Review
Bordetella pertussis epidemiology and evolution in the light of pertussis resurgence

https://doi.org/10.1016/j.meegid.2016.02.032Get rights and content

Highlights

  • The changing nature of B. pertussis epidemiology in regions where pertussis is resurgent is described.

  • The role of switching from using whole cell- to acellular-pertussis vaccines in pertussis resurgence is evaluated.

  • Recent genomics-based investigations of B. pertussis evolution and diversity are discussed in the context of resurgence.

Abstract

Whooping cough, or pertussis, is resurgent in many countries world-wide. This is linked to switching from the use of whole cell vaccines to acellular vaccines in developed countries. Current evidence suggests that this has resulted in the earlier waning of vaccine-induced immunity, an increase in asymptomatic infection with concomitant increases in transmission and increased selection pressure for Bordetella pertussis variants that are better able to evade vaccine-mediated immunity than older isolates. This review discusses recent findings in B. pertussis epidemiology and evolution in the light of pertussis resurgence, and highlights the important role for genomics-based studies in monitoring B. pertussis adaptation.

Section snippets

Pertussis

Bordetella pertussis is a gram-negative bacterium that causes the serious respiratory disease whooping cough, or pertussis. Often considered a disease affecting only children, it is now clear that all ages are affected but young infants are at greatest risk of severe pertussis as a result of their immature respiratory systems and being too young to have received the full course of vaccination. Infection begins with acquisition of B. pertussis by the inhalation of contaminated aerosol droplets (

Vaccination

In the first half of the 20th century, pertussis was an endemic childhood disease worldwide. For example, in the UK there were many tens of thousands of cases each year, with peaks every 3–4 years, Fig. 1. The first pertussis vaccines were developed during the 1930s and implemented in most developed countries during the 1940s and 50s (Cherry, 1996). These were whole cell vaccines (WCVs) comprised of chemically killed bacteria. They were administered in combination with diphtheria and tetanus

Pertussis resurgence

During recent years a number of countries, including the U.S., U.K., Australia and the Netherlands, have experienced an increase in the incidence of pertussis, including a number of significant outbreaks (Burns et al., 2014). For example, the UK suffered an outbreak in 2012, in which 9711 laboratory-confirmed cases were recorded in England and Wales (Fig. 2), leading to fourteen deaths in infants less than 3 months of age (Amirthalingam, 2013). This was much greater than the previous recent

Disease epidemiology

Gaining an accurate picture of B. pertussis epidemiology has proved stubbornly difficult. As classically described whooping cough affects mainly infants and children, the disease was considered to be one largely of childhood. Over time, it was realised that mild or atypical pertussis is common, and importantly, that B. pertussis is frequently detected in adults presenting with chronic cough (Cherry, 2014). Thus, B. pertussis is probably endemic throughout the population.

In countries

Strain typing — pregenomics

Early studies of B. pertussis revealed it to be a monomorphic pathogen, with little variation between isolates, certainly when compared to many other bacteria. A number of approaches have been developed to distinguish between, or type, strains. For example, serotyping is based on the detection of the fimbrial antigens expressed by a particular strain. However, expression of fimbriae is subject to phase variation and there is insufficient variation among fim genes to enable subtyping, giving

Outlook

It is clear that although ACVs protect vaccinated infants from severe pertussis, the limited duration of ACV-induced immunity and its apparent inability to prevent colonisation of, and transmission from, vaccinated individuals strongly suggest that the epidemiology of B. pertussis has changed since the introduction of ACVs.

There is increasing evidence that vaccination shapes B. pertussis evolution, and a possible outcome of this is selection for strains better able to avoid vaccine-mediated

Acknowledgments

The support of a Public Health England studentship and BBSRC iCASE studentship (BB/K011642/1), supported by GSK Biologicals, is gratefully acknowledged.

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