Epidemiologic and laboratory features of a large outbreak of pertussis-like illnesses associated with cocirculating Bordetella holmesii and Bordetella pertussis--Ohio, 2010-2011 - PubMed (original) (raw)

doi: 10.1093/cid/cis888. Epub 2012 Oct 19.

Stacey W Martin, Amanda Cohn, Jeremy Budd, Mario Marcon, Andrew Terranella, Sema Mandal, Douglas Salamon, Amy Leber, Maria-Lucia Tondella, Kathleen Tatti, Kevin Spicer, Allen Emanuel, Elizabeth Koch, Londell McGlone, Lucia Pawloski, Mysheika Lemaile-Williams, Naomi Tucker, Radhika Iyer, Thomas A Clark, Mary Diorio

Affiliations

• PMID: 23087388
• DOI: 10.1093/cid/cis888

Epidemiologic and laboratory features of a large outbreak of pertussis-like illnesses associated with cocirculating Bordetella holmesii and Bordetella pertussis--Ohio, 2010-2011

Loren Rodgers et al. Clin Infect Dis. 2