Pertussis: Microbiology, Disease, Treatment, and Prevention

Abstract

Pertussis is a severe respiratory infection caused by Bordetella pertussis, and in 2008, pertussis was associated with an estimated 16 million cases and 195,000 deaths globally. Sizeable outbreaks of pertussis have been reported over the past 5 years, and disease reemergence has been the focus of international attention to develop a deeper understanding of pathogen virulence and genetic evolution of B. pertussis strains. During the past 20 years, the scientific community has recognized pertussis among adults as well as infants and children. Increased recognition that older children and adolescents are at risk for disease and may transmit B. pertussis to younger siblings has underscored the need to better understand the role of innate, humoral, and cell-mediated immunity, including the role of waning immunity. Although recognition of adult pertussis has increased in tandem with a better understanding of B. pertussis pathogenesis, pertussis in neonates and adults can manifest with atypical clinical presentations. Such disease patterns make pertussis recognition difficult and lead to delays in treatment. Ongoing research using newer tools for molecular analysis holds promise for improved understanding of pertussis epidemiology, bacterial pathogenesis, bioinformatics, and immunology. Together, these advances provide a foundation for the development of new-generation diagnostics, therapeutics, and vaccines.

FIG 1

Incidence rates of pertussis by age group reported to the Centers for Disease Control and Prevention from 1990 to 2014. (Adapted from CDC National Notifiable Disease Surveillance System and Supplemental Pertussis Surveillance System [http://www.cdc.gov/pertussis/surv-reporting.html].)

FIG 2

Forest plot of clinical trials reporting efficacy of acellular and whole-cell pertussis vaccines (38, 404, 590–593). See Table S1 in the supplemental material for additional details. Greco et al. (a) compared the efficacy of a three-component DTaP vaccine with that of DTP vaccine. Greco et al. (b) compared the efficacy of another three-component DTaP vaccine (from a different manufacturer) with that of DTP vaccine. Gustafsson et al. (a) compared the efficacy of a two-component DTaP vaccine with that of DTP vaccine. Gustafsson et al. (b) compared the efficacy of a five-component DTaP vaccine with that of DTP vaccine. Olin et al. (a) compared the efficacy of a three-component DTaP vaccine with that of DTP vaccine. Olin et al. (b) compared the efficacy of a five-component DTaP vaccine with that of DTP vaccine. DTaP, diphtheria and tetanus toxoids and acellular pertussis; DTP, diphtheria and tetanus toxoids and whole-cell pertussis.