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Few data exist on asymptomatic carriage of Bordetella species among populations receiving acellular pertussis vaccine. We conducted a cross-sectional study among acellular-vaccinated children presenting to an emergency department (ED). Bordetella pertussis carriage prevalence was <1% in this population, a lower prevalence than that found in recent studies among whole-cell pertussis-vaccinated participants. [ABSTRACT FROM AUTHOR]

What is Known and Objective: Live‐attenuated bacterial veterinary vaccines can constitute an infection risk for individuals with any defect in their phagocytic function, including chronic granulomatous disease, leukocyte adhesion deficiency, myeloperoxidase deficiency, as well as Chediak‐Higashi syndrome, from accidental acquisition of licenced attenuated live bacterial vaccine, at vaccination or from their vaccinated pet. Ownership of small companion animals, including cats and dogs, is popular within the cystic fibrosis (CF) community. These animals require vaccines as part of their routine care, which may involve live viral and bacterial vaccines, with potential for infection in the CF owner. This report examines the scope of current canine and feline vaccines, with particular emphasis on veterinary vaccination strategies against the Gram‐negative pathogen, Bordetella bronchiseptica and describes new vaccine innovations offering protection to both pet and CF owner. Comment: The Gram‐negative bacterium, Bordetella bronchoseptica, may cause respiratory disease in small companion animals, as well as in certain human vulnerable groups, including those with CF. Live licenced veterinary bacterial vaccines for Bordetella bronchiseptica (Kennel Cough) are available for cats and dogs, which are an infection concern for humans with CF who may come into contact with vaccinated animals. Live licenced veterinary bacterial vaccines for Bordetella bronchiseptica (Kennel Cough) are available for intranasal administration to cats and dogs. These vaccines require a withdrawal period of vaccinated animal from vulnerable owner, ranging from 35 days – 11 weeks. Recently, a new dead IM vaccine is now available not requiring exclusion of the vaccinated pet from CF owner. What is new & conclusion: CF pharmacists, hospital pharmacists and community pharmacists are important custodians of vaccine‐related advice to people with CF, who are frequently consulted for such advice. Pharmacists should be aware of the recent innovations in veterinary medicines, so that they can give appropriate advice to people with CF when asked. Immunocompromised patients, that is those with CF or those with any defect in their phagocytic function (chronic granulomatous disease, leukocyte adhesion deficiency, myeloperoxidase deficiency, Chediak‐Higashi syndrome) should avoid exposure to live veterinary bacterial vaccines and seek animal vaccination utilising non‐live vaccines. Most importantly, this manuscript highlights the development of a new veterinary vaccine for dogs, which we want to make the CF healthcare community aware of, which is an acellular dead vaccine, so that those patients with dogs needing annual vaccination can select this vaccine pathway, thereby minimising risk of infection from the vaccine strains and avoiding the social exclusion between CF patient and their pet. CF patients should understand the potential infection implications of live‐attenuated viral and bacterial strains as vaccines, whether these are small companion animals, exotic animals or large farm animals. Patients should make their veterinarian aware of their CF status, so that a safe and efficacious vaccine strategy is used, both mitigating the potential infection risks from live vaccine components with the CF patient, but simultaneously offering maximum immunological protection to the animal. [ABSTRACT FROM AUTHOR]

From 2015 to 2017, 3197 interpretable Bordetella polymerase chain reaction (PCR) tests were performed for 2760 children presenting to our tertiary university hospital. Requests mainly came from the emergency department (62%) and for children older than 1 year (68%). Only 32 PCR (1%) results were positive, mainly in children younger than 1 year (n = 29/32, 90.6%; p <0.001). When focusing on the PCR indications in 2017, we found the requests were mainly based on nonspecific respiratory symptoms and were clinically unjustified in 383 cases (39%). Pediatricians overused Bordetella PCR in clinical practice. They should reserve their requests for cases of young children with symptoms suggestive of respiratory illness and/or incomplete pertussis immunization. [ABSTRACT FROM AUTHOR]

