Incidence and severity of pertussis hospitalisations in infants aged less than 1 year in 37 hospitals of six EU/EEA countries, results of PERTINENT sentinel pilot surveillance system, December 2015 to December 2018

Merdrignac, Lore; Belghiti, Fatima Aït El; Pandolfi, Elisabetta; Jané, Mireia; Murphy, J; Fabiánová, Kateřina; Cenoz, Manuel García; Flem, Elmira; Guillot, Sophie; Tozzi, Alberto Eugenio; Carmona, Glòria; Habington, Adele; Zavadilová, Jana; Navasués, Ana; Bøås, Håkon; Lévy-Brühl, Daniel; Ferretti, Beatrice; Lanaspa, Miguel; O'Sullivan, Niam; Křížová, Pavla; Fernandino, Leticia; Bekkevold, Terese; Hanslik, Thomas; Muñoz‐Almagro, Carmen; Bacci, Sabrina; Spiteri, Gianfranco; Valenciano, Marta; Moren, Alain

doi:10.2807/1560-7917.es.2021.26.4.1900762

Cited by 11 publications

(16 citation statements)

References 20 publications

(22 reference statements)

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“…Parents were more frequently tested as positive contact (66.0%), followed by siblings (24.5%). This relationship with infant and age distribution of primary case contacts was recently shown to be similar in HIC where aPVs are used [ 24 ]. The important rate of pertussis infection among contact cases observed herein highlights the underreporting among older children and adults and are in line with studies evidencing substantial circulation of pertussis among Iranian children and adolescents [ 10 , 25 ].…”

Section: Discussionmentioning

confidence: 66%

Hospital-based prospective study of pertussis in infants and close contacts in Tehran, Iran

et al. 2021

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Background Pertussis remain a global health concern, especially in infants too young to initiate their vaccination. Effective vaccination and high coverage limit the circulation of the pathogen, yet duration of protection is limited and boosters are recommended during a lifetime. In Iran, boosters are given at 18 months and 6 years old using whole pertussis vaccines for which efficacy is not known, and pertussis surveillance is scant with only sporadic biological diagnosis. Burden of pertussis is not well understood and local data are needed. Methods Hospital-based prospective study implementing molecular laboratory testing in infants aged ≤6 months and presenting ≥5 days of cough associated to one pertussis-like symptom in Tehran. Household and non-household contact cases of positive infants were evaluated by comprehensive pertussis diagnosis (molecular testing and serology) regardless of clinical signs. Clinical evaluation and source of infection were described. Results A total of 247 infants and 130 contact cases were enrolled. Pertussis diagnosis result was obtained for 199 infants and 104 contact cases. Infant population was mostly < 3 months old (79.9%; 157/199) and unvaccinated (62.3%; 124/199), 20.1% (40/199) of them were confirmed having B. pertussis infection. Greater cough duration and lymphocyte counts were the only symptoms associated to positivity. Half of the contact cases (51.0%; 53/104) had a B. pertussis infection, median age was 31 years old. A proportion of 28.3% (15/53) positive contacts did not report any symptom. However, 67.9% (36/53) and 3.8% (2/53) of them reported cough at inclusion or during the study, including 20.8% (11/53) who started coughing ≥7 days before infant cough onset. Overall, only five samples were successfully cultured. Conclusion These data evidenced the significant prevalence of pertussis infection among paucy or poorly symptomatic contacts of infants with pertussis infection. Widespread usage of molecular testing should be implemented to identify B. pertussis infections.

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Section: Discussionmentioning

confidence: 66%

Hospital-based prospective study of pertussis in infants and close contacts in Tehran, Iran

et al. 2021

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“…According to the PERTINENT surveillance system, a significant decrease in pertussis incidence rates was observed in France in infants between 2017 (49.1; 95% CI: 39.5-60.3) and 2018 (34.7; 95% CI: 26.7-44.4), corresponding to an incidence rate ratio of 0.71 (p = 0.034) [7]. Between these 2 years, incidence rate ratios were 1.43 in Czechia (p = 0.468), 0.25 in Catalonia, Spain (p = 0.002), 0.21 in Navarra, Spain (p = 0.148), 0.14 in Ireland (p = 0.002), 0.63 in Italy (p = 0.053), and zero in Norway [7]. Our estimates of incidence for infants in 2017 (84; 95% CI: 0-204) were comparable to those of PERTINENT estimates, while they were well below for 2018 (0; 95% CI: 0-0).…”

Section: Discussionmentioning

confidence: 99%

“…Microbiologists are encouraged to send the isolates to the National Reference Center for Whooping Cough, and typically do so [6]. In 2015, the European Centre for Disease Prevention and Control (ECDC) set up 'Pertussis in Infants European Network' (PERTINENT), a hospitalbased active pilot surveillance system that involves 41 hospitals from six countries, including 21 French hospitals participating in the Renacoq surveillance [7]. This system monitors laboratory-confirmed cases of pertussis (by PCR and/or culture) among infants attending hospitals participating in the network [7].…”

