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Clinical and epidemiological picture of B pertussis and B parapertussis infections after introduction of acellular pertussis vaccines
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  1. J G Liese,
  2. C Renner,
  3. S Stojanov,
  4. B H Belohradsky,
  5. The Munich Vaccine Study Group
  1. University Childrens Hospital Munich, Ludwig-Maximilians-Universität, Lindwurmstr. 4, 80337 Munich, Germany
  1. Correspondence to:
    Dr J Liese, Universitäts-Kinderklinik im Dr. v. Haunerschen Kinderspital, Ludwig-Maximilians-Universität, Lindwurmstr. 4, 80337 Munich, Germany;
    Johannes.Liese{at}kk-i.med.uni-muenchen.de

Abstract

Aims: To investigate the clinical picture and frequency of Bordetella pertussis and B parapertussis infections after introduction of acellular pertussis (acP) vaccines in Germany.

Methods: Prospective surveillance for B pertussis and B parapertussis in 14 144 toddlers. Pertussis vaccination coverage was 86%, either with acP (75%) or whole cell pertussis (wcP) vaccine (11%). All children presenting with cough for more than seven days were examined for B pertussis and B parapertussis by culture, PCR, and serology (for cough duration ≥21 days).

Results: There were 180 Bordetella infections; 116 (64%) were caused by B pertussis and 64 (36%) by B parapertussis. Incidence rates were 4.8 and 2.8 per 1000 person-years, respectively. Paroxysmal cough, post-tussive whooping, and vomiting ≥21 days was found in 53%, 22%, and 8% of all B pertussis cases and in 22%, 5%, and 0% of all B parapertussis cases, respectively. A total of 81/116 (70%) B pertussis cases and 56/64 (87.5%) B parapertussis cases had received at least one dose of pertussis vaccine. Typical pertussis with paroxysmal cough ≥21 days was present in 29/35 (83%) unvaccinated B pertussis cases, in contrast to 33/81 (41%) vaccinated B pertussis cases.

Conclusion: Following the increase of pertussis vaccination coverage, we observed a relative increase of B parapertussis cases in comparison to B pertussis cases. In vaccinated children B pertussis disease frequently presented as a mild disease, clinically difficult to distinguish from diseases associated with coughing caused by B parapertussis and other viral or bacterial infections.

  • B pertussis
  • B parapertussis
  • epidemiology
  • incidence
  • pertussis vaccine

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