title: Pertussis resurgence: waning immunity and pathogen adaptation - two sides of the same coin.
abstract: 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.
authors: Laboratory for Infectious Disease, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: F R
authors: FR
authors: Mooi
authors: Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: N A T
authors: NA
authors: Van Der Maas
authors: Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors: H E
authors: HE
authors: De Melker
mesh_terms: D000595:Amino Acid Sequence; D001886:Bordetella pertussis / Q000276:immunology / Q000472:pathogenicity; D021821:Communicable Diseases, Emerging; D058872:Epidemics; D006801:Humans; D008969:Molecular Sequence Data; D009154:Mutation; D037342:Pertussis Toxin / Q000737:chemistry / Q000276:immunology; D010567:Pertussis Vaccine / Q000276:immunology*; D016415:Sequence Alignment; D014917:Whooping Cough
chemical_list: D010567:Pertussis Vaccine; D037342:Pertussis Toxin