy way to decrease this increased lifetime susceptibility.
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Affiliation(s)
- James D Cherry
- Department of Pediatrics, David Geffen School of Medicine at UCLA
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8
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Acquisition of specific antibodies and their influence on cell-mediated immune response in neonatal cord blood after maternal pertussis vaccination during pregnancy. Vaccine 2019; 37:2569-2579. [PMID: 30955978 DOI: 10.1016/j.vaccine.2019.03.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 11/20/2022]
Abstract
Maternal immunization with pertussis acellular vaccine (Tdap) is an intervention that provides protection to newborns. However, it has been reported that high maternal antibody levels may adversely affect the immune response of infants after active immunization. In this study, we evaluated neonatal passive acquisition of pertussis-specific antibodies and their influence on the neonatal cell-mediated immune response. Pregnant women were either vaccinated with Tdap vaccine (case group, n = 66) or received no vaccine (control group, n = 101). Whole-cell Bordetella pertussis (Bp), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN)-specific serum IgG were quantified in paired maternal-cord sera, and Bp- and PT-specific IgA were evaluated in colostrum by ELISA. Ex vivo neonatal blood lymphocyte responsiveness after Bp stimulation was assessed in case (n = 17) and control (n = 15) groups using flow cytometry to detect proliferation, cytokine production and activation phenotype of lymphocytes in the context of high specific IgG acquired after maternal vaccination. Anti-Bp, PT, FHA and PRN IgG concentrations in maternal and cord sera from case group were higher than those in control group with positive correlation indexes in both groups for all pertussis antigens. The control group presented higher placental transfer ratios of specific antibodies and, in the case group, vaccination between 26 and 31 gestation weeks was associated with the best placental transfer ratios. Specific IgA concentrations in colostrum were not affected by vaccine status. Whole blood assays revealed that newborns responded to Bp stimulation with higher expression of CD40L, CD69 and CD4+ T cell proliferation compared to unstimulated cells, and a lower Th1 response, while a preserved Th2 response compared to adults, but there were no differences between the neonatal groups for any of the studied parameters. Our results indicate that higher pertussis-specific IgG levels in newborn sera after maternal vaccination do not affect the neonatal ex vivo cell-mediated immune response.
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Abstract
Pertussis or whooping cough, mainly caused by Bordetella pertussis, is a severe respiratory disease that can affect all age groups but is most severe and can be life-threatening in young children. Vaccines against this disease are widely available since the 1950s. Despite high global vaccination coverage, the disease is not under control in any country, and its incidence is even increasing in several parts of the world. Epidemiological and experimental evidence has shown that the vaccines fail to prevent B. pertussis infection and transmission, although they are very effective in preventing disease. Given the high infection rate of B. pertussis, effective control of the disease likely requires prevention of infection and transmission in addition to protection against disease. With rare exceptions B. pertussis infections are restricted to the airways and do not usually disseminate beyond the respiratory epithelium. Therefore, protection at the level of the respiratory mucosa may be helpful for an improved control of pertussis. Yet, compared to systemic responses, mucosal immune responses have attracted relatively little attention in the context of pertussis vaccine development. In this review we summarize the available literature on the role of mucosal immunity in the prevention of B. pertussis infection. In contrast to vaccination, natural infection in humans and experimental infections in animals induce strong secretory IgA responses in the naso-pharynx and in the lungs. Several studies have shown that secretory IgA may be instrumental in the control of B. pertussis infection. Furthermore, studies in mouse models have revealed that B. pertussis infection, but not immunization with current acellular pertussis vaccines induces resident memory T cells, which may also contribute to protection against colonization by B. pertussis. As these resident memory T cells are long lived, vaccines that are able to induce them should provide long-lasting immunity. As of today, only one vaccine designed to induce potent mucosal immunity is in clinical development. This vaccine is a live attenuated B. pertussis strain delivered nasally in order to mimic the natural route of infection. Due to its ability to induce mucosal immunity it is expected that this approach will contribute to improved control of pertussis.
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Affiliation(s)
- Luis Solans
- Center of Infection and Immunity of Lille, Institut Pasteur de Lille, Lille, France
- Inserm U1019, Lille, France
- CNRS UMR8204, Lille, France
- Center for Infection and Immunity of Lille, Univ. Lille, Lille, France
| | - Camille Locht
- Center of Infection and Immunity of Lille, Institut Pasteur de Lille, Lille, France
- Inserm U1019, Lille, France
- CNRS UMR8204, Lille, France
- Center for Infection and Immunity of Lille, Univ. Lille, Lille, France
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IL-17-dependent SIgA-mediated protection against nasal Bordetella pertussis infection by live attenuated BPZE1 vaccine. Mucosal Immunol 2018; 11:1753-1762. [PMID: 30115992 DOI: 10.1038/s41385-018-0073-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/05/2018] [Accepted: 07/23/2018] [Indexed: 02/04/2023]
Abstract
BPZE1 is a live attenuated Bordetella pertussis vaccine for nasal administration to mimic the natural route of infection. Here, we studied the mechanism of BPZE1-induced immunity in the murine nasal cavity in contrast to acellular vaccine (aPV), although both vaccines protected against lung colonization. Transfer of splenocytes or serum from BPZE1-vaccinated or aPV-vaccinated mice protected naïve mice against lung colonization but not against nasal colonization. However, transfer of nasal washes from BPZE1-vaccinated mice resulted in protection against nasal colonization, which was lost in IgA-deficient or poly-Ig receptor-deficient mice, indicating that it depends on secretory IgA (SIgA) induction induced in the nose. BPZE1-induced protection against nasal colonization was long-lived despite the relatively rapid decay of SIgA, indicating a potent BPZE1-induced local memory response, likely due to CD4+ tissue-resident memory T cells induced in the nose by BPZE1. These cells produced interleukin-17 (IL-17), known to be important for SIgA secretion. Furthermore, BPZE1 failed to protect Il17-/- mice against nasal colonization by B. pertussis and induced only background levels of nasal SIgA. Thus, our results show important differences in the protective mechanism between the upper and the lower murine respiratory tract and demonstrate an IL-17-dependent SIgA-mediated mechanism of BPZE1-induced protection against B. pertussis nasopharyngeal colonization.
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Caldera F, Saha S, Wald A, Garmoe CA, McCrone S, Megna B, Ley D, Reichelderfer M, Hayney MS. Lower Sustained Diphtheria and Pertussis Antibody Concentrations in Inflammatory Bowel Disease Patients. Dig Dis Sci 2018; 63:1532-1540. [PMID: 29594970 DOI: 10.1007/s10620-018-5043-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are often immunosuppressed, and those patients receiving anti-tumor necrosis factor α (TNF) therapy can have lower antibody responses to vaccines. Pertussis cases are at their highest levels in the post-vaccine era. There is little data regarding responses to the Tdap (tetanus, diphtheria, and acellular pertussis) vaccine in IBD patients. AIMS The aim of this study was to compare sustained vaccine-induced Tdap antibody concentrations in a cohort of IBD patients stratified by medication regimens with healthy controls (HC) who had received an adult Tdap booster. METHODS We performed a cross-sectional study evaluating antibody responses to Tdap vaccine among IBD patients compared to HC. Our study consisted of three patient groups: adults with IBD stratified by maintenance medication regimen: (1) thiopurine monotherapy; (2) anti-TNF monotherapy; and (3) combination therapy (anti-TNF and immunomodulator (thiopurine or methotrexate)). RESULTS Ninety IBD patients and 20 HC participated. Pertussis pertactin antibody concentrations were significantly lower in IBD patients (p = 0.021) compared to HC, and those on anti-TNF agents (monotherapy or combination) had lower antibody concentrations compared to those on thiopurine monotherapy (p = 0.028). Diphtheria antibody concentrations were also lower in IBD patients (p < 0.001), and those on anti-TNF agents (monotherapy or combination) had lower antibody concentrations compared to the thiopurine monotherapy group (p < 0.001). CONCLUSION IBD patients on anti-TNF agents had lower antibody concentrations to diphtheria and pertussis. These findings suggest a need for different Tdap booster schedules for IBD patients on anti-TNF therapy. Clinical Trials Registry NCT02434133.
