title: Epidemiologic and laboratory features of a large outbreak of pertussis-like illnesses associated with cocirculating Bordetella holmesii and Bordetella pertussis--Ohio, 2010-2011.
abstract: BACKGROUND
  During 9 May 2010-7 May 2011, an outbreak of pertussis-like illness (incidence, 80 cases per 100 000 persons) occurred in Franklin County, Ohio. The majority of cases were identified by IS481-directed polymerase chain reaction (PCR), which does not differentiate among Bordetella species. We sought to determine outbreak etiology and epidemiologic characteristics.
  
  
  METHODS
  We obtained demographic, clinical, and vaccination-related data from the Ohio Disease Reporting System and Impact Statewide Immunization Information System. We tested sera from 14 patients for anti-pertussis toxin (PT) antibodies and used species-specific PCR on 298 nasopharyngeal specimens.
  
  
  RESULTS
  Reported cases totaled 918. IS481 results were available for 10 serologically tested patients; 5 of 10 had discordant anti-PT antibody and IS481 results, suggestive of Bordetella holmesii, which lacks PT and harbors IS481. We identified specific Bordetella species in 164 of 298 specimens tested with multitarget PCR; B. holmesii and Bordetella pertussis were exclusively detected among 48 (29%) and 112 (68%), respectively; both were detected in 4 (2%). Among 48 patients with B. holmesii infections, 63% were aged 11-18 years, compared with 35% of 112 patients with B. pertussis infections (P = .001). Symptoms were similar among B. holmesii- and B. pertussis-infected patients. Adolescent pertussis ("Tdap") booster vaccinations were more effective against B. pertussis than B. holmesii (effectiveness: 67% and 36%, respectively; 95% confidence intervals, 38%-82% and -33% to 69%, respectively).
  
  
  CONCLUSIONS
  We report the first documented mixed outbreak of B. pertussis and B. holmesii infections. Bordetella holmesii particularly affected adolescents. Although laboratory capacity limitations might inhibit routine use of multitarget PCR for clinical diagnosis, focused testing and enhanced surveillance might improve understanding the burden of B. holmesii infection.
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lrodgers@cdc.gov
authors.forename: Loren
authors.initials: L
authors.lastname: Rodgers
authors.forename: Stacey W
authors.initials: SW
authors.lastname: Martin
authors.forename: Amanda
authors.initials: A
authors.lastname: Cohn
authors.forename: Jeremy
authors.initials: J
authors.lastname: Budd
authors.forename: Mario
authors.initials: M
authors.lastname: Marcon
authors.forename: Andrew
authors.initials: A
authors.lastname: Terranella
authors.forename: Sema
authors.initials: S
authors.lastname: Mandal
authors.forename: Douglas
authors.initials: D
authors.lastname: Salamon
authors.forename: Amy
authors.initials: A
authors.lastname: Leber
authors.forename: Maria-Lucia
authors.initials: ML
authors.lastname: Tondella
authors.forename: Kathleen
authors.initials: K
authors.lastname: Tatti
authors.forename: Kevin
authors.initials: K
authors.lastname: Spicer
authors.forename: Allen
authors.initials: A
authors.lastname: Emanuel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Koch
authors.forename: Londell
authors.initials: L
authors.lastname: McGlone
authors.forename: Lucia
authors.initials: L
authors.lastname: Pawloski
authors.forename: Mysheika
authors.initials: M
authors.lastname: Lemaile-Williams
authors.forename: Naomi
authors.initials: N
authors.lastname: Tucker
authors.forename: Radhika
authors.initials: R
authors.lastname: Iyer
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Clark
authors.forename: Mary
authors.initials: M
authors.lastname: Diorio
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood; D015373:Bacterial Typing Techniques; D001884:Bordetella / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D001886:Bordetella pertussis / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D002648:Child; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D006801:Humans; D009305:Nasopharynx / Q000382:microbiology; D009820:Ohio / Q000453:epidemiology; D037342:Pertussis Toxin / Q000276:immunology; D016133:Polymerase Chain Reaction / Q000379:methods; D014917:Whooping Cough / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D037342:Pertussis Toxin