Section: Introductionmentioning

confidence: 99%

Pertussis surveillance results from a French general practitioner network, France, 2017 to 2020

et al. 2022

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Introduction In France, three complementary surveillance networks involving hospitals and paediatrician practices currently allow pertussis surveillance among infants (<1 year old) and children (1–12 years old). Data on incidences among adolescents (13–17 years old) and adults (≥ 18 years) are scarce. In 2017, a sentinel surveillance system called Sentinelles network, was implemented among general practitioners (GPs). Aim The purpose of Sentinelles network is to assess pertussis incidence, monitor the cases’ age distribution and evaluate the impact of the country’s vaccination policy. We present the results from the first 4 years of this surveillance. Methods GPs of the French Sentinelles network reported weekly numbers of epidemiologically or laboratory-confirmed cases and their characteristics. Results A total of 132 cases were reported over 2017–2020. Estimated national incidence rates per 100,000 inhabitants were 17 (95% confidence interval (CI): 12–22) in 2017, 10 (95% CI: 6–14) in 2018, 15 (95% CI: 10–20) in 2019 and three (95% CI: 1–5) in 2020. The incidence rate was significantly lower in 2020 than in 2017–2019. Women were significantly more affected than men (83/132; 63% of women, p = 0.004); 66% (87/132) of cases were aged 15 years or over (median age: 31.5 years; range: 2 months–87 years). Among 37 vaccinated cases with data, 33 had received the recommended number of doses for their age. Conclusions These results concur with incidences reported in other European countries, and with studies showing that the incidences of several respiratory diseases decreased in 2020 during the COVID-19 pandemic. The results also suggest a shift of morbidity towards older age groups, and a rapid waning of immunity after vaccination, justifying to continue this surveillance.

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“…It might be the same for FHA(−) strains. During the Pertinent study, a European hospital-based study, some patients were biologically confirmed by PCR but did not have symptoms, suggesting that they might have been infected by a PT(−) strain [ 46 ]. It will then be of interest to follow the clinical symptoms of patients with a positive pertussis PCR, including coinfections, according to their age, vaccination status and contacts.…”

Section: Pertussismentioning

confidence: 99%

Can vaccines control bacterial virulence and pathogenicity? Bordetella pertussis: the advantage of fitness over virulence

Guiso

Soubeyrand²,

Macina

2022

Evolution, Medicine, and Public Health

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Some vaccines, such as diphtheria toxoid and acellular pertussis vaccines (aPVs), may favor the emergence of less pathogenic strains of the respective bacteria they target. This review discusses the impact of the wide use of aPV on Bordetella pertussis phenotype evolutions and their beneficial consequences in the light of the diphtheria toxoid immunization program experience and structuring evidence review in a causal analysis following Bradford Hill’s causality criteria. All aPVs contain the pertussis toxin (PT), the main virulence factor of B. pertussis, alone or with one adhesin (Filamentous hemagglutinin (FHA)), two adhesins (FHA and pertactin (PRN)) or four adhesins (FHA, PRN and two fimbriae (Fim 2/3)). In countries where the coverage of aPVs containing PRN is high, PRN negative B. pertussis isolates are increasing in prevalence, but isolates non-producing the other antigens are rarely reported. We hypothesize that the selective pressure at play with PRN should exist against all aVP antigens, although detection biases may hinder its detection for other antigens, especially PT. PT being responsible for clinically frank cases of the disease, the opportunity to collect PT negative isolates is far lower than to collect PRN negative isolates which have a limited clinical impact. The replacement of current B. pertussis by far less pathogenic isolates no longer producing the factors contained in aPVs should be expected as a consequence of the wide aPV use. LAY SUMMARY Reviewing the existing evidence, we hypothesize that acellular whooping cough vaccines induced selective pressure on the bacteria causing whooping cough. To survive the bacteria must stop the production of virulence factors targeted by the vaccine that should decrease the severity of the disease and jeopardise the detection of the bacteria.

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Incidence and severity of pertussis hospitalisations in infants aged less than 1 year in 37 hospitals of six EU/EEA countries, results of PERTINENT sentinel pilot surveillance system, December 2015 to December 2018

Cited by 11 publications

References 20 publications

Hospital-based prospective study of pertussis in infants and close contacts in Tehran, Iran

Hospital-based prospective study of pertussis in infants and close contacts in Tehran, Iran

Pertussis surveillance results from a French general practitioner network, France, 2017 to 2020

Can vaccines control bacterial virulence and pathogenicity? Bordetella pertussis: the advantage of fitness over virulence

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