Background: In an effort to improve the pertussis diagnosis, the Global Pertussis Initiative (GPI) proposed an algorithm of the signs/symptoms of pertussis for three age groups: 0–3 months, 4 months to 9 years, and ≥10 years of age. Methods: We evaluated the accuracy of the clinical case definitions for pertussis proposed by the GPI using laboratory-confirmed pertussis as a reference standard for four groups: clinically suspected pertussis without comorbidity; asthma exacerbation; allergic constitution, and other diagnoses (bronchitis, bronchiolitis, laryngitis, and tracheitis). We included only patients who fulfilled one or more criteria of clinical case definitions for the age groups (0–3 months, 4 months–9 years, and ≥10 years of age). The data for this prospective epidemiological study were collected between 1st January 2013–31st December 2016 at the outpatients and inpatients health care settings in the South Bačka District of Autonomous Province of Vojvodina, Serbia. We evaluated accuracy of the certain sign and symptom combinations of GPI case definitions based on their sensitivity, specificity, and likelihood ratios. Results: A total of 1043 participants were included, with 306 (29.3%) laboratory-confirmed pertussis cases. In patients aged 0–3 months, whoop and apnoea associated with laboratory confirmation of pertussis. In patients aged 4 months-9 years with a pertussis suspicion infection or with one of the other diagnoses, the highest accuracy was found for whoop combined with apnoea or post-tussive emesis. In patients aged 10 years and older, several different sign and symptom combinations were associated with an increased risk of pertussis among all enrolment diagnoses. There were fewer hospitalizations among the fully vaccinated children than in partly or unvaccinated children aged 4 months to 6 years (20.7% vs. 60.0%, p = 0.017). Conclusions: The numerous sign and symptom combinations in the observed case definitions were good predictors for laboratory-confirmed pertussis among all enrolment diagnoses, therefore suggesting the necessity for increased awareness of possibility for pertussis in patients with certain pertussis-like medical conditions. [ABSTRACT FROM AUTHOR]

Background: We describe the epidemiology of pertussis in Alberta, Canada by person, place, and time between 2004 and 2015, identify outbreak years, and examine vaccination coverage and vaccination timeliness.Methods: We used health data from Alberta's Communicable Disease Registry System for the period of January 1, 2004 through August 31, 2015 to identify unique cases of pertussis. Unique cases were deterministically linked to data in Alberta's immunization repository and health care insurance plan registry. Population estimates and vaccination coverage were extracted from Alberta's online Interactive Health Data Application. We estimated pertussis incidence rates per 100,000 persons by year, age group, gender, and health zone. Outbreak years were identified using a one-sided cumulative sum (CUSUM) analysis by comparing annual incidence rates to baseline rates.Results: Over the period, 3510 cases of pertussis were confirmed by laboratory testing or epidemiological linkage. Incidence rates per 100,000 persons were highest in 2004 (20.5), 2005 (13.6), and 2015 (10.4) for all age groups. Incidence rates were highest among the youngest age groups and decreased as age groups increased. Based on CUSUM analysis, 2008 and 2012 met the criteria for outbreak years. Vaccination coverage was over 90% among the general population, however only 61% of cases received at least one dose. About 60% of cases were diagnosed 5+ years after receiving the vaccine. Approximately 87-91% of vaccinated cases did not receive the first three vaccine doses in a timely manner.Conclusion: Pertussis incidence rates fluctuated over the period across all age groups. The majority of cases had no record of vaccination or were delayed in receiving vaccines. CUSUM analysis was an effective method for identifying outbreaks. [ABSTRACT FROM AUTHOR]

