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Published on: February 22, 2019
Pertussis vaccines, epidemiology and evolution
Matthieu Domenech de Cellès1, Pejman Rohani2,3,4
1Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany.
Insights
Pertussis (whooping cough) remains a threat, with recent resurgences in vaccinated populations. This review explores the complex immunology and epidemiology of Bordetella pertussis, aiming to explain current challenges.
Area of Science:
- Immunology
- Epidemiology
- Evolutionary Biology
Background:
- Pertussis, caused by Bordetella pertussis, is a highly infectious disease with a long history.
- While whole-cell pertussis (wP) vaccines drastically reduced incidence, concerns over reactogenicity led to acellular (aP) vaccines.
- Recent pertussis resurgences in countries with high aP coverage have sparked debate.
Purpose of the Study:
- To review the complexities of contemporary pertussis epidemiology and immunology.
- To address controversies surrounding natural and vaccine-derived immunity duration and effectiveness.
- To propose explanations for incongruous observations in pertussis resurgence.
Main Methods:
- Review of existing literature on pertussis immunology, epidemiology, and bacterial evolution.
- Analysis of factors contributing to pertussis resurgence despite vaccination.
- Discussion of challenges in pertussis surveillance and diagnosis.
Main Results:
- Controversy exists regarding vaccine effectiveness in preventing transmission and severe disease.
- Bordetella pertussis evolution may impact vaccine-induced immunity.
- Incomplete case detection and diagnostic heterogeneity complicate understanding.
Conclusions:
- Understanding pertussis requires addressing complexities in immunity, transmission, and bacterial evolution.
- Further research is needed to resolve debates on vaccine efficacy and pertussis resurgence.
- A parsimonious explanation for current pertussis challenges is proposed.
Abstract:
Pertussis, which is caused by Bordetella pertussis, has plagued humans for at least 800 years, is highly infectious and can be fatal in the unvaccinated, especially very young infants. Although the rollout of whole-cell pertussis (wP) vaccines in the 1940s and 1950s was associated with a drastic drop in incidence, concerns regarding the reactogenicity of wP vaccines led to the development of a new generation of safer, acellular (aP) vaccines that have been adopted mainly in high-income countries. Over the past 20 years, some countries that boast high aP coverage have experienced a resurgence in pertussis, which has led to substantial debate over the basic immunology, epidemiology and evolutionary biology of the bacterium. Controversy surrounds the duration of natural immunity and vaccine-derived immunity, the ability of vaccines to prevent transmission and severe disease, and the impact of evolution on evading vaccine immunity. Resolving these issues is made challenging by incomplete detection of pertussis cases, the absence of a serological marker of immunity, modest sequencing of the bacterial genome and heterogeneity in diagnostic methods of surveillance. In this Review, we lay out the complexities of contemporary pertussis and, where possible, propose a parsimonious explanation for apparently incongruous observations.
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