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Clin Infect Dis. 2015 Jan 15;60(2):223-7. doi: 10.1093/cid/ciu788. Epub 2014 Oct 9.

Pertactin-negative Bordetella pertussis strains: evidence for a possible selective advantage.

Author information

1
Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Vermont Department of Health, Burlington.
3
Washington State Department of Health, Seattle.
4
Seattle Children's Hospital, Seattle, Washington.
5
Multnomah County Health Department, Portland, Oregon.
6
Minnesota Department of Health, St. Paul.
7
New York State Department of Health, Albany.
8
Connecticut Department of Health, Hartford.
9
Colorado Department of Health and Environment, Denver.
10
New Mexico Department of Health, Santa Fe.

Abstract

BACKGROUND:

A recent increase in Bordetella pertussis without the pertactin protein, an acellular vaccine immunogen, has been reported in the United States. Determining whether pertactin-deficient (PRN(-)) B. pertussis is evading vaccine-induced immunity or altering the severity of illness is needed.

METHODS:

We retrospectively assessed for associations between pertactin production and both clinical presentation and vaccine history. Cases with isolates collected between May 2011 and February 2013 from 8 states were included. We calculated unadjusted and adjusted odds ratios (ORs) using multivariable logistic regression analysis.

RESULTS:

Among 753 isolates, 640 (85%) were PRN(-). The age distribution differed between cases caused by PRN(-) B. pertussis and cases caused by B. pertussis producing pertactin (PRN(+)) (P = .01). The proportion reporting individual pertussis symptoms was similar between the 2 groups, except a higher proportion of PRN(+) case-patients reported apnea (P = .005). Twenty-two case-patients were hospitalized; 6% in the PRN(+) group compared to 3% in the PRN(-) group (P = .11). Case-patients having received at least 1 pertussis vaccine dose had a higher odds of having PRN(-) B. pertussis compared with unvaccinated case-patients (adjusted OR = 2.2; 95% confidence interval [CI], 1.3-4.0). When restricted to case-patients at least 1 year of age and those age-appropriately vaccinated, the adjusted OR increased to 2.7 (95% CI, 1.2-6.1).

CONCLUSIONS:

The significant association between vaccination and isolate pertactin production suggests that the likelihood of having reported disease caused by PRN(-) compared with PRN(+) strains is greater in vaccinated persons. Additional studies are needed to assess whether vaccine effectiveness is diminished against PRN(-) strains.

KEYWORDS:

Bordetella pertussis; acellular vaccine; mutations; pertactin; waning immunity

PMID:
25301209
DOI:
10.1093/cid/ciu788
[Indexed for MEDLINE]

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