Bordetella holmesii causes both invasive and respiratory diseases in humans. Although the number of cases of pertussis-like respiratory illnesses due to B. holmesii infection has increased in the last decade worldwide, little is known about the virulence factors of the organism. Here, we analyzed a B. holmesii isolate that forms large aggregates and precipitates in suspension, and subsequently demonstrated that the autoagglutinating isolate is deficient in Bordetella intermediate protein A (BipA) and that this deletion is caused by a frame-shift mutation in the bipA gene. A BipA-deficient mutant generated by homologous recombination also exhibited the autoagglutination phenotype. Moreover, the BipA mutant adhered poorly to an abiotic surface and failed to form biofilms, as did two other B. holmesii autoagglutinating strains, ATCC 51541 and ATCC 700053, which exhibit transcriptional down-regulation of bipA gene expression, indicating that autoagglutination indirectly inhibits biofilm formation. In a mouse intranasal infection model, the BipA mutant showed significantly lower levels of initial lung colonization than did the parental strain (P < 0.01), suggesting that BipA might be a critical virulence factor in B. holmesii respiratory infection. Together, our findings suggest that BipA production plays an essential role in preventing autoagglutination and indirectly promoting biofilm formation by B. holmesii. [ABSTRACT FROM AUTHOR]

We investigated the seasonality of pertussis in Queensland, Australia, between 2008 and 2011 using notification and laboratory data. Polymerase chain reaction and serology testing data demonstrate that in the vaccine era, pertussis remains a seasonal illness, with annual peaks in summer months, and that the seasonality of notification data is masked by testing trends. [ABSTRACT FROM AUTHOR]

We calculated the effectiveness of pertussis vaccine in preventing parapertussis among Oregon children 2 months to 10 years of age using 2 methods. During 2011–2016, the 2 VE methods found 66% (95% CI, 59–75%) and 82% (95% CI, 69–90%) effectiveness against parapertussis. Pertussis vaccine may induce cross-immunity. [ABSTRACT FROM AUTHOR]

Bordetella pertussis still poses an important health threat in developing countries. In Niger, notified pertussis cases are few despite the low diphtheria–tetanus–pertussis/pentavalent vaccine coverage. We aimed to estimate the prevalence of B. pertussis in children aged <5 years consulting at a pediatric ward. A 5-month study in 2011 recruited 342 children with respiratory symptoms at the National Hospital of Niamey. Nasopharyngeal aspirates were tested by culture and real-time polymerase chain reaction. Overall, 34 (11.2%) of the 305 available nasopharyngeal aspirates tested by real-time polymerase chain reaction were positive for a Bordetella spp., with an estimated prevalence of 8.2 cases per 1000 children aged <5. None was notified to the surveillance network. A single specimen was positive on culture. This study, the first to provide laboratory-confirmed data on pertussis in Niger, highlights the need to sensitize health care personnel to actively notify clinical cases and to integrate laboratory diagnosis in the existing surveillance system. [ABSTRACT FROM PUBLISHER]

Background: Pertussis, a vaccine preventable disease, is still responsible of significant morbidity and mortality around the world, mostly in newborns. The aim of the present study was (1) to introduce pertussis surveillance in the major pediatric hospital of Casablanca (2) to analyze the prevalence of pertussis among children under 14 years of age and their entourage in Casablanca, Morocco.Methods: This is a prospective and non-case controlled study, including children suspected of Pertussis admitted at the Abderrahim Harouchi Pediatric Hospital in Casablanca, from January 2013 to June 2015. Nasopharyngeal samples were obtained for Bordetella spp. culture and Real time PCR detection (RT-PCR) with specific primers of Bordetella spp., B. pertussis, B. parapertussis and B. holmesii. The detection of Bordetella spp. was also performed in some household contacts of the children suspected of pertussis.Results: During the 2.5-years period, a total of 282 samples were collected from hospitalized children (156) and in some of their contacts (126). Among 156 samples from the children (from whom 57% were under 2 month of age), Bordetella DNA was detected in 61% (96/156) by RT-PCR. Among these positive samples, 91.7% (88/96) corresponded to B. pertussis DNA. Furthermore, in 39.5% (38/96) of the Bordetella positive samples, B. holmesii DNA was also detected. B. parapertussis DNA was detected in only one sample (1/156). Out of the 156 samples collected from the hospitalized children, only 48 were tested by culture, and 4 B. pertussis were isolated (8.3%). Among the 126 samples from the contacts of the children, mostly mothers (115 cases), Bordetella DNA was detected in 47% (59/126), 90% (53/59) being B. pertussis DNA. Moreover, B. holmesii DNA was also detected in 18.6% (11/59) of the Bordetella positive samples, and coexistence of B. pertussis and B. holmesii DNA in 36.5% (35/96). Two B. pertussis were isolated by culture performed on 43 samples of the contacts of the children (4.6%).Conclusions: This study highlights the circulation of B. pertussis but also of B. holmesii in Casablanca-Morocco with a high proportion of co-infections B. holmesii/B. pertussis in infants and their mothers, indicate that infection of non-vaccinated infants could be more associated with young parents. Moreover, the RT- PCR provides a sensitive and specific diagnosis of B. pertussis infections and distinguishes it from other Bordetella species, and is therefore suitable for implementation in the diagnostic laboratory. [ABSTRACT FROM AUTHOR]

