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Multiclonal Dissemination of ptxP3 Allele Macrolide-Resistant Bordetella pertussis in Okinawa, Japan

Tetsuya Kakita1, Haruno Taira1, Tsuyoshi Kudeken1

  • 1Research Center of Infectious Disease, Okinawa Prefectural Institute of Health and Environment, Japan.

Japanese Journal of Infectious Diseases
|August 31, 2025
PubMed

Insights

Macrolide-resistant Bordetella pertussis strains, identified by the A2047G mutation, are causing an epidemic in Okinawa. Genomic analysis revealed these strains are genetically related to international isolates but show distinct clusters, suggesting multiple introductions.

Area of Science:

  • Microbiology
  • Genomics
  • Epidemiology

Background:

  • An ongoing pertussis epidemic has been reported in Okinawa since November 2024, with 227 cases documented.
  • Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis.

Purpose of the Study:

  • To investigate the genetic characteristics and origins of macrolide-resistant Bordetella pertussis (MRBP) strains.
  • To understand the dissemination patterns of MRBP during the Okinawa pertussis epidemic.

Main Methods:

  • Clinical specimens were collected from 31 pertussis cases between December 2024 and February 2025.
  • Isolation and identification of 18 macrolide-resistant Bordetella pertussis (MRBP) strains.
  • Confirmation of the A2047G mutation in the 23S rRNA gene using real-time PCR.
  • Genomic analysis of 20 MRBP strains, including whole-genome sequencing and SNP analysis.

Main Results:

  • Eighteen macrolide-resistant Bordetella pertussis (MRBP) strains were isolated, all possessing the A2047G mutation.
  • Genomic analysis indicated that Okinawa MRBP strains are genetically related to the ptxP3 allele found in China and France.
  • Okinawa MRBP strains formed three distinct genetic clusters, differing from Chinese and French isolates by at least eight SNPs.

Conclusions:

  • The A2047G mutation confers macrolide resistance in Bordetella pertussis strains circulating in Okinawa.
  • The genetic relatedness to international strains with the ptxP3 allele, coupled with distinct clustering, suggests multi-source introductions of MRBP into Okinawa.
  • Further investigation is warranted to track the sources and spread of these resistant pertussis strains.
Keywords:
Bordetella pertussisOkinawacore genome SNPgenome sequencesmacrolide-resistant

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