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Current Opinion in Infectious Diseases Jun 2016The purpose of this review is to summarize and discuss recent findings and selected topics of interest in Bordetella pertussis virulence and pathogenesis and treatment... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize and discuss recent findings and selected topics of interest in Bordetella pertussis virulence and pathogenesis and treatment of pertussis. It is not intended to cover issues on immune responses to B. pertussis infection or problems with currently used pertussis vaccines.
RECENT FINDINGS
Studies on the activities of various B. pertussis virulence factors include the immunomodulatory activities of filamentous hemagglutinin, fimbriae, and adenylate cyclase toxin. Recently emerging B. pertussis strains show evidence of genetic selection for vaccine escape mutants, with changes in vaccine antigen-expressing genes, some of which may have increased the virulence of this pathogen. Severe and fatal pertussis in young infants continues to be a problem, with several studies highlighting predictors of fatality, including the extreme leukocytosis associated with this infection. Treatments for pertussis are extremely limited, though early antibiotic intervention may be beneficial. Neutralizing pertussis toxin activity may be an effective strategy, as well as targeting two host proteins, pendrin and sphingosine-1-phosphate receptors, as novel potential therapeutic interventions.
SUMMARY
Pertussis is reemerging as a major public health problem and continued basic research is revealing information on bacterial virulence and disease pathogenesis, as well as potential novel strategies for vaccination and targets for therapeutic intervention.
Topics: Anti-Bacterial Agents; Bordetella pertussis; Communicable Diseases, Emerging; Humans; Pertussis Vaccine; Virulence Factors, Bordetella; Whooping Cough
PubMed: 26906206
DOI: 10.1097/QCO.0000000000000264 -
Frontiers in Immunology 2019Pertussis is an acute respiratory disease caused by . Due to its frequency and severity, prevention of pertussis has been considered an important public health issue for... (Review)
Review
Pertussis is an acute respiratory disease caused by . Due to its frequency and severity, prevention of pertussis has been considered an important public health issue for many years. The development of the whole-cell pertussis vaccine (wPV) and its introduction into the pediatric immunization schedule was associated with a marked reduction in pertussis cases in the vaccinated cohort. However, due to the frequency of local and systemic adverse events after immunization with wPV, work on a less reactive vaccine was undertaken based on isolated components that induced protective immune responses with fewer local and systemic reactions. These component vaccines were termed acellular vaccines and contained one or more pertussis antigens, including pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN), and fimbrial proteins 2 (FIM2) and 3 (FIM3). Preparations containing up to five components were developed, and several efficacy trials clearly demonstrated that the aPVs were able to confer comparable short-term protection than the most effective wPVs with fewer local and systemic reactions. There has been a resurgence of pertussis observed in recent years. This paper reports the results of a Consensus Conference organized by the World Association for Infectious Disease and Immunological Disorders (WAidid) on June 22, 2018, in Perugia, Italy, with the goal of evaluating the most important reasons for the pertussis resurgence and the role of different aPVs in this resurgence.
Topics: Bordetella pertussis; Humans; Pertussis Vaccine; Vaccines, Acellular; Whooping Cough
PubMed: 31333640
DOI: 10.3389/fimmu.2019.01344 -
The Journal of Infectious Diseases Apr 2014Pertussis is a worldwide public health threat. Bordetella pertussis produces multiple virulence factors that have been studied individually, and many have recently been... (Review)
Review
Pertussis is a worldwide public health threat. Bordetella pertussis produces multiple virulence factors that have been studied individually, and many have recently been found to have additional biological activities. Nevertheless, how they interact to cause the disease pertussis remains unknown. New animal models, particularly the infection of infant baboons with B. pertussis, are enabling longstanding questions about pertussis pathogenesis to be answered and new ones to be asked. Enhancing our understanding of pathogenesis will enable new approaches to the prevention and control of pertussis.
Topics: Animals; Animals, Newborn; Bacterial Proteins; Bordetella pertussis; Disease Models, Animal; Papio; Virulence; Virulence Factors; Whooping Cough
PubMed: 24626533
DOI: 10.1093/infdis/jit639 -
BMC Medicine Sep 2016In 2012 England and Wales experienced a resurgence of pertussis and an increase in infant deaths. This occurred 8 years after acellular pertussis (aP) vaccine replaced...
BACKGROUND
In 2012 England and Wales experienced a resurgence of pertussis and an increase in infant deaths. This occurred 8 years after acellular pertussis (aP) vaccine replaced whole cell (wP) primary vaccine despite continued high coverage for the primary series and pre-school aP booster. We developed a mathematical model to describe pertussis transmission dynamics in England and Wales since the 1950s and used it to investigate the cause of the resurgence and the potential impact of additional vaccination strategies.
METHODS
An age-structured, compartmental, deterministic model of the pertussis transmission dynamics was fitted to 60 continuous years of age-stratified pertussis notification data in England and Wales. The model incorporated vaccine-induced and natural immunity and differentiated between vaccine-induced protection against clinical disease and infection.