Background and Aims Pertussis is a common and potentially serious disease affecting mainly infants and young children. In its non-classic presentation, pertussis can be clinically indistinguishable from other respiratory illnesses. Pertussis today often remains underdiagnosed in adults. Our aims was to report a complicated cases of pertussis. Results A case of serologically confirmed pertussis occurred in an 18-year-old man presenting with pneumomediastinum, subcutaneous emphysema in the neck and chest, and persistent attacks of coughing with apnea that required treatment in the intensive care unit. Conclusion Pneumomediastinum and subcutaneous emphysema have never been described in adult patients with pertussis. Physicians should be aware that patients presenting with persistent cough and pneumomediastinum may have pertussis and include this in their differential diagnosis. [ABSTRACT FROM AUTHOR]

Background. Pertussis continues to be a public health concern around the world because of increasing morbidity among vaccinated children and adults, severe disease forms in infants and late diagnosis. It is frequently believed that pertussis is exclusively a "childhood disease", but there have been increasing reports of B. pertussis infection among adolescents and adults, although the peak incidence and the highest mortality occur among infants. Case presentation. 7-week-old infant illness started with a dry cough, on the 8th day of her illness it became paroxysmal. The infant's recurrent apnea episodes started on the day 12 of the illness, she started vomiting and developed severe respiratory failure. The patient required intubation and ventilation and stayed in PICU for 9 days. Blood showed lymphocytic leukocytosis. Pertussis diagnosis was confirmed by specific IgM antibody seroconversion. Disease to her 30-year-old mother began with catarrhal symptoms, later her paroxysmal coughing became accompanied by vomiting. Atypical bacterial bronchitis was suspected. Rigorous epidemiological history and detection of pertussis antibodies have helped to the confirmation of the pertussis diagnosis. The clinical course of B. pertussis infection in the infant was severe, and the mother's course was mild. Conclusions. Our presented clinical case of the infant and her mother's B. pertussis infection illustrates the complex diagnostic difficulties in diagnosing pertussis, requiring laboratory confirmation, analysis of epidemiological data and appropriate evaluation. Pertussis to the infant and the mother occurred with the typical three stages: catarrhal, paroxysmal and convalescente. The infant underwent a severe form of the disease, but the outcome was good. Understanding the source of pertussis may provide new approaches to preventing pertussis in the most vulnerable infants. Ivadas. Del didejancio vakcinuotu nuo kokliušo vaiku bei suaugusiu žmoniu sergamumo, sunkiu kudikiu ligos formu, velyvos diagnostikos kokliušas išlieka viena svarbiausiu visuomenes sveikatos apsaugos problemu visame pasaulyje. Nors neretai manoma, kad kokliušas yra išimtinai vaiku liga, taciau pranešimai rodo, kad dideja paaugliu ir suaugusiuju sergamumas kokliušu. Klinikinis atvejis. Septyniu savaiciu kudikio liga prasidejo sausu kosuliu, kuris veliau tapo priepuoliniu. Dvylikta ligos diena prasidejo apneja, vemimas, triko kvepavimas. Paciente buvo intubuota, taikyta dirbtine plauciu ventiliacija. Ji buvo gydyta intensyviosios terapijos skyriuje 9 dienas. Atlikus bendraji kraujo tyrima buvo nustatyta limfocitine leukocitoze. Kokliušo diagnoze buvo patvirtinta specifiniu IgM antikunu serokonversija. Trisdešimties metu motinos liga prasidejo nedideliais katariniais simptomais, veliau atsirado priepuolinis kosulys, kuris pasibaigdavo vemimu. Buvo itartas netipiniu bakteriju sukeltas bronchitas. Detali epidemiologine anamneze ir kokliušo antikunu aptikimas patvirtino kokliušo diagnoze. Kudikis kokliušu sirgo labai sunkiai, o motina - lengvai. Išvados. Musu pateiktas kudikio ir motinos kokliušo klinikinis atvejis atskleide diagnostikos sunkumus, epidemiologiniu duomenu bei laboratoriniu tyrimu svarba. Kudikio ir motinos kokliušas buvo tipines formos su trimis ligos stadijomis (katarine, kosulio priepuoliu ir sveikimo). Kudikis kokliušu sirgo labai sunkiai, o motina - lengvai. Gilesnes žinios apie kokliuša gali suteikti nauja požiuri i kudikiu, kaip labiausiai pažeidžiamu asmenu, apsauga. [ABSTRACT FROM AUTHOR]

