Research ArticleEpidemiology

The impact of past vaccination coverage and immunity on pertussis resurgence

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Science Translational Medicine  28 Mar 2018:
Vol. 10, Issue 434, eaaj1748
DOI: 10.1126/scitranslmed.aaj1748

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  • RE: Improved diagnosis and better awareness can explain as well the reported resurgence of pertussis

    We read with interest the eLetter by H. Turki. We agree that the diagnosis of pertussis is a key topic that has major implications to interpret incidence data over long time periods. As we reported in our article (Ref. [1], Table S1), several changes in pertussis diagnosis indeed occurred in Massachusetts during the past decades. Chief among these was the introduction, in 1987, of serological testing in individuals aged >11 years, which led to an immediate and substantial increase in the number of reported cases in this demographic [2]. Another important change was the introduction of PCR testing in 2005. As we reported, however, this new diagnostic method did not appear to have an immediate impact, with no noticeable increase in the number of reports in 2005 (Ref.[1], Figure S5). These considerations motivated our choice to restrict the analysis to data during 1990–2005, a period of stable surveillance in Massachusetts. Importantly, our models also took into account the differences of diagnosis between age groups. Specifically, we estimated an increased reporting fidelity of pertussis in adolescents and adults (Ref. [1], Tables S6–S7), a result consistent with the high sensitivity of serological testing. Hence, the claim that these “[. . . ] other factors were not reported by the authors [. . . ]” is ill-founded.

    We argue that a purely observation-based explanation of pertussis resurgence in the US is implausible. Although this hypothesis has enjoyed some popula...

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    Competing Interests: None declared.
  • Improved diagnosis and better awareness can explain as well the reported resurgence of pertussis
    • Houcemeddine Turki, Undergraduate researcher, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia

    I have recently read with attention the work of de Cellès et al. published in Science Translational Medicine and trying to explain the reasons of the resurgence of pertussis through the analysis of the data of past incidence, vaccination coverage, and immunity of pertussis in Massachusetts, United States (de Cellès, Magpantay, King, & Rohani, 2018) as well as its summary published in Science (Charneski, 2018). I must recognize that the work succeeded to confirm that waning vaccine-conferred immunity is behind the resurgence of the disease (de Cellès, Magpantay, King, & Rohani, 2018). However, this factor should not be considered as the only one that explains the resurgence of pertussis. Effectively, there are other factors that were not reported by the authors and that are also responsible for this phenomenon.

    On the one hand, the innovative use of ELISA serology during the 1980s and the 1990s and of PCR since the 2000s for the diagnosis of pertussis (Berbers, de Greeff, & Mooi, 2009; He & Mertsola, 2008) caused a progressive improvement of the wide spread (Cherry, Epidemic pertussis in 2012—the resurgence of a vaccine-preventable disease, 2012) and of the sensitivity, specificity and speed (He & Mertsola, 2008; Tozzi, Celentano, degli Atti, & Salmaso, 2005; Ewanowich, Chui, Paranchych, Peppler, Marusyk, & Albritton, 1993) of the diagnosis of pertussis over years. This led to a gradually ameliorated detection of new cases of the disease t...

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    Competing Interests: None declared.

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