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Affiliation(s)
- Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA.
| | - Sumona Saha
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - Arnold Wald
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - Christine A Garmoe
- School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI, 53705, USA
| | - Sue McCrone
- School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI, 53705, USA
| | - Bryant Megna
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave., Madison, WI, 53705, USA
| | - Dana Ley
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave., Madison, WI, 53705, USA
| | - Mark Reichelderfer
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI, 53705, USA
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Halperin SA, Donovan C, Marshall GS, Pool V, Decker MD, Johnson DR, Greenberg DP. Randomized Controlled Trial of the Safety and Immunogenicity of Revaccination With Tetanus-Diphtheria-Acellular Pertussis Vaccine (Tdap) in Adults 10 Years After a Previous Dose. J Pediatric Infect Dis Soc 2018; 8:105-114. [PMID: 29438562 PMCID: PMC6510947 DOI: 10.1093/jpids/pix113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/17/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended in many countries for boosting immunity in adolescents and adults. Although immunity to these antigens wanes with time, currently available Tdap products are not labeled for repeat administration in the United States. METHODS We performed an observer-blinded, randomized controlled trial in 1330 adults aged 18 to <65 years who received either the Tdap (n = 1002) or tetanus-diphtheria (Td) (n = 328) vaccine 8 to 12 years after a dose of Tdap vaccine administered previously. Solicited adverse events following immunization were documented for 7 days after vaccination, and serious adverse events and adverse events of medical significance were documented for 6 months after vaccination. Levels of antibodies against component vaccine antigens were measured before and 1 month after vaccination. RESULTS A solicited adverse event was reported by 87.7% of Tdap and 88.0% of Td vaccine recipients. We found no significant differences in the rates of injection-site reactions, systemic reactions, or serious adverse events between the vaccine groups. A robust antibody response to each pertussis antigen in the Tdap-vaccinated group was found; postvaccination-to-prevaccination geometric mean antibody concentration ratios were 8:1 (pertussis toxoid), 5.9 (filamentous hemagglutinin), 6.4 (pertactin), and 5.2 (fimbriae 2 and 3). Postvaccination geometric mean concentrations of tetanus antibody (4.20 and 4.74 IU/mL, respectively) and diphtheria antibody (10.1 and 12.6 IU/mL, respectively) were similar in the Tdap and Td groups, and the rates of seroprotection against tetanus and diphtheria were >99% in both groups. CONCLUSIONS A second dose of Tdap vaccine in adults approximately 10 years after a previous dose was well tolerated and immunogenic. These data might facilitate consideration of providing Tdap booster doses to adults.
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Affiliation(s)
- Scott A Halperin
- Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia,Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, Nova Scotia,Correspondence: S. A. Halperin, MD, Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada ()
| | - Catherine Donovan
- Department of Health and Community Services, Government of Newfoundland and Labrador, St. John’s, Newfoundland,Division of Community Health and Humanities, Memorial University of Newfoundland, St. John’s, Newfoundland
| | - Gary S Marshall
- Department of Pediatrics, University of Louisville School of Medicine, Kentucky
| | | | - Michael D Decker
- Sanofi Pasteur, Swiftwater, Pennsylvania,Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - David P Greenberg
- Sanofi Pasteur, Swiftwater, Pennsylvania,Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania
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Yao N, Zeng Q, Wang Q. Seroepidemiology of diphtheria and pertussis in Chongqing, China: serology-based evidence of Bordetella pertussis infection. Public Health 2018; 156:60-66. [PMID: 29408190 DOI: 10.1016/j.puhe.2017.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/08/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In order to gain further insight into the seroepidemiology of Bordetella pertussis infection and immunity against diphtheria in Chongqing, China, the concentrations of antibodies to pertussis toxin (PT) and diphtheria toxin (DT) were investigated in a healthy population. STUDY DESIGN Cross-sectional study. METHODS In total, 1080 healthy people were recruited into this study. Sera antibodies to DT and PT were measured quantitatively using commercial enzyme-linked immunosorbent assay kits. Age-specific incidence of infection with B. pertussis was estimated and compared with notified cases of pertussis. RESULTS The mean concentration of anti-DT IgG was 0.71 IU/ml (95% confidence interval [CI] = 0.60-0.82), with a positive rate (>0.01 IU/ml) of 97.41% (1052/1080). The mean concentration of anti-PT IgG was 7.65 IU/ml (95% CI = 6.65-8.65), with a positive rate (>100 IU/ml) of 1.17% (11/944). The estimated pertussis infection rate was 7290/100,000, which was far higher than the reported incidence of 1.29/100,000 in 2015. The peaks of estimated incidence of infection were found in subjects aged 7-14 years (9971/100,000) and ≥20 years (13,898/100,000). CONCLUSIONS B. pertussis infection occurs frequently in young infants and adolescents/adults; the latter are often responsible for the transmission of pertussis to young infants. The existing surveillance system may underestimate the true incidence of pertussis in older age groups in Chongqing, and the immunisation programme should be improved to provide protection against pertussis for adolescents and young adults.
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Affiliation(s)
- N Yao
- Chongqing Centre for Disease Control and Prevention, Chongqing, China; Department of Medical Statistics, School of Management and Public Health, Chongqing Medical University, Chongqing, China
| | - Q Zeng
- Department of Medical Statistics, School of Management and Public Health, Chongqing Medical University, Chongqing, China.
| | - Q Wang
- Chongqing Centre for Disease Control and Prevention, Chongqing, China
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14
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Rubin K, Glazer S. The pertussis hypothesis: Bordetella pertussis colonization in the pathogenesis of Alzheimer’s disease. Immunobiology 2017; 222:228-240. [DOI: 10.1016/j.imbio.2016.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022]
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Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: Microbiology, Disease, Treatment, and Prevention. Clin Microbiol Rev 2016; 29:449-86. [PMID: 27029594 PMCID: PMC4861987 DOI: 10.1128/cmr.00083-15] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pertussis is a severe respiratory infection caused by Bordetella pertussis, and in 2008, pertussis was associated with an estimated 16 million cases and 195,000 deaths globally. Sizeable outbreaks of pertussis have been reported over the past 5 years, and disease reemergence has been the focus of international attention to develop a deeper understanding of pathogen virulence and genetic evolution of B. pertussis strains. During the past 20 years, the scientific community has recognized pertussis among adults as well as infants and children. Increased recognition that older children and adolescents are at risk for disease and may transmit B. pertussis to younger siblings has underscored the need to better understand the role of innate, humoral, and cell-mediated immunity, including the role of waning immunity. Although recognition of adult pertussis has increased in tandem with a better understanding of B. pertussis pathogenesis, pertussis in neonates and adults can manifest with atypical clinical presentations. Such disease patterns make pertussis recognition difficult and lead to delays in treatment. Ongoing research using newer tools for molecular analysis holds promise for improved understanding of pertussis epidemiology, bacterial pathogenesis, bioinformatics, and immunology. Together, these advances provide a foundation for the development of new-generation diagnostics, therapeutics, and vaccines.