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Introduction In 2005, in Finland, the whole-cell pertussis vaccine was replaced by acellular given at 3–5–12 months, and boosters at 4 and 11–15 years of age. From July 2012, military conscripts have been offered a pertussis booster dose. Conscription is mandatory for Finnish men, and >95% were 19–21 years old when enrolled during 2012–2015. We describe the epidemiology of pertussis in Finland during 1995–2015, and show the indirect effect of the booster in conscripts on pertussis incidence in the Finnish population. Materials and methods We extracted data on laboratory confirmed notified pertussis cases from the National Infectious Diseases Register. We calculated annual incidence using as denominator population data and incidence rate ratios (IRR) using Poisson regression. Results The overall pertussis incidence peaked in 2004 (31/100,000) and was lowest in 2015 (3.0/100,000), with 66 reported cases in <3 months infants in 2004 versus 6 in 2015. The majority of the cases were female (59%) with a male-to-female case ratio of 1:1.5. Cases were spread throughout the year with highest incidence during August-February. Among the 19- to 21-year-olds in the general population, incidence decreased from 49/100,000 in 2011 to 0.51/100,000 in 2015 (IRR = 0.01; 95%CI, 0.00–0.16). Among the same age group, comparing the 3.5-year period before and after July 2012, incidence decreased from 33/100,000 to 5.3/100,000 (IRR = 0.16; 95%CI, 0.06–0.40) in males and from 16/100,000 to 5.0/100,000 (IRR = 0.31; 95%CI, 0.11–0.84) in females. Conclusions Implementation of the pertussis booster dose in Finnish military conscripts was followed by a significant decrease in pertussis incidence both among the 19- to 21-year-old males and females, possibly reflecting herd immunity effect. Together with booster doses in adolescents this has resulted in low incidence in the whole population including infants. Our results support the implementation of the booster dose for conscripts. We recommend continuing monitoring pertussis epidemiology to optimize pertussis vaccination strategies in Finland. [ABSTRACT FROM AUTHOR]

Pertussis is a severe respiratory disease that can be fatal in young infants. Its main aetiological agent is the Gram-negative micro-organism Bordetella pertussis . Vaccines against the disease have been in use since the 1950s, and global vaccination coverage has now reached more than 85%. Nevertheless, the disease has not been controlled in any country, and has even made a spectacular come-back in the industrialized world, where the first-generation whole-cell vaccines have been replaced by the more recent, less reactogenic, acellular vaccines. Several hypotheses have been proposed to explain these observations, including the fast waning of acellular vaccine-induced protection. However, recent mathematical modelling studies have indicated that asymptomatic transmission of B. pertussis may be the main reason for the current resurgence of pertussis. Recent studies in non-human primates have shown that neither whole-cell, nor acellular vaccines prevent infection and transmission of B. pertussis , in contrast to prior exposure. New vaccines that can be applied nasally to mimic natural infection without causing disease may therefore be useful for long-term control of pertussis. Several vaccine candidates have been proposed, the most advanced of which is the genetically attenuated B. pertussis strain BPZE1. This vaccine candidate has successfully completed a first-in-man phase I trial and was shown to be safe in young male volunteers, able to transiently colonize the nasopharynx and to induce antibody responses to B. pertussis antigens in all colonized individuals. Whether BPZE1 will indeed be useful to ultimately control pertussis obviously needs to be assessed by carefully conducted human efficacy trials. [ABSTRACT FROM AUTHOR]

