Pertactin deficiency of <i>Bordetella pertussis</i>: Insights into epidemiology, and perspectives on surveillance and public health impact
Creators: name: Heininger, Ulrich
name: Martini, Helena
name: Eeuwijk, Jennifer
name: Prokić, Ivana
name: Guignard, Adrienne P.
name: Turriani, Elisa
name: Duchenne, Maurine
name: Berlaimont, Valérie
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Immunology
subject: FOS: Clinical medicine
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Computational Biology

description: Pertussis resurgence has been documented even in countries with high pediatric vaccine coverage. The proportion of <i>Bordetella pertussis</i> isolates not expressing pertactin (PRN) has increased in several countries where acellular pertussis (aP) vaccines are used. We systematically reviewed published literature up to July 2023 on PRN-negative <i>B. pertussis</i> isolates in MEDLINE and Embase with no geographical limitations, complemented with a gray literature search. An increase in the proportion of PRN-negative isolates was observed in countries where aP vaccines were used, while such isolates seem to be absent in countries using whole-cell pertussis vaccination. We reviewed the data supporting aP vaccine-driven evolution of <i>B. pertussis</i>, explored the effects of PRN deficiency on the clinical presentation of pertussis, summarized the evidence for preserved aP vaccine effectiveness, and proposed actions to further improve assessment of the clinical significance of PRN deficiency and its potential impact on pertussis prevention. The burden of pertussis (whooping cough), once a common cause of morbidity and mortality among children, was greatly reduced by the introduction of pediatric pertussis vaccination. Two types of pertussis vaccines exist: whole-cell pertussis (wP) vaccines, containing inactivated <i>Bordetella pertussis</i> bacteria, and acellular pertussis (aP) vaccines, containing purified antigens. Having lower reactogenicity, aP vaccines have replaced wP vaccines in many developed countries. In other parts of the world, wP vaccines are still used. Over time, the proportion of <i>B. pertussis</i> isolates not expressing pertactin (PRN, a surface antigen involved in virulence and contained in most aP vaccines) increased in countries using aP vaccines, but not in those using only wP vaccines. We performed a systematic literature review to collect data on the epidemiology of PRN-negative <i>B. pertussis</i> isolates identified worldwide. We combined these data with information on the type of pertussis vaccine used in each country and on the year aP vaccines were introduced, to assess if aP vaccine use was associated with a higher proportion of PRN-negative <i>B. pertussis</i> strains. We then selected three countries (Belgium, France, and Canada), for which we present data on pertussis diagnosis, surveillance, epidemiology, pertussis vaccine recommendations, and vaccine coverage, in connection with the PRN-negative <i>B. pertussis</i> data retrieved by our search. We found that the symptoms and severity of pertussis cases appear to be similar regardless of whether they were caused by PRN-negative or PRN-positive strains. There is no evidence of impaired protection by aP vaccines in countries where most circulating <i>B. pertussis</i> strains are PRN-negative.