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Affiliation(s)
- Paul E Kilgore
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Abdulbaset M Salim
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Marcus J Zervos
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Health System and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Heinz-Josef Schmitt
- Medical and Scientific Affairs, Pfizer Vaccines, Paris, France Department of Pediatrics, Johannes Gutenberg-University, Mainz, Germany
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Abstract
Pertussis, caused by Bordetella (B.) pertussis, a Gram-negative bacterium, is a highly contagious airway infection. Especially in infants, pertussis remains a major health concern. Acute infection with B. pertussis can cause severe illness characterized by severe respiratory failure, pulmonary hypertension, leucocytosis, and death. Over the past years, rising incidence rates of intensive care treatment in young infants were described. Due to several virulence factors (pertussis toxin, tracheal cytotoxin, adenylate cyclase toxin, filamentous hemagglutinin, and lipooligosaccharide) that promote bacterial adhesion and invasion, B. pertussis creates a unique niche for colonization within the human respiratory tract. The resulting long-term infection is mainly caused by the ability of B. pertussis to interfere with the host's innate and adaptive immune system. Although pertussis is a vaccine-preventable disease, it has persisted in vaccinated populations. Epidemiological data reported a worldwide increase in pertussis incidence among children during the past years. Either acellular pertussis (aP) vaccines or whole-cell vaccines are worldwide used. Recent studies did not detect any differences according to pertussis incidence when comparing the different vaccines used. Most of the currently used aP vaccines protect against acute infections for a period of 6-8 years. The resurgence of pertussis may be due to the lack of herd immunity caused by missing booster immunizations among adolescents and adults, low vaccine coverages in some geographic areas, and genetic changes of different B. pertussis strains. Due to the rising incidence of pertussis, probable solution strategies are discussed. Cocooning strategies (vaccination of close contact persons) and immunizations during pregnancy appear to be an approach to reduce neonatal contagiousness. During the past years, studies focused on the pathway of the immune modulation done by B. pertussis to provide a basis for the identification of new therapeutic targets to enhance the host's immune response and to probably modulate certain virulence factors.
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Affiliation(s)
- Manuela Zlamy
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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17
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van Twillert I, Bonačić Marinović AA, van Gaans-van den Brink JAM, Kuipers B, Berbers GAM, van der Maas NAT, Verheij TJM, Versteegh FGA, Teunis PFM, van Els CACM. The Use of Innovative Two-Component Cluster Analysis and Serodiagnostic Cut-Off Methods to Estimate Prevalence of Pertussis Reinfections. PLoS One 2016; 11:e0148507. [PMID: 26848833 PMCID: PMC4743910 DOI: 10.1371/journal.pone.0148507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/19/2016] [Indexed: 01/13/2023] Open
Abstract
Bordetella pertussis circulates even in highly vaccinated countries affecting all age groups. Insight into the scale of concealed reinfections is important as they may contribute to transmission. We therefore investigated whether current single-point serodiagnostic methods are suitable to estimate the prevalence of pertussis reinfection. Two methods based on IgG-Ptx plasma levels alone were used to evaluate the proportion of renewed seroconversions in the past year in a cohort of retrospective pertussis cases ≥ 24 months after a proven earlier symptomatic infection. A Dutch population database was used as a baseline. Applying a classical 62.5 IU/ml IgG-Ptx cut-off, we calculated a seroprevalence of 15% in retrospective cases, higher than the 10% observed in the population baseline. However, this method could not discriminate between renewed seroconversion and waning of previously infection-enhanced IgG-Ptx levels. Two-component cluster analysis of the IgG-Ptx datasets of both pertussis cases and the general population revealed a continuum of intermediate IgG-Ptx levels, preventing the establishment of a positive population and the comparison of prevalence by this alternative method. Next, we investigated the complementary serodiagnostic value of IgA-Ptx levels. When modelling datasets including both convalescent and retrospective cases we obtained new cut-offs for both IgG-Ptx and IgA-Ptx that were optimized to evaluate renewed seroconversions in the ex-cases target population. Combining these cut-offs two-dimensionally, we calculated 8.0% reinfections in retrospective cases, being below the baseline seroprevalence. Our study for the first time revealed the shortcomings of using only IgG-Ptx data in conventional serodiagnostic methods to determine pertussis reinfections. Improved results can be obtained with two-dimensional serodiagnostic profiling. The proportion of reinfections thus established suggests a relatively increased period of protection to renewed infection after clinical pertussis.
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Affiliation(s)
- Inonge van Twillert
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Axel A. Bonačić Marinović
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Betsy Kuipers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Guy A. M. Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nicoline A. T. van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Theo J. M. Verheij
- Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Florens G. A. Versteegh
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, the Netherlands
- Ghent University Hospital, department of pediatrics, Ghent, Belgium
| | - Peter F. M. Teunis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- RSPH, Emory University, Atlanta, United States of America
| | - Cécile A. C. M. van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail:
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Masseria C, Krishnarajah G. The estimated incidence of pertussis in people aged 50 years old in the United States, 2006-2010. BMC Infect Dis 2015; 15:534. [PMID: 26584525 PMCID: PMC4653927 DOI: 10.1186/s12879-015-1269-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 11/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background Pertussis is believed to be widely underreported and under-recognized, particularly among adults. The aim of this study was to estimate the incidence of private practitioner-attended cough illness that could be attributed to Bordetella pertussis in adults aged ≥50 years in the US. Methods Multiple linear regressions were employed to estimate the overall incidence of pertussis. Data were extracted from IMS’ private practice database of longitudinal, patient-level claims and IMS’ commercial laboratory database during 4/1/2006–12/31/2010. Patients were ≥50 years old and had ≥1 ICD-9-CM claim for cough illness relating to pertussis, cough, or acute bronchitis. Pertussis positive laboratory tests, seasonal and secular variables were used for estimating the B. pertussis attributable fraction of cough illness. Results During the study period, there were 20.7 million cases of cough illness among people aged 50–64 and 27.5 million cases among those ≥65; of which the model attributed 2.5 and 1.7 %, respectively, to B. pertussis. The estimated incidences of cough illness attributed to B. pertussis during the study period were on average 202 and 257/100,000 among people aged 50–64 and ≥65 years, respectively, and increased over the years in both age groups. Depending on the year, estimated pertussis incidences were 42 to 105 times higher than medically attended ones in the same database. Conclusions These findings indicate that the B. pertussis disease incidence in adults aged ≥50 years is significantly higher than generally estimated. Additional research regarding pertussis reporting and diagnosis in the adult populations is needed to validate these findings.
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Affiliation(s)
- Cristina Masseria
- Global Health & Value, Pfizer Inc., 235 E 42nd street, New York, NY, 10017, USA.
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19
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Estimated and reported incidence of pertussis in Estonian adults: A seroepidemiological study. Vaccine 2015; 33:4756-61. [DOI: 10.1016/j.vaccine.2015.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
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20
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Villarino Romero R, Osicka R, Sebo P. Filamentous hemagglutinin of Bordetella pertussis: a key adhesin with immunomodulatory properties? Future Microbiol 2015; 9:1339-60. [PMID: 25517899 DOI: 10.2217/fmb.14.77] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The filamentous hemagglutinin of pathogenic Bordetellae is a prototype of a large two-partner-system-secreted and β-structure-rich bacterial adhesin. It exhibits several binding activities that may facilitate bacterial adherence to airway mucosa and host phagocytes in the initial phases of infection. Despite three decades of research on filamentous hemagglutinin, there remain many questions on its structure-function relationships, integrin interactions and possible immunomodulatory signaling capacity. Here we review the state of knowledge on this important virulence factor and acellular pertussis vaccine component. Specific emphasis is placed on outstanding questions that are yet to be answered.
