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Bordetella pertussis strains with increased toxin production associated with pertussis resurgence

Frits R Mooi1, Inge H M van Loo, Marjolein van Gent

  • 1National Institute for Public Health and the Environment, Bilthoven, the Netherlands. frits.mooi@rivm.nl

Emerging Infectious Diseases
|September 16, 2009
PubMed

Insights

Pertussis outbreaks are increasing in highly vaccinated populations due to new Bordetella pertussis strains producing more pertussis toxin. This suggests vaccination may inadvertently select for more virulent strains, necessitating updated control strategies.

Area of Science:

  • Microbiology
  • Epidemiology
  • Immunology

Background:

  • Pertussis (whooping cough) was a leading cause of infant mortality before widespread childhood vaccination.
  • Vaccination dramatically reduced pertussis incidence, but resurgence has occurred since the 1990s in industrialized nations.
  • Pertussis is now the most common vaccine-preventable disease in developed countries.

Purpose of the Study:

  • To investigate the cause of pertussis resurgence in the Netherlands.
  • To identify potential genetic changes in Bordetella pertussis associated with increased disease prevalence.
  • To explore the implications of these changes for pertussis virulence and control.

Main Methods:

  • Analysis of Bordetella pertussis strains from the Netherlands.
  • Genotyping of pertussis toxin promoter alleles.
  • Correlation of strain emergence with epidemiological data on pertussis incidence.
  • Assessment of potential virulence changes based on Ptx production.

Main Results:

  • A dramatic increase in pertussis cases in the Netherlands was temporally linked to the emergence of B. pertussis strains with a novel pertussis toxin promoter allele.
  • These new strains exhibit increased pertussis toxin (Ptx) production.
  • Epidemiological data suggest these strains may be more virulent in humans.

Conclusions:

  • The emergence of hypervirulent B. pertussis strains, possibly driven by vaccine-induced selection, is a key factor in the ongoing pertussis resurgence.
  • Pertussis toxin plays a critical role in transmission and virulence.
  • Current vaccination strategies may need re-evaluation to effectively control pertussis in the face of evolving bacterial strains.

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