Epidemiology and Infection

Pertussis

Pertussis resurgence: waning immunity and pathogen adaptation – two sides of the same coin

F. R. MOOIa1 c1, N. A. T. VAN DER MAASa2 and H. E. De MELKERa2

a1 Laboratory for Infectious Disease, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

a2 Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

SUMMARY

Pertussis or whooping cough has persisted and resurged in the face of vaccination and has become one of the most prevalent vaccine-preventable diseases in Western countries. The high circulation rate of Bordetella pertussis poses a threat to infants that have not been (completely) vaccinated and for whom pertussis is a severe, life-threatening, disease. The increase in pertussis is mainly found in age groups in which immunity has waned and this has resulted in the perception that waning immunity is the main or exclusive cause for the resurgence of pertussis. However, significant changes in B. pertussis populations have been observed after the introduction of vaccinations, suggesting a role for pathogen adaptation in the persistence and resurgence of pertussis. These changes include antigenic divergence with vaccine strains and increased production of pertussis toxin. Antigenic divergence will affect both memory recall and the efficacy of antibodies, while higher levels of pertussis toxin may increase suppression of the innate and acquired immune system. We propose these adaptations of B. pertussis have decreased the period in which pertussis vaccines are effective and thus enhanced the waning of immunity. We plead for a more integrated approach to the pertussis problem which includes the characteristics of the vaccines, the B. pertussis populations and the interaction between the two.

(Received October 11 2012)

(Revised December 12 2012)

(Accepted January 07 2013)

(Online publication February 13 2013)

Key words

  • Emerging infections;
  • epidemics;
  • epidemiology;
  • pertussis (whooping cough);
  • vaccination (immunization)

Correspondence

c1 Author for correspondence: Professor F. R. Mooi, Laboratory for Infectious Disease, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. (Email: frits.mooi@rivm.nl)

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