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Affiliation(s)
- Rodrigo Villarino Romero
- Institute of Microbiology of the Academy of Sciences of the Czech Republic, v.v.i., Videnska 1083, 142 20 Prague, Czech Republic
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Barkoff AM, Gröndahl-Yli-Hannuksela K, He Q. Seroprevalence studies of pertussis: what have we learned from different immunized populations. Pathog Dis 2015. [PMID: 26208655 DOI: 10.1093/femspd/ftv050] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bordetella pertussis is a pathogen-causing whooping cough (pertussis) in humans. Although vaccination against the disease is effective, the bacterium is still circulating among population and can even cause death. Especially young infants, who lack protection, are vulnerable. The laboratory diagnostic methods to detect B. pertussis are culture, PCR and ELISA serology. Reported cases of the disease vary among countries but usually the incidence rates are low, <1 to 10/100 000. However, pertussis often goes unrecognized among patients as it presents itself like the common cold, especially in adults and elders who are often the source of the infection. This makes pertussis difficult to monitor and control. Serological surveillance is an easy manner to estimate the real burden of the disease among population. Furthermore, to have reliable results, anti-PT IgG antibodies should be measured, as PT is the only specific antigen to B. pertussis. This review aims to evaluate available pertussis seroprevalence studies throughout the world, and to compare the findings from countries with different vaccination histories and strategies. Estimation of the real burden of pertussis is compared to reported numbers. In addition, future aspects in seroprevalence studies are considered.
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Affiliation(s)
- Alex-Mikael Barkoff
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | | | - Qiushui He
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
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The History of Pertussis (Whooping Cough); 1906–2015: Facts, Myths, and Misconceptions. CURR EPIDEMIOL REP 2015. [DOI: 10.1007/s40471-015-0041-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Cherry JD, Paddock CD. Pathogenesis and histopathology of pertussis: implications for immunization. Expert Rev Vaccines 2014; 13:1115-23. [PMID: 24992986 DOI: 10.1586/14760584.2014.935766] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pertussis is a unique infectious disease in that it can be severe and fatal but occurs without fever and other evidence of an inflammatory illness. The authors with others have studied the histopathology of fatal pertussis and also the unique characteristics of severe pertussis in young infants. Histopathologic observations from approximately 100 years ago, and from recent evaluation, indicate that the histopathologic changes of the upper respiratory tract of patients with fatal pertussis are often relatively normal unless there is a secondary bacterial infection. Bordetella pertussis contains many protein antigens and perhaps a polysaccharide capsule which contribute to the infectious process. However, only two of these antigens contribute to clinical illness. These antigens are pertussis toxin and the yet to be identified 'cough toxin'. The authors speculate as to the nature of the 'cough toxin' and discuss the implications of their observations and concepts for the future control of pertussis.
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Affiliation(s)
- James D Cherry
- Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC 22-442, Los Angeles, CA 90095, USA
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Cherry JD. Adult pertussis in the pre- and post-vaccine eras: lifelong vaccine-induced immunity? Expert Rev Vaccines 2014; 13:1073-80. [DOI: 10.1586/14760584.2014.935765] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Han WGH, van Twillert I, Poelen MCM, Helm K, van de Kassteele J, Verheij TJM, Versteegh FGA, Boog CJP, van Els CACM. Loss of multi-epitope specificity in memory CD4(+) T cell responses to B. pertussis with age. PLoS One 2013; 8:e83583. [PMID: 24391789 PMCID: PMC3877060 DOI: 10.1371/journal.pone.0083583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/06/2013] [Indexed: 02/05/2023] Open
Abstract
Pertussis is still occurring in highly vaccinated populations, affecting individuals of all ages. Long-lived Th1 CD4(+) T cells are essential for protective immunity against pertussis. For better understanding of the limited immunological memory to Bordetella pertussis, we used a panel of Pertactin and Pertussis toxin specific peptides to interrogate CD4(+) T cell responses at the epitope level in a unique cohort of symptomatic pertussis patients of different ages, at various time intervals after infection. Our study showed that pertussis epitope-specific T cell responses contained Th1 and Th2 components irrespective of the epitope studied, time after infection, or age. In contrast, the breadth of the pertussis-directed CD4(+) T cell response seemed dependent on age and closeness to infection. Multi-epitope specificity long-term after infection was lost in older age groups. Detailed knowledge on pertussis specific immune mechanisms and their insufficiencies is important for understanding resurgence of pertussis in highly vaccinated populations.
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Affiliation(s)
- Wanda G. H. Han
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Inonge van Twillert
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Martien C. M. Poelen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kina Helm
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jan van de Kassteele
- Department of Statistics, Mathematical Modelling and Data Logistics, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Theo J. M. Verheij
- Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Cécile A. C. M. van Els
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Berbers GAM, van de Wetering MSE, van Gageldonk PGM, Schellekens JFP, Versteegh FGA, Teunis PFM. A novel method for evaluating natural and vaccine induced serological responses to Bordetella pertussis antigens. Vaccine 2013; 31:3732-8. [PMID: 23742995 DOI: 10.1016/j.vaccine.2013.05.073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/26/2013] [Accepted: 05/17/2013] [Indexed: 11/17/2022]
Abstract
We studied the time course of serum IgG antibodies against 3 different pertussis vaccine antigens: PT (pertussis toxin), FHA (filamentous hemagglutinin), Prn (pertactin) in sera from individuals vaccinated with four different pertussis vaccines at 4 years of age: (N=44, 44, 23 and 23, respectively,) and compared the responses to/after natural infection with Bordetella pertussis (N=44, age 1-8 years). These longitudinal data were analyzed with a novel method, using a mathematical model to describe the observed responses, and their variation among subjects. This allowed us to estimate biologically meaningful characteristics of the serum antibody response, like peak level and decay rate, and to compare these among natural infections and vaccine responses. Compared to natural infection, responses to PT after vaccination with the tested vaccines are smaller in magnitude and tend to decay slightly faster. When present in vaccines, FHA and Prn tend to produce high peak levels, higher than those in naturally infected patients, but these decay faster. As expected, the Dutch whole cell vaccine produced lower antibody responses than the acellular vaccines. This model allows a better comparison of the kinetics of vaccine induced antibody responses and after natural infection over a long follow up period.
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Affiliation(s)
- G A M Berbers
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
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Libster R, Edwards KM. Re-emergence of pertussis: what are the solutions? Expert Rev Vaccines 2013; 11:1331-46. [PMID: 23249233 DOI: 10.1586/erv.12.118] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Whooping cough, due to Bordetella pertussis and Bordetella parapertussis, is an important cause of childhood morbidity and mortality. Despite widespread pertussis immunization in childhood, there are an estimated 50 million cases and 300,000 deaths due to pertussis globally each year. Infants who are too young to be vaccinated, children who are partially vaccinated and fully-vaccinated persons with waning immunity are especially vulnerable to disease. Since pertussis is one of the vaccine-preventable diseases on the rise, additional vaccine approaches are needed. These approaches include vaccination of newborns, additional booster doses for older adolescents and adults, and immunization of pregnant women with existing vaccines. Innovative new vaccines are also being studied. Each of these options will be discussed and their potential impact on pertussis control assessed.
