In 2005, a literature review was undertaken using MEDLINE complemented by a collection provided by WHO Geneva originally compiled by Artur Galazka and then extended to include articles held in WHO regional databases. MEDLINE searches of articles used the MeSH terms “pertussis complications”, “epidemiology”, “mortality”, “prevention and control”, and “transmission” to identify articles published since 1966. Papers were prioritised to meet the space constraints of the Seminar.
SeminarRecent developments in pertussis
Section snippets
Clinical features of pertussis
Pertussis (whooping cough) is an infectious respiratory disease caused by the bacterium Bordetella pertussis, an exclusively human pathogen recorded worldwide. The differential diagnosis includes a wide range of respiratory pathogens, such as Bordetella parapertussis and respiratory syncytial virus infection.3
Pertussis is very infectious with high secondary attack rates in households.4 Published incubation periods range between 5 and 21 days, with 7 days being most common, and rarely lasting
Microbiology
B pertussis is a small gram-negative coccobacillus, strictly aerobic, and fastidious, needing special media (such as charcoal blood agar with cefalexin) for its isolation. The bacterium produces a range of adhesins, fimbriae, and toxins. Some are associated with adhesion and colonisation, including filamentous haemagglutinin, pertactin, and components of pertussis toxin, and some are implicated in the pathogenesis of clinical pertussis, including other components of pertussis toxin, an
Treatment
Supportive treatment is most important for infants. For optimum clinical effectiveness, antibiotic treatment should be given rapidly: it also shortens the infectious period.33 There is probably no effect on outcome if started more than 1 week after onset of illness. Erythromycin is the traditional treatment, but the newer macrolides azithromycin and clarithromycin have similar effectiveness with fewer side-effects.58, 59 7 days of treatment with erythromycin have been shown to be as effective
Whole-cell and acellular pertussis vaccines
Whole-cell pertussis vaccines were developed in the 1940s and have been used worldwide for many years, having been part of the WHO Expanded Program of Immunization since its launch in 1974. Whole-cell pertussis vaccine is a suspension of killed B pertussis organisms. Safety of whole-cell vaccines has been reviewed in detail, and of a range of adverse events considered, evidence suggests a causal relation only for anaphylaxis, prolonged or inconsolable crying, and febrile seizures.65 For other
Routine surveillance
Surveillance of pertussis is a challenge because the clinical range is wide, all ages can be affected, and laboratory confirmation is not straightforward. Data from different countries are difficult to compare because surveillance systems vary greatly: case definitions, diagnostic methods, clinical and reporting practice, and public-health law all differ.97 Surveillance of pertussis in most countries relies on statutory clinical notifications and laboratory reports.98 Both are recognised to
Conclusions
Pertussis is a substantial health burden worldwide, and for many developing countries the challenge is simple—to achieve high vaccination coverage of timely immunisation for infants. Public-health authorities could do much to improve the quality of routine information used to assess changes to vaccination programmes, such as adolescent and adult boosters. All countries should apply standardised case definitions for surveillance and outbreak investigation, and make better use of laboratory
Search strategy and selection criteria
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Cited by (213)
Bordetella pertussis
2023, Molecular Medical Microbiology, Third EditionDiagnostic performance of commercial serological assays measuring Bordetella pertussis IgG antibodies
2018, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :The main result of the present study is that commercial assays using PT as the only antigen have a better performance as compared to those using a mixture of different antigens, displaying a good to an excellent diagnostic accuracy. This finding confirms previous data (Riffelmann et al., 2010) and the notion that other B. pertussis antigens, such as filamentous hemagglutinin, pertactin, and fimbriae, are less specific due to cross-reactivity with other microbial antigens (e.g., other Bordetella species, Haemophilus species, Mycoplasma pneumoniae, Escherichia coli) (Crowcroft and Pebody, 2006; Guiso et al., 2011). Some of the kits produced misclassifications, which could be in theory explained by random error.