Background: Pertussis remain a global health concern, especially in infants too young to initiate their vaccination. Effective vaccination and high coverage limit the circulation of the pathogen, yet duration of protection is limited and boosters are recommended during a lifetime. In Iran, boosters are given at 18 months and 6 years old using whole pertussis vaccines for which efficacy is not known, and pertussis surveillance is scant with only sporadic biological diagnosis. Burden of pertussis is not well understood and local data are needed.Methods: Hospital-based prospective study implementing molecular laboratory testing in infants aged ≤6 months and presenting ≥5 days of cough associated to one pertussis-like symptom in Tehran. Household and non-household contact cases of positive infants were evaluated by comprehensive pertussis diagnosis (molecular testing and serology) regardless of clinical signs. Clinical evaluation and source of infection were described.Results: A total of 247 infants and 130 contact cases were enrolled. Pertussis diagnosis result was obtained for 199 infants and 104 contact cases. Infant population was mostly < 3 months old (79.9%; 157/199) and unvaccinated (62.3%; 124/199), 20.1% (40/199) of them were confirmed having B. pertussis infection. Greater cough duration and lymphocyte counts were the only symptoms associated to positivity. Half of the contact cases (51.0%; 53/104) had a B. pertussis infection, median age was 31 years old. A proportion of 28.3% (15/53) positive contacts did not report any symptom. However, 67.9% (36/53) and 3.8% (2/53) of them reported cough at inclusion or during the study, including 20.8% (11/53) who started coughing ≥7 days before infant cough onset. Overall, only five samples were successfully cultured.Conclusion: These data evidenced the significant prevalence of pertussis infection among paucy or poorly symptomatic contacts of infants with pertussis infection. Widespread usage of molecular testing should be implemented to identify B. pertussis infections. [ABSTRACT FROM AUTHOR]

Isolation of Bordetella pertussis and detection of the pertussis genome are not always successful because of low bacterial loads in adult patients with pertussis. Antibodies against pertussis toxin (PT) are measured but have low sensitivity in vaccinated subjects. There is no reliable diagnostic method at present. In this study, a fluorescent-EIA against several pertussis antigens and genome detection were investigated to establish clinical laboratory diagnostic methods for pertussis. The study was conducted in an outpatient clinic between September 2007 and 2013. Subjects consisted of 209 patients including adults suspected of pertussis and 35 staff members of the clinic. Loop-mediated isothermal amplification (LAMP) was performed to detect the pertussis genome in 5′ UTR of the pertussis toxin (PT) gene. The catalytic region of the adenylate cyclase toxin (catACT), C-terminal of filamentous hemagglutinin (cFHA), and type 3 fimbria (Fim3) were selected, which are not pertussis vaccine component. Conventional PT and FHA antibodies were examined together with type 2 fimbria (Fim2) antibodies, and these are vaccine antigens. Pertussis DNA was detected in 23 (11%) out of 209. Detection sensitivity was high in young infants. Antibodies against Fim3 showed a higher positive rate in all age groups. Staff members at the pediatric outpatient clinic showed serological booster responses in Fim2 and Fim3 antibodies more sensitively than those in PT antibodies during outbreaks. LAMP was useful for detecting the pertussis genome in young infants, whereas a serological assay for fluorescent-EIA against Fim2 and Fim3 was preferable for adolescents and adults. [ABSTRACT FROM AUTHOR]