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Affiliation(s)
- Romina Libster
- Vanderbilt University School of Medicine, Department of Pediatrics, Vanderbilt Vaccine Research Program, Nashville, TN, USA
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28
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Nitsch-Osuch A, Korzeniewski K, Kuchar E, Zielonka T, Życińska K, Wardyn K. Epidemiological and immunological reasons for pertussis vaccination in adolescents and adults. Respir Physiol Neurobiol 2013; 187:99-103. [PMID: 23419520 DOI: 10.1016/j.resp.2013.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/09/2013] [Accepted: 02/11/2013] [Indexed: 11/29/2022]
Abstract
The resurgence of pertussis has been the subject of considerable debate. Hypotheses to explain increased reporting in developed countries have focused mainly on three aspects: (1) increased recognition of the disease in adolescents and adults; (2) waning of vaccine-induced immunity and (3) loss of vaccine efficacy due to an antigenic shift of Bordetella pertussis. Waning immunity after vaccination or natural infection combined with the absence of regular boosters either in the form of vaccine boosters or natural exposure to B. pertussis - due to the low circulation of the bacterium in well-immunized populations - has been suggested to explain this shift in the age distribution of pertussis. The highest incidence of the disease is currently reported among adolescents and adults who may additionally serve as the source of infection for susceptible infants. Immunological and epidemiological data indicates the need for a universal booster vaccination against pertussis for adolescents and adults.
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Affiliation(s)
- Aneta Nitsch-Osuch
- Department of Family Medicine, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland.
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Zhang Q, Zheng H, Liu M, Han K, Shu J, Wu C, Xu N, He Q, Luo H. The seroepidemiology of immunoglobulin G antibodies against pertussis toxin in China: a cross sectional study. BMC Infect Dis 2012; 12:138. [PMID: 22892100 PMCID: PMC3447642 DOI: 10.1186/1471-2334-12-138] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/11/2012] [Indexed: 11/17/2022] Open
Abstract
Background Pertussis is a reported vaccine-preventable respiratory disease in China. Because the routine laboratory methods for diagnosis are not in use, the reported cases are mainly in infants with classical paroxysmal cough and the true incidence related to pertussis is most likely under estimated. In China, however, few studies have attempted to address this issue. The purpose of this cross sectional study was to estimate the incidence rates using the method of sero-epidemiology of immunoglobulin (Ig) G antibodies against pertussis toxin (PT) among healthy populations in China. Methods Blood samples were obtained from 1313 healthy individuals aged 0 to 95 years in Guangdong province of China throughout September 2010. Serum IgG antibodies against PT were determined by commercial ELISA kits. Subjects with concentration of anti-PT IgG higher than 30 IU/mL were indicated to have recent Bordetella pertussis infection, if they have not received a booster dose of pertussis vaccine within one year. Results Of the 1313 study subjects, 117 (8.91%) were found to have anti-PT antibodies higher than 30 IU/mL. The estimated incidence of recent infection was thus 9395 per 100,000 for individuals older than 7 years. Peaks of the estimated incidence rate of recent infection were found to be 11561 per 100,000 in age group of 41–50 years and 11428 per 100,000 in the group aged 13–19 years. Conclusions Our study indicated that B.pertussis infections are considerablely common, particularly in adolescents and adults in China. The study also stresses the importance of laboratory diagnosis for pertussis and employment of booster dose of pertussis vaccine in adolescents and adults in this country.
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Affiliation(s)
- Qi Zhang
- National Institute for Communicable Disease Control and Prevention, State Key Laboratory for Infectious Diseases Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, People's Republic of China
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Age-related differences in patterns of increased Bordetella pertussis antibodies. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:545-50. [PMID: 22357646 DOI: 10.1128/cvi.05725-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the period 2008 to 2010, we identified 11,386 serum samples with increased (positive) levels of antibodies recognizing Bordetella pertussis antigens. We sought to characterize the distribution of positive antibody result patterns in relation to patient age. IgG and IgA antibodies recognizing pertussis toxin (PT) and filamentous hemagglutinin (FHA) were quantified using a multianalyte immunodetection assay. Four mutually exclusive positive result patterns were observed: increased FHA antibodies only, increased PT IgA but not IgG, increased PT IgG but not IgA, and increased PT IgG and IgA. In patients < 21 years old, the predominant pattern was increased PT IgG but not IgA, whereas in patients ≥ 21 years old, it was increased FHA antibodies only. The proportion of positive serum samples exhibiting increased PT IgA but not IgG was < 20% in all age categories but showed a stepwise rise with age. The proportions of positive serum samples exhibiting increased PT IgG and IgA were similar (26 to 32%) in the age categories spanning 11 to 60 years of age but lower in the < 11- and > 60-year-old groups. In 3 of 5 age categories, a significant rise in the proportion of positive serum samples exhibiting increased FHA antibodies only occurred in 2010. Patterns of positive B. pertussis antibody results varied with age. The predominance of increased FHA antibodies only in patients > 20 years old suggests that many adults thought to have B. pertussis infections actually have other infections that induce FHA-reactive antibodies. Similarly, the 2010 rise in the frequency of increased FHA antibodies only in some age groups suggests an increase in non-B. pertussis infections.
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Vaccination of adults 65 years of age and older with tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Boostrix®): Results of two randomized trials. Vaccine 2012; 30:1721-8. [DOI: 10.1016/j.vaccine.2011.12.055] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 12/08/2011] [Accepted: 12/11/2011] [Indexed: 11/19/2022]
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Seroprevalence of antibodies to pertussis and diphtheria among healthy adults in China. J Infect 2011; 63:441-6. [DOI: 10.1016/j.jinf.2011.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/18/2011] [Accepted: 07/08/2011] [Indexed: 11/24/2022]
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Van Damme P, McIntyre P, Grimprel E, Kuriyakose S, Jacquet JM, Hardt K, Messier M, Van Der Meeren O. Immunogenicity of the reduced-antigen-content dTpa vaccine (Boostrix®) in adults 55 years of age and over: A sub-analysis of four trials. Vaccine 2011; 29:5932-9. [DOI: 10.1016/j.vaccine.2011.06.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022]
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Immunization of teenagers with a fifth dose of reduced DTaP-IPV induces high levels of pertussis antibodies with a significant increase in opsonophagocytic activity. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1269-74. [PMID: 21677109 DOI: 10.1128/cvi.05067-11] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Waning vaccine-induced immunity against Bordetella pertussis is observed among adolescents and adults. A high incidence of pertussis has been reported in this population, which serves as a reservoir for B. pertussis. A fifth dose of reduced antigen of diphtheria-tetanus-acellular-pertussis and inactivated polio vaccine was given as a booster dose to healthy teenagers. The antibody activity against B. pertussis antigens was measured prior to and 4 to 8 weeks after the booster by different assays: enzyme-linked immunosorbent assays (ELISAs) of IgG and IgA against pertussis toxin (PT) and filamentous hemagglutinin (FHA), IgG against pertactin (PRN), opsonophagocytic activity (OPA), and IgG binding to live B. pertussis. There was a significant increase in the IgG activity against PT, FHA, and PRN following the booster immunization (P < 0.001). The prebooster sera showed a geometric mean OPA titer of 65.1 and IgG binding to live bacteria at a geometric mean concentration of 164.9 arbitrary units (AU)/ml. Following the fifth dose, the OPA increased to a titer of 360.4, and the IgG concentration against live bacteria increased to 833.4 AU/ml (P < 0.001 for both). The correlation analyses between the different assays suggest that antibodies against FHA and PRN contribute the most to the OPA and IgG binding.