RESULTS
The degree of protection of wP vaccine against infection was estimated to be higher than that of aP vaccine. Furthermore, the duration of protection for natural and wP-induced immunity was likely to be at least 15 years, but for aP vaccine it could be as low as 5 years. Model results indicated that the likely cause of the resurgence was the replacement of wP by less efficacious aP vaccine and that an elevated level of pertussis would continue. The collapse in wP vaccine coverage in the 1970s and resultant outbreaks in the late 1970s and early 1980s could not explain the resurgence. Addition of an adolescent or toddler booster was predicted to have little impact on the disease in infants.
CONCLUSIONS
Our findings support the recent recommendation by the World Health Organisation that countries currently using wP vaccine for primary immunisation should not change to aP vaccine unless additional strategies to control infant disease such as maternal immunisation can be assured. Improved pertussis vaccines that provide better protection against infection are needed.
Topics: Adolescent; Child, Preschool; England; Female; Humans; Infant; Models, Theoretical; Pertussis Vaccine; Vaccination; Wales; Whooping Cough
PubMed: 27580649
DOI: 10.1186/s12916-016-0665-8 -
Indian Pediatrics Aug 2016Though vaccines have been in use for over seventy years, we have been unable to eradicate or control pertussis. This disease is a worldwide problem, and recently has...
Though vaccines have been in use for over seventy years, we have been unable to eradicate or control pertussis. This disease is a worldwide problem, and recently has been occurring in outbreaks even in places with good immunization coverage. The debate about the use of acellular or whole cell vaccine has taken attention away from the other significant issues. The high rate of serious disease and death in young infants, and the repeated outbreaks of pertussis even in highly-vaccinated populations is a matter for grave concern. Finding strategies to protect the most vulnerable is a priority. Newer vaccines are under development, and will be welcome, but may be too expensive for mass use in resource-poor nations. It is important to adopt cost-effective strategies to deal with this disease.
Topics: Child; Child, Preschool; Diphtheria-Tetanus-Pertussis Vaccine; Humans; Infant; Infant, Newborn; Mothers; Pertussis Vaccine; Whooping Cough
PubMed: 27567644
DOI: 10.1007/s13312-016-0909-x -
Annali Dell'Istituto Superiore Di Sanita 2017Pertussis or whooping cough remains one of the most poorly controlled vaccine-preventable diseases across the world. Universal vaccination has dramatically reduced its...
Pertussis or whooping cough remains one of the most poorly controlled vaccine-preventable diseases across the world. Universal vaccination has dramatically reduced its incidence but has failed to bring it completely under control. In the last decades, changes in pertussis epidemiology have been noted, likely related to the introduction of acellular pertussis vaccines. Increasing incidence is recorded among adolescents and adults who have become a reservoir for transmission to unimmunized infants, who are at risk of severe disease and death. In Italy, experimental evidences suggest a sustained circulation of Bordetella pertussis in the adult population and a significant health burden of pertussis among infants less than six months of age. Public health systems are currently exploring new vaccination strategies, including a cocooning strategy to prevent the transmission of the disease from family members to the newborn and vaccination of pregnant mothers to transmit protective antibodies to the offspring, and neonatal vaccination. An integrated approach for pertussis control and prevention is needed to enhance the current surveillance system and provide an accurate estimate of the real burden of pertussis in our Country, particularly among infants.
Topics: Bordetella pertussis; Humans; Infant; Infant, Newborn; Pertussis Vaccine; Whooping Cough
PubMed: 28617254
DOI: 10.4415/ANN_17_02_04 -
American Family Physician Oct 2013Pertussis, also known as whooping cough, is an acute respiratory tract infection that has increased in incidence in recent years. The initial catarrhal stage presents... (Review)
Review
Pertussis, also known as whooping cough, is an acute respiratory tract infection that has increased in incidence in recent years. The initial catarrhal stage presents with nonspecific symptoms of malaise, rhinorrhea, sneezing, lacrimation, and mild cough. During the paroxysmal stage, severe outbreaks of coughing often lead to the classic high-pitched whooping sound patients make when gasping for breath. The paroxysmal stage is followed by the convalescent stage and resolution of symptoms. Complications vary by age, with infants more likely to experience severe complications such as apnea, pneumonia, seizures, or death. In adolescents and adults, complications are the result of chronic cough. The diagnosis depends on clinical signs and laboratory testing. Both culture and polymerase chain reaction testing can be used to confirm the diagnosis; serologic testing is not standardized or routinely recommended. Although antibiotics have not shown clear effectiveness in the treatment of pertussis, they eradicate nasal bacterial carriage and may reduce transmission rates. Macrolide antibiotics such as azithromycin are first-line treatments to prevent transmission; trimethoprim/sulfamethoxazole is an alternative in cases of allergy or intolerance to macrolides. Immunization against pertussis is essential for disease prevention. Current recommendations in the United States consist of administering five doses of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine to children before seven years of age, and administering a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster between 11 and 18 years of age. Recent efforts have focused on the vaccination of adolescents and adults, with new recommendations for a single dose of the Tdap booster if it has not been previously administered.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Infant; Pertussis Vaccine; Practice Guidelines as Topic; Whooping Cough
PubMed: 24364571
DOI: No ID Found -
Toxins Jun 2019Pertussis, caused by respiratory tract infection with the bacterial pathogen , has long been considered to be a toxin-mediated disease. Bacteria adhere and multiply... (Review)
Review
Pertussis, caused by respiratory tract infection with the bacterial pathogen , has long been considered to be a toxin-mediated disease. Bacteria adhere and multiply extracellularly in the airways and release several toxins, which have a variety of effects on the host, both local and systemic. Predominant among these toxins is pertussis toxin (PT), a multi-subunit protein toxin that inhibits signaling through a subset of G protein-coupled receptors in mammalian cells. PT activity has been linked with severe and lethal pertussis disease in young infants and a detoxified version of PT is a common component of all licensed acellular pertussis vaccines. The role of PT in typical pertussis disease in other individuals is less clear, but significant evidence supporting its contribution to pathogenesis has been accumulated from animal model studies. In this review we discuss the evidence indicating a role for PT in pertussis disease, focusing on its contribution to severe pertussis in infants, modulation of immune and inflammatory responses to infection, and the characteristic paroxysmal cough of pertussis.
