The History of Pertussis (Whooping Cough); 1906–2015: Facts, Myths, and Misconceptions

Abstract

Pertussis and Bordetella pertussis infections since 1906 are reviewed with an attempt to address facts, myths, and misconceptions. Clinical pertussis is a noninflammatory illness which occurs without fever or productive cough, and its hallmark is the distinctive paroxysmal cough. Because of its significant mortality and morbidity, whole-cell vaccines were developed in the 1930s, and the universal use of these vaccines decreased the incidence of reported pertussis 157-fold by 1970. Because of real and perceived reactions to diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTwP) vaccines, diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) vaccines were developed and put into universal use in the USA in 1997. Pertussis has two epidemiologies; one is reported pertussis and the other is B. pertussis illness. The study of these two epidemiologies indicate that reported pertussis is just the tip of the iceberg and B. pertussis cough illnesses occur in all age groups and they are very common; also, asymptomatic infection is more common than symptomatic infection. DTaP vaccines are less reactogenic than DTwP vaccines, but their effectiveness is less. B. pertussis infection is caused by many protein antigens, but illness due to this organism is caused by just two factors, pertussis toxin (PT) and a Bcough toxinŵ hich, as yet, has not been discovered. The present Bresurgence of pertussis^is mainly due to greater awareness and the use of PCR for diagnosis. There are also many other factors which have contributed to the Bresurgence.^New vaccines are clearly needed; with our present vaccines (DTaP and adolescent and adult formulated tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)), if used correctly, severe pertussis and deaths in infants can be prevented.

Pertussis in Young Infants Throughout the World

“…The clinical spectrum of B. pertussis illness in young infants extends from a trivial illness to severe illness resulting in death [1, 3–9, 11, 13–15]. This spectrum is influenced by many factors, including the presence and magnitude of transplacentally acquired antibodies to B. pertussis antigens, the sex of the infant, the age and weight of the infant at the time of exposure, the concentration of the bacterial exposure, and whether or not the infant was breastfed.…”

“…In the cycles of reported pertussis in the prevaccine era, rate increases occurred every 2–5 years [1, 4, 12–15]. This cyclic pattern continued to occur in the whole-cell pertussis vaccine era and is still occurring in the present acellular vaccine era in countries that switched to this vaccine.…”

“…During the last 110 years, many biologically active components of B. pertussis have been described [1, 3, 4, 11, 13]. Most of these antigens have been discovered in various mouse-model symptoms.…”

“…Illness due to Bordetella pertussis is significantly different clinically from illnesses caused by most other infectious agents [1–4]. Bordetella pertussis can cause severe disease and death but the illness is noninflammatory in nature, except when there is a concomitant or secondary bacterial or viral infection.…”

A Unusual Presentation of Bordetella pertussis

“…While unvaccinated children are affected with the most severe clinical manifestations of the infection, vaccinated children can still show characteristic symptoms. The clinical spectrum of B. pertussis infection ranges from a mild illness to severe illness leading to death [2].…”