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Zhang X, Goel T, Goodfield LL, Muse SJ, Harvill ET. Decreased leukocyte accumulation and delayed Bordetella pertussis clearance in IL-6-/- mice. THE JOURNAL OF IMMUNOLOGY 2011; 186:4895-904. [PMID: 21398615 DOI: 10.4049/jimmunol.1000594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IL-6, a pleiotropic cytokine primarily produced by the innate immune system, has been implicated in the development of acquired immune responses, though its roles are largely undefined and may vary in the context of different diseases. Using a murine model of infection, we established that IL-6 influences the adaptive immune responses against the endemic human respiratory pathogen Bordetella pertussis. IL-6 was induced in the lungs of C57BL/6 mice by B. pertussis. IL-6(-/-) mice showed a protracted infectious course and were less efficiently protected by B. pertussis vaccination than wild-type mice. Abs from IL-6(-/-) mice, though lower in titer, efficiently reduced B. pertussis numbers in IL-6-sufficient mice. Pulmonary leukocyte recruitment and splenic or pulmonary T cell cytokine responses to B. pertussis, including Th1 and Th17 cytokine production, were lower in IL-6(-/-) mice than in wild-type mice. Adoptive transfer of immune wild-type CD4(+) cells ameliorated the defect of IL-6(-/-) mice in the control of B. pertussis numbers. Together, these results reveal the dysregulation of multiple aspects of adaptive immune responses in B. pertussis-infected IL-6(-/-) mice and suggest that IL-6 is involved in regulating Ab generation, pulmonary leukocyte accumulation, and T cell cytokine production in response to B. pertussis as well as the generation of effective vaccine-induced immunity against this pathogen.
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Affiliation(s)
- Xuqing Zhang
- Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA 16802, USA
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Bart MJ, van Gent M, van der Heide HGJ, Boekhorst J, Hermans P, Parkhill J, Mooi FR. Comparative genomics of prevaccination and modern Bordetella pertussis strains. BMC Genomics 2010; 11:627. [PMID: 21070624 PMCID: PMC3018138 DOI: 10.1186/1471-2164-11-627] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 11/11/2010] [Indexed: 11/23/2022] Open
Abstract
Background Despite vaccination since the 1950s, pertussis has persisted and resurged. It remains a major cause of infant death worldwide and is the most prevalent vaccine-preventable disease in developed countries. The resurgence of pertussis has been associated with the expansion of Bordetella pertussis strains with a novel allele for the pertussis toxin (Ptx) promoter, ptxP3, which have replaced resident ptxP1 strains. Compared to ptxP1 strains, ptxP3 produce more Ptx resulting in increased virulence and immune suppression. To elucidate how B. pertussis has adapted to vaccination, we compared genome sequences of two ptxP3 strains with four strains isolated before and after the introduction vaccination. Results The distribution of SNPs in regions involved in transcription and translation suggested that changes in gene regulation play an important role in adaptation. No evidence was found for acquisition of novel genes. Modern strains differed significantly from prevaccination strains, both phylogenetically and with respect to particular alleles. The ptxP3 strains were found to have diverged recently from modern ptxP1 strains. Differences between ptxP3 and modern ptxP1 strains included SNPs in a number of pathogenicity-associated genes. Further, both gene inactivation and reactivation was observed in ptxP3 strains relative to modern ptxP1 strains. Conclusions Our work suggests that B. pertussis adapted by successive accumulation of SNPs and by gene (in)activation. In particular changes in gene regulation may have played a role in adaptation.
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Affiliation(s)
- Marieke J Bart
- Laboratory for Infectious Diseases and Screening, Netherlands Centre for Infectious Diseases Control, RIVM, Bilthoven, Netherlands
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Interleukin-1 receptor signaling is required to overcome the effects of pertussis toxin and for efficient infection- or vaccination-induced immunity against Bordetella pertussis. Infect Immun 2010; 79:527-41. [PMID: 20974829 DOI: 10.1128/iai.00590-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interleukin-1 receptor-deficient (IL-1R(-/-)) mice are healthy despite being colonized by commensal microbes but are defective in defenses against specific pathogens, suggesting that IL-1R-mediated effects contribute to immune responses against specific pathogenic mechanisms. To better define the role of IL-1R in immunity to respiratory infections, we challenged IL-1R(-/-) mice with Bordetella pertussis and Bordetella parapertussis, the causative agents of whooping cough. Following inoculation with B. pertussis, but not B. parapertussis, IL-1R(-/-) mice showed elevated bacterial numbers and more extensive inflammatory pathology than wild-type mice. Acellular B. pertussis vaccines were not efficiently protective against B. pertussis in IL-1R(-/-) mice. B. pertussis-stimulated dendritic cells from IL-1R(-/-) mice produced higher levels of tumor necrosis factor alpha (TNF-α) and IL-6 than wild-type cells. Moreover, elevated levels of gamma interferon (IFN-γ) and TNF-α but lower levels of IL-10 were detected during B. pertussis infection in IL-1R(-/-) mice. Since B. parapertussis did not cause severe disease in IL-1R(-/-) mice, we hypothesized that the extreme requirement for IL-1R involves pertussis toxin (Ptx), which is expressed only by B. pertussis. An isogenic Ptx-deficient B. pertussis strain had only a modest phenotype in wild-type mice but was completely defective in causing lethal disease in IL-1R(-/-) mice, indicating that the particular virulence of B. pertussis in these mice requires Ptx. Ptx contributes to IL-1β induction by B. pertussis, which is involved in IL-10 induction through IL-1R signaling. IL-10 treatment reduced B. pertussis numbers in IL-1R(-/-) mice, suggesting that the lower IL-10 responses partially account for the uncontrolled inflammation and bacterial growth in these mice.