Topics: Animals; Humans; Pertussis Toxin; Whooping Cough
PubMed: 31252532
DOI: 10.3390/toxins11070373 -
Euro Surveillance : Bulletin Europeen... Sep 2013This review summarises the epidemiology and control of pertussis in England and Wales since the introduction of routine immunisation and considers the implications for... (Review)
Review
This review summarises the epidemiology and control of pertussis in England and Wales since the introduction of routine immunisation and considers the implications for future control. Routine infant immunisation with a whole-cell pertussis (wP) vaccine was introduced in 1957 and had a marked impact on the overall disease burden. Following a fall in vaccine coverage during the 1970s and 80s linked to a safety scare with wP vaccine, there was an extended period of high coverage and pertussis incidence fell dramatically. Incidence continued to decrease with the introduction of an acellular pertussis vaccine in the pre-school booster in November 2001 and in the primary United Kingdom (UK) schedule in September 2004 but has increased since July 2011. In response to a high rate of pertussis in infants, a temporary vaccination programme for pregnant women was introduced in October 2012. The key aim of the programme is to protect vulnerable infants from birth in the first months of life, before they can be fully protected by routine infant immunisation. A review of the UK adolescent immunisation programme is currently ongoing and the inclusion of a pertussis booster is being considered.
Topics: History, 20th Century; Humans; Immunization; Immunization Programs; Pertussis Vaccine; Vaccination; Whooping Cough
PubMed: 24084340
DOI: 10.2807/1560-7917.es2013.18.38.20587 -
Clinical Infectious Diseases : An... May 2016Acellular pertussis (aP) and whole-cell (wP) pertussis vaccines are presumed to have similar short-term (<3 years after completion of the primary series) efficacy.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acellular pertussis (aP) and whole-cell (wP) pertussis vaccines are presumed to have similar short-term (<3 years after completion of the primary series) efficacy. However, vaccine effect varies between individual pertussis vaccine formulations, and many originally studied formulations are now unavailable. An updated analysis of the short-term protective effect of pertussis vaccines limited to formulations currently on the market in developed countries is needed.
METHODS
We conducted a systematic review and meta-analysis of published studies that evaluated pertussis vaccine efficacy or effectiveness within 3 years after completion (>3 doses) of a primary series of a currently available aP or wP vaccine formulation. The primary outcome was based on the World Health Organization (WHO) clinical case definitions for pertussis. Study quality was assessed using the approach developed by the Child Health Epidemiology Research Group. We determined overall effect sizes using random-effects meta-analyses, stratified by vaccine (aP or wP) and study (efficacy or effectiveness) type.
RESULTS
Meta-analysis of 2 aP vaccine efficacy studies (assessing the 3-component GlaxoSmithKline and 5-component Sanofi-Pasteur formulations) yielded an overall aP vaccine efficacy of 84% (95% confidence interval [CI], 81%-87%). Meta-analysis of 3 wP vaccine effectiveness studies (assessing the Behringwerke, Pasteur/Mérieux, and SmithKline Beecham formulations) yielded an overall wP vaccine effectiveness of 94% (95% CI, 88%-97%) (bothI(2)= 0%).
CONCLUSIONS
Although all contemporary aP and wP formulations protect against pertussis disease, in this meta-analysis the point estimate for short-term protective effect against WHO-defined pertussis in young children was lower for currently available aP vaccines than wP vaccines.
Topics: Child; Child, Preschool; Humans; Infant; Infant, Newborn; Pertussis Vaccine; Treatment Outcome; Whooping Cough
PubMed: 26908803
DOI: 10.1093/cid/ciw051