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Pertactin-deficient Bordetella pertussis isolates: evidence of increased circulation in Europe, 1998 to 2015
Alex-Mikael Barkoff1, Jussi Mertsola2, Denis Pierard3
1Institute of Biomedicine, Department of Microbiology, Virology and Immunology, University of Turku, Turku, Finland.
Abstract:
IntroductionPertussis outbreaks have occurred in several industrialised countries using acellular pertussis vaccines (ACVs) since the 1990s. High prevalence of pertactin (PRN)-deficient Bordetella pertussis isolates has been found in these countries.AimsTo evaluate in Europe: (i) whether proportions of PRN-deficient strains increased in consecutive collections of B. pertussis clinical isolates; (ii) if the frequency of PRN-deficient strains in countries correlated with the time since ACV introduction; (iii) the presence of pertussis toxin (PT)-, filamentous haemagglutinin (FHA)- or fimbriae (Fim)-deficient isolates.MethodsB. pertussis clinical isolates were obtained from different European countries during four periods (EUpert I-IV studies): 1998 to 2001 (n = 102), 2004 to 2005 (n = 154), 2007 to 2009 (n = 140) and 2012 to 2015 (n = 265). The isolates' selection criteria remained unchanged in all periods. PRN, PT, FHA and Fim2 and Fim3 expression were assessed by ELISA.ResultsIn each period 1.0% (1/102), 1.9% (3/154), 6.4% (9/140) and 24.9% (66/265) of isolates were PRN-deficient. In EUpert IV, PRN-deficient isolates occurred in all countries sampled and in six countries their frequency was higher than in EUpert III (for Sweden and the United Kingdom, p < 0.0001 and p = 0.0155, respectively). Sweden and Italy which used ACVs since the mid 1990s had the highest frequencies (69%; 20/29 and 55%; 11/20, respectively) while Finland, where primary immunisations with ACV containing PRN dated from 2009 had the lowest (3.6%). Throughout the study, no PT- or FHA-deficient isolate and one Fim2/3-deficient was detected.ConclusionResults suggest that the longer the period since the introduction of ACVs containing PRN, the higher the frequency of circulating PRN-deficient isolates.
Insights
Pertussis outbreaks are linked to pertactin (PRN)-deficient Bordetella pertussis strains. Longer use of acellular pertussis vaccines (ACVs) containing PRN correlates with a higher frequency of these deficient strains in Europe.
Area of Science:
- Microbiology
- Vaccinology
- Epidemiology
Background:
- Pertussis outbreaks have been observed in industrialized nations utilizing acellular pertussis vaccines (ACVs).
- A high prevalence of pertactin (PRN)-deficient Bordetella pertussis isolates has been noted in these countries, raising concerns about vaccine effectiveness and bacterial evolution.
Purpose of the Study:
- To investigate the increasing proportion of PRN-deficient Bordetella pertussis strains in Europe over time.
- To determine if the frequency of PRN-deficient strains correlates with the duration of acellular pertussis vaccine (ACV) use in different countries.
- To assess the prevalence of isolates deficient in other vaccine components, such as pertussis toxin (PT), filamentous hemagglutinin (FHA), or fimbriae (Fim).
Main Methods:
- Analysis of Bordetella pertussis clinical isolates collected across Europe during four study periods (1998-2015).
- Quantification of pertactin (PRN)-deficient strains using ELISA to assess PRN, PT, FHA, and Fim2/Fim3 expression.
- Correlation analysis between the frequency of PRN-deficient strains and the time since the introduction of acellular pertussis vaccines (ACVs) containing PRN.
Main Results:
- The proportion of PRN-deficient Bordetella pertussis isolates significantly increased from 1.0% in 1998-2001 to 24.9% in 2012-2015.
- Countries with longer histories of using acellular pertussis vaccines (ACVs) containing PRN exhibited higher frequencies of PRN-deficient strains.
- No pertussis toxin (PT)- or filamentous hemagglutinin (FHA)-deficient isolates were detected; only one fimbriae (Fim)-deficient isolate was found.
Conclusions:
- The findings suggest an evolutionary adaptation of Bordetella pertussis, leading to an increased circulation of PRN-deficient strains.
- The duration of acellular pertussis vaccine (ACV) use, particularly those containing pertactin (PRN), appears to be a driving factor in the selection of PRN-deficient isolates.
- Further research is needed to understand the implications of PRN-deficient strains on pertussis vaccine efficacy and public health strategies.
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