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Kretzschmar M, Teunis PFM, Pebody RG. Incidence and reproduction numbers of pertussis: estimates from serological and social contact data in five European countries. PLoS Med 2010; 7:e1000291. [PMID: 20585374 PMCID: PMC2889930 DOI: 10.1371/journal.pmed.1000291] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 05/06/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite large-scale vaccination programmes, pertussis has remained endemic in all European countries and has been on the rise in many countries in the last decade. One of the reasons that have been discussed for the failure of vaccination to eliminate the disease is continued circulation of the pathogen Bordetella pertussis by mostly asymptomatic and mild infections in adolescents and adults. To understand the impact of asymptomatic and undiagnosed infection on the transmission dynamics of pertussis we analysed serological data from five European countries in combination with information about social contact patterns from five of those countries to estimate incidence and reproduction numbers. METHODS AND FINDINGS We compared two different methods for estimating incidence from individual data on IgG pertussis toxin (PT) titres. One method combines the cross-sectional surveys of titres with longitudinal information about the distribution of amplitude and decay rate of titres in a back-calculation approach. The second method uses age-dependent contact matrices and cross-sectional surveys of IgG PT titres to estimate a next generation matrix for pertussis transmission among age groups. The next generation approach allows for computation of basic reproduction numbers for five European countries. Our main findings are that the seroincidence of infections as estimated with the first method in all countries lies between 1% and 6% per annum with a peak in the adolescent age groups and a second lower peak in young adults. The incidence of infections as estimated by the second method lies slightly lower with ranges between 1% and 4% per annum. There is a remarkably good agreement of the results obtained with the two methods. The basic reproduction numbers are similar across countries at around 5.5. CONCLUSIONS Vaccination with currently used vaccines cannot prevent continued circulation and reinfection with pertussis, but has shifted the bulk of infections to adolescents and adults. If a vaccine conferring lifelong protection against clinical and subclinical infection were available pertussis could be eliminated. Currently, continuing circulation of the pathogen at a subclinical level provides a refuge for the pathogen in which it can evolve and adjust to infect vaccinated populations. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Mirjam Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Dalby T, Petersen JW, Harboe ZB, Krogfelt KA. Antibody responses to pertussis toxin display different kinetics after clinical Bordetella pertussis infection than after vaccination with an acellular pertussis vaccine. J Med Microbiol 2010; 59:1029-1036. [PMID: 20508003 DOI: 10.1099/jmm.0.020826-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The measurement of IgG anti-pertussis toxin (IgG anti-PT) antibodies by ELISA is a frequently used method for studying the antibody responses after pertussis vaccination and after Bordetella pertussis infection. Such responses vary according to the different vaccines used as well as to the immunization and infection history of the participants. In the present study, the decay kinetics of the IgG anti-PT antibody response was determined for 71 Danish children and adults with bacteriologically confirmed B. pertussis infection and for 20 Danish adults booster-vaccinated with an acellular pertussis vaccine. For both groups, biphasic decay was seen, but the individual antibody responses varied greatly. No differences related to age were seen. Within each group, individual decay profiles showed parallel log-linear decay for the late part of the response. Antibody half-life was calculated for the late, slower part of the biphasic response curves for both groups (>5 months after diagnosis for individuals with confirmed infection; >3 months for vaccinated individuals). The median half-life for post-infection antibodies was 221 days [interquartile range (IQR) 159-314 days, 36 individuals], and the median half-life for post-vaccination antibodies was 508 days (IQR 428-616 days, 14 individuals). This difference was statistically significant (P<0.0001). Thus, in this setting, we found that the IgG anti-PT antibody decay after an infection with B. pertussis is more than twice as fast as the decay after booster vaccination with an acellular pertussis vaccine. Such knowledge of the IgG anti-PT decay kinetics is crucial for interpretation of serological data that will be used either for diagnosis or for epidemiological studies and surveillance of B. pertussis infections.
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Affiliation(s)
- Tine Dalby
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Zitta B Harboe
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Karen Angeliki Krogfelt
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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Li WC, Wu TZ, Huang YC, Huang LM. Boostrix: a reduced-dose acellular pertussis vaccine for use in adolescents and adults. Expert Rev Vaccines 2009; 8:1317-27. [PMID: 19803753 DOI: 10.1586/erv.09.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pertussis remains a serious problem in many countries. Even in countries with high vaccine coverage and a long vaccination history, pertussis outbreaks occur periodically. Rather than being a disease of young children, pertussis has shifted to affect adolescents and adults. Increased pertussis burden in adolescents and adults is the major source of severe infection for young infants. An effective vaccine is needed to control the spread of pertussis beyond preschool children. Boostrix is a reduced-dose acellular pertussis vaccine with diphtheria and tetanus toxoids, and is designed for use in adolescents and adults. Current evidence suggests that Boostrix is immunogenic and well tolerated. The pertussis component of Boostrix has been shown to be efficacious in a large-scale Phase III trial. More than 50 countries have given permit to the use of Boostrix, and many of them formally recommend the use of Boostrix in adolescents and adults. Designed as a vaccine for adolescence and adults, Boostrix has a long way to go to achieve large-scale use in those target groups. Nevertheless, we expect that the advent of Boostrix will lead to a much better control of pertussis in the general population.
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Affiliation(s)
- Wen-Chen Li
- Division of Pediatric Infectious Diseases, Children's Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan and Graduate School of Clinical Medicine, Taoyuan, Taiwan.
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Mooi FR. Bordetella pertussis and vaccination: the persistence of a genetically monomorphic pathogen. INFECTION GENETICS AND EVOLUTION 2009; 10:36-49. [PMID: 19879977 DOI: 10.1016/j.meegid.2009.10.007] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/11/2009] [Accepted: 10/20/2009] [Indexed: 01/08/2023]
Abstract
Before childhood vaccination was introduced in the 1950s, pertussis or whooping cough was a major cause of infant death worldwide. Widespread vaccination of children was successful in significantly reducing morbidity and mortality. However, despite vaccination, pertussis has persisted and, in the 1990s, resurged in a number of countries with highly vaccinated populations. Indeed, pertussis has become the most prevalent vaccine-preventable disease in developed countries with estimated infection frequencies of 1-6%. Recently vaccinated children are well protected against pertussis disease and its increase is mainly seen in adolescents and adults in which disease symptoms are often mild. The etiologic agent of pertussis, Bordetella pertussis, is extremely monomorphic and its ability to persist in the face of intensive vaccination is intriguing. Numerous studies have shown that B. pertussis populations changed after the introduction of vaccination suggesting adaptation. These adaptations did not involve the acquisition of novel genes but small genetic changes, mainly SNPs, and occurred in successive steps in a period of 40 years. The earliest adaptations resulted in antigenic divergence with vaccine strains. More recently, strains emerged with increased pertussis toxin (Ptx) production. Here I argue that the resurgence of pertussis is the compound effect of pathogen adaptation and waning immunity. I propose that the removal by vaccination of naïve infants as the major source for transmission was the crucial event which has driven the changes in B. pertussis populations. This has selected for strains which are more efficiently transmitted by primed hosts in which immunity has waned. The adaptation of B. pertussis to primed hosts involved delaying an effective immune response by antigenic divergence with vaccine strains and by increasing immune suppression through higher levels of Ptx production. Higher levels of Ptx may also benefit transmission by enhancing clinical symptoms. The study of B. pertussis populations has not only increased our understanding of pathogen evolution, but also suggests way to improve pertussis vaccines, underlining the public health significance of population-based studies of pathogens.
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Affiliation(s)
- Frits R Mooi
- Lab for Infectious Diseases and Screening, Netherlands Centre for Infectious Diseases Control, Natl Institute for Public Health and the Environment, RIVM, PO Box 1, 3720 BA Bilthoven, Netherlands.
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Abstract
A critical level of serum IgG pertussis toxin antibody is both essential and sufficient to confer individual and herd immunity to pertussis. Monocomponent pertussis toxoid conferred such immunity in Sweden and in Denmark. We refute the notion that filamentous hemagglutinin, pertactin, and fimbriae add to the immunity conferred by pertussis toxoid and describe the artifact created when efficacy is estimated for multicomponent pertussis vaccines. Lastly, the genetically-inactivated mutant pertussis toxoid is safer, more immunogenic, and should be more effective than the current chemically-inactivated pertussis toxin.
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Halasa NB, O'Shea A, Shi JR, LaFleur BJ, Edwards KM. Poor immune responses to a birth dose of diphtheria, tetanus, and acellular pertussis vaccine. J Pediatr 2008; 153:327-32. [PMID: 18534242 PMCID: PMC3773719 DOI: 10.1016/j.jpeds.2008.03.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 01/18/2008] [Accepted: 03/12/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the safety and immunogenicity of an additional birth dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP). STUDY DESIGN Fifty infants between 2 to 14 days of age were randomly assigned to receive either DTaP and hepatitis B vaccines (experimental) or hepatitis B alone (control) at birth. At 2, 4, 6, and 17 months of age, DTaP and routine vaccines were administered to both groups. Safety data were collected after each dose, and sera were obtained at birth, 6, 7, 17, and 18 months. Immune responses to pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae were measured by enzyme-linked immunosorbent assay; responses to other vaccines were assessed. RESULTS No differences were seen between the 2 groups in either local or systemic reactions; all vaccines were well tolerated. Compared with the control group, infants in the experimental group demonstrated significantly lower geometric mean antibody concentrations for pertussis toxin and pertactin 6, 7, and 18 months, for fimbrae at 6, 7, 17, and 18 months, and for FHA at 18 months, and lower geometric mean antibody concentrations for diphtheria at 7 months. Immune responses to all other vaccine antigens were comparable. CONCLUSION Administration of an additional dose of DTaP at birth was safe but was associated with a significantly lower response to diphtheria and 3 of 4 pertussis antigens compared with controls.
