title: The pertussis enigma: reconciling epidemiology, immunology and evolution.
abstract: Pertussis, a highly contagious respiratory infection, remains a public health priority despite the availability of vaccines for 70 years. Still a leading cause of mortality in developing countries, pertussis has re-emerged in several developed countries with high vaccination coverage. Resurgence of pertussis in these countries has routinely been attributed to increased awareness of the disease, imperfect vaccinal protection or high infection rates in adults. In this review, we first present 1980-2012 incidence data from 63 countries and show that pertussis resurgence is not universal. We further argue that the large geographical variation in trends probably precludes a simple explanation, such as the transition from whole-cell to acellular pertussis vaccines. Reviewing available evidence, we then propose that prevailing views on pertussis epidemiology are inconsistent with both historical and contemporary data. Indeed, we summarize epidemiological evidence showing that natural infection and vaccination both appear to provide long-term protection against transmission and disease, so that previously infected or vaccinated adults contribute little to overall transmission at a population level. Finally, we identify several promising avenues that may lead to a consistent explanation of global pertussis epidemiology and to more effective control strategies.
authors.affiliation: Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Domenech de Cellès
authors.affiliation: Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Felicia M G
authors.initials: FM
authors.lastname: Magpantay
authors.affiliation: Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: King
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA Odum School of Ecology, University of Georgia, Athens, GA 30602, USA College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA rohani@uga.edu.
authors.forename: Pejman
authors.initials: P
authors.lastname: Rohani
mesh_terms: D000328:Adult; D001886:Bordetella pertussis / Q000276:immunology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000276:immunology / Q000635:transmission; D004197:Disease Reservoirs; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D032541:Mass Vaccination; D014917:Whooping Cough / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000635:transmission
keywords: infection-derived immunity; pertussis; pertussis epidemiology; pertussis resurgence; pertussis vaccines; vaccine-derived immunity