Gülşen ERSÖZ, Özlem TEZOL, Asuman AKAR, Semra ERDOĞAN, Gönül ASLAN, Necdet KUYUCU

Determination of Bordetella pertussis Seroprevalence and Colonization in Adolescents

Objective: Pertussis is a contagious respiratory disease caused by Bordetella pertussis (B. pertussis) which can affect all age groups. We aimed to identify B. pertussis infection and determine age-specific antibody levels and provide epidemiologic data for national immunization strategies. Material and Method: Children aged 10-18 years with cough were examined for B. pertussis PCR (polymerase chain reaction), nasopharyngeal specimen culture, serum B.pertussis IgG by ELISA (enzyme-linked immunosorbent assay). Results: Of 429 subjects, mean age was 13,04 ± 2,16 years; 229 (53,4%) were male, 200 (46,6%) were female. Cough duration’ median was 4 days (minimum 1 day and maximum 90 days). Of 405 (94%) fully vaccinated children, we accepted 27% of subjects were applied five, 67% were applied four doses of B.pertussis. Since fifth dose of B.pertussis is applied in school age, we accepted all subjects in appropriate age had five doses with hesitation. Subjects were negative for the culture. Three subjects (0,69%) were positive with B. pertussis PCR. Forty three subjects (10%) were positive for B. pertussis IgG. There was a linear correlation between age and B.pertussis IgG absorbance value (r =0,112; p =0,020). Cough duration was significantly longer in B. pertussis IgG positive group compared to those negative (p =0,012). The highest seropositivity was in 13-15 ages. Conclusion: To decrease the frequency of pertussis infection, to prevent pertussis infection transmisson to infants via adolescents; we recommend sustaining infanthood vaccinations and applying a booster dose at 10-13 years of age in addition to the fifth dose.

Adolesanlarda Bordetella pertussis Seroprevalansının ve Kolonizasyonunun Belirlenmesi

Amaç: Boğmaca, Bordetella pertussis (B. pertussis’ in etken olduğu her yaştan kişileri etkileyebilen bulaşıcı bir solunum sistemi hastalığıdır. Çalışmamızda B. pertussis infeksiyonu olan adolesanları tanımlamayı, yaşa özgü antikor düzeylerini saptamayı ve ulusal aşı stratejileri için epidemiyolojik veri sağlamayı hedefledik. Gereç ve Yöntem: Öksürük yakınması olan 10-18 yaş arası çocukların nazofarengeal sürüntü örneklerinde B. pertussis PCR (polimeraz zincir reaksiyonu) ve kültürü, serumlarında B. pertussis IgG çalışıldı. Bulgular: Çalışmadaki 429 adolesanın 229’u (%53,4) erkek, 200’ü (%46,6) kızdı, yaş ortalaması 13,04 ± 2,16 yıldı. Öksürük süresi median 4 gün (minimum 1 gün ve maksimum 90 gün) olarak saptandı. Katılımcıların 405’i (%94) boğmaca için tam aşılı olarak saptandı. Boğmaca aşısının 2010 yılında başlatılan beşinci dozu okul çağında uygulandığı için uygun yaştakilerin tümüne beş doz aşı uygulandığının kab ulü hususunda çekincemiz olmakla beraber boğmaca aşılı hastaların %27’si 5; %67,4’ü 4 doz B.pertussis aşısı uygulanmış olarak kabul edildi. Kültürde üreme olmadı, 3 adolesanda B. pertussis PCR pozitif, 43 adolesanda B. pertussis IgG pozitif saptandı. B. pertussis IgG absorbans değeri ile yaş arasında doğrusal korelasyon saptandı (r =0,112; p =0,020). B. pertussis IgG pozitif olan grupta, öksürük süresi antikor negatif olan gruba göre daha yüksek bulundu ( p =0,012). Seropozitiflik 13-15 yaş grubunda en yüksekti. Sonuç: Ülkemizde boğmaca enfeksiyon sıklığını azaltmak, adölesanlar aracılığıyla boğmaca enfeksiyonunun bebeklere geçişini önlemek amacıyla yaşamın ilk iki yılındaki aşılara devam edilmesi, ilkokul birinci sınıfta yapılan beşinci doza ek olarak 10-13 yaş grubuna boğmaca aşısının pekiştirme dozunun yapılmasının uygun olacağı kanısındayız.

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1. Ebell MH, Marchello C, Callahan M. Clinical diagnosis of bordetella pertussis ınfection: A systematic review. J Am Board Fam Med 2017; 30: 308-19.

2. World Health Organisation Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2015; 35: 433-60.

3. Kuchar E, Karlikowska-Skwarnik M, Han S, Nitsch-Osuch A. Pertussis: History of the disease and current prevention failure. Adv Exp Med Biol 2016; 934: 77-82.