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Affiliation(s)
- Natasha B Halasa
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA
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Al-Murieb A, Brown AM, Raulli A, George C, Gander C, Forrester P, Gibson S. Evidence of pertussis clusters in three aged-care facilities in the former Macquarie Area Health Service, NSW. NEW SOUTH WALES PUBLIC HEALTH BULLETIN 2008; 19:157-160. [PMID: 19091180 DOI: 10.1071/nb07054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
During a limited outbreak of pertussis in an area health service in NSW, three clusters occurred in aged-care facilities--the first reported outbreaks of pertussis in Australian nursing homes. The attack rates across the three clusters were 16.7% for staff and 15.7% for residents. Our investigation revealed that older adults are not immune to pertussis. We suggest methods for controlling a pertussis outbreak in an aged-care facility.
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Affiliation(s)
- Ala'a Al-Murieb
- Population Health Division, Greater Western Area Health Service
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Spector J, Rathlev NK. Pertussis in an elderly Asian-American man: a case report. J Emerg Med 2008; 38:434-8. [PMID: 18462908 DOI: 10.1016/j.jemermed.2007.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 01/18/2007] [Accepted: 07/13/2007] [Indexed: 10/22/2022]
Abstract
Cough is a frequent presenting complaint in the Emergency Department. The differential diagnosis for cough is variable depending on patient age and symptom duration. We report the case of an elderly gentleman with a history of asthma who presented with cough, with the ultimate diagnosis of Bordetella pertussis infection. The management of the patient in the Emergency Department placed hospital staff at risk for infection from a virulent pathogen. Details regarding typical and atypical presentations of pertussis and the establishment of transmission-based precautions are discussed.
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Affiliation(s)
- Jordan Spector
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
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Mertens PLJM, Stals FS, Steyerberg EW, Richardus JH. Sensitivity and specificity of single IgA and IgG antibody concentrations for early diagnosis of pertussis in adults: an evaluation for outbreak management in public health practice. BMC Infect Dis 2007; 7:53. [PMID: 17553132 PMCID: PMC1924524 DOI: 10.1186/1471-2334-7-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 06/06/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate, practical laboratory test is needed to confirm clinical diagnosis of pertussis in adults during the first 3 symptomatic weeks, when treatment is effective and transmission can be interrupted. METHODS The sensitivity and specificity of single IgA and IgG levels were assessed in a cohort study of a pertussis epidemic in 99 adults in a closed community. Sensitivities were assessed in the sera of 46 laboratory confirmed clinical pertussis cases during the first 3 weeks. Specificities were calculated in sera of 35 asymptomatic controls without clinical symptoms or laboratory confirmed infections from the same community (internal controls). We compared these specificities with the specificities of single IgA and IgG levels in 4275 external controls from a cross-section of the general Dutch population aged 21-79 years who had not coughed for more than 2 weeks in the past year, and without pertussis diagnoses. The study was done in the Netherlands when whole-cell pertussis vaccine was used in the national vaccination programme. RESULTS Levels of 24 U/ml for IgA and 27 U/ml for IgG gave sensitivities of 100% and 75%, respectively, in the first 2 weeks, 100% in the third week, and 97% after the fourth week. The levels were reached within 2 days after onset of increase, and remained above these levels for roughly 7.2 and 5.1 months, respectively. Specificity was 82% for IgA and 89% for IgG in the internal controls and 90% in the external controls, respectively. CONCLUSION We suggest levels of 24 U/ml for IgA level and 27 U/ml (= 27 International Units (IU)/ml) for IgG as sensitive, specific, and practical for laboratory confirmation of clinical pertussis in adults in the first 3 weeks of outbreak management.
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Affiliation(s)
- Paul LJM Mertens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Municipal Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
| | | | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Jan H Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Municipal Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
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Aase A, Herstad TK, Merino S, Brandsdal KT, Berdal BP, Aleksandersen EM, Aaberge IS. Opsonophagocytic activity and other serological indications of Bordetella pertussis infection in military recruits in Norway. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007; 14:855-62. [PMID: 17507542 PMCID: PMC1951054 DOI: 10.1128/cvi.00081-07] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bordetella pertussis is the causative agent of pertussis (whooping cough). Despite high vaccination coverage, pertussis remains a significant disease in many countries. Besides vaccination, transient carriage of Bordetella spp. or other cross-reacting organisms adds to the immunity against pertussis. However, the various immunological mechanisms conferring protection remain largely unknown. In this study, paired serum samples from 464 healthy Norwegian military recruits were collected, the first at enrolment and the second about 8 months later. The prevalence of pertussis during military service was examined by comparing the paired serum samples for immunoglobulin G (IgG) antibodies against pertussis toxin (PT) by enzyme-linked immunosorbent assay (ELISA). Seventy-eight percent of the recruits had low levels of IgG antibodies against PT in both samples. Conversely, 8.4% of the recruits demonstrated high anti-PT IgG levels in the first sample, indicative of recent pertussis prior to enrolment. One recruit experienced seroconversion, indicating pertussis during service. A subset of 248 serum samples with low, medium, and high anti-PT IgG titers were analyzed by a different ELISA kit for IgG and IgA antibodies against PT and filamentous hemagglutinin (FHA) and for opsonophagocytic activity (OPA), for induction of C3b deposition products, and for IgG binding with live B. pertussis as the antigen. We observed high correlations between OPA and IgG against live bacteria (r = 0.83), between OPA and IgG anti-FHA (r = 0.79), between OPA and anti-PT IgG (r = 0.68), and between OPA and C3b binding (r = 0.70) (P < 0.0001 for all). Anti-PT IgA did not correlate closely with the other assays.
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Affiliation(s)
- Audun Aase
- Division of Infectious Disease Control, Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway.
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Kotton CN. Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients. Clin Infect Dis 2007; 44:857-66. [PMID: 17304461 DOI: 10.1086/511859] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 11/25/2006] [Indexed: 02/05/2023] Open
Abstract
Numerous reports exist of the transmission of zoonoses to humans during and after solid-organ and hematopoietic stem cell transplantation. Donor-derived infections of numerous etiologies, including West Nile virus infection, Chagas disease, toxoplasmosis, rabies, lymphocytic choriomeningitis virus infection, and infection due to Brucella species have been reported. Most zoonoses occur as a primary infection after transplantation, and immunocompromised patients are more likely to experience significant morbidity and mortality from these infections. Risks of zoonotic infection in the posttransplantation period could be reduced by patient education. Increased recognition of the risks of zoonoses, as well as the advent of molecular biology-based testing, will potentially augment diagnostic aptitude. Documented zoonotic infection as it affects transplantation will be the primary focus of this review.
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Affiliation(s)
- Camille N Kotton
- Transplant and Immunocompromised Host Section, Infectious Diseases Division, Massachusetts General Hospital, Boston, MA 02114, USA.
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