4. Bouchez V, Guiso N. Bordetella pertussis, B. parapertussis, vaccines and cycles of whooping cough. Path Dis 2015;73, pii: ftv055. doi: 10.1093/femspd/ftv055.

5. Lee SY, Han SB, Bae EY, et al. Pertussis seroprevalence in Korean adolescents and adults using anti- pertussis toxin immunoglobulin G. J Korean Med Sci 2014; 29: 652-56.

6. Karagul A, Ogunc D, Midilli K, et al. Epidemiology of pertussis in adolescents and adults in Turkey. Epidemiol Infect 2015; 143: 2613-18.

7. Centers for Disease Control and Prevention Pertussis (Whooping cough). 2014; https://www.cdc.gov/pertussis/about/index.html

8. Tan T, Dalby T, Forsyth K, et al. Pertussis across the globe: recent epidemiologic trends from 2000 to 2013. Pediatr Infect Dis J 2015; 34: 222-32.

9. Trainor EA, Nicholson TL, Merkel TJ. Bordetella pertussis transmission. Pathog Dis 2015; 73: ftv068. doi: 10.1093/femspd/ftv068.

10. Meade BD, Plotkin SA, Locht, C. Possible options for new pertussis vaccine. J Infect Dis 2014; 209 (Suppl 1): S24-7.

11. Guiso N, Berbers G, Fry NK, He Q, Riffelmann M, Wirsing von König CH; EU Pertstrain group. What to do and what not to do in serological diagnosis of pertussis: recommendations from EU reference laboratories. Eur J Clin Microbiol Infect Dis 2011; 30: 307-12.

12. Plotkin SA. The pertussis problem. Clin Infect Dis 2013; 58: 830-3.

13. Lee SY, Han SB, Kang JH, Kim JS. Pertussis prevalence in Korean adolescents and adults with persistent cough. J Korean Med Sci 2015; 30: 988- 90.

14. Long SS, Edwards KM, Mertsola J. Bordetella pertussis (Pertussis) and other Bordetella species. In: Long, S.S. (Ed). Principles and Practice of Pediatric Infectious Diseases, 2012, 4th Edition. Saunders, Philadelphia.

15. Cornia P, Lipsky BA. Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis. 2015; https://www.uptodate.com.

16. Guiso N, Levy C, Romain O, et al. Whooping cough surveillance in France in pediatric private practice in 2006-2015. Vaccine 2017; 35: 6083-8.

17. Kurugol Z. Pertussis Epidemiology in Turkey: Are booster doses necessary? J Pediatr Inf 2009; 3: 14- 18.

18. Kafes FD, Aslan G, Yarpuzlu M, Kuyucu N, Emekdaş G. Determination of Bordetella pertussis seroprevalence in young adults and adolescent. J Pediatr Inf 2013; 7: 136-42.

19. Cevik M, Beyazova U, Aral AL, et al. Seroprevalence of IgG antibodies against Bordetella pertussis in healthy individuals aged 4-24 years in Turkey. Clin Microbiol Infect 2018; 14: 388-90.

20. Ozkan S, Aksakal FN, Tuzun H, et al. Bordetella pertussis seroprevalence among vaccinated school children in Ankara, Turkey. Infection 2007; 35: 387-9.

21. Zepp F, Heininger U, Mertsola J, et al. Rationale for pertussis booster vaccination throughout life in Europe. Lancet Infect Dis 2011; 11: 557-70.

22. Sigera S, Perera J, Rasarathinam J, Samaranayake D, Ediriweera D. Seroprevalence of Bordetella pertussis specific Immunoglobulin G antibody levels among asymptomatic individuals aged 4 to 24 years: a descriptive cross sectional study from Sri Lanka. BMC Infect Dis 2016; 16: 729-37.

23. McGirr A, Fisman D. Duration of pertussis immunity after DTaP immunization: A meta-analysis. Pediatrics 2015; 135: 1-15.

24. Okada K, Ueda K, Morokuma K, et al. Seroepidemiologic study on pertussis, diphtheria, and tetanus in the Fukuoka area of southern Japan: seroprevalence among persons 0-80 years old and vaccination program. Jpn J Infect Dis 2004; 57: 67-71.

25. Centers for Disease Control and Prevention Pertussis. Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine and guidance for use as a booster dose. MMWR Morb Mortal Wkly Rep 2015; 64; 948-9.

26. Kurugol Z. Pertussis vaccine and problems. ANKEM Derg 2011;25: 212-7.

27. Forsyth K, Plotkin S, Tan T,von König CW. Strategies to decrease pertussis transmission to infants. Pediatrics 2015; 135:1475-82.

28. Mooi FR, Van Der Maas NA, De Melker HE. Pertussis resurgence: waning immunity and pathogen adaptation - two sides of the same coin. Epidemiol Infect 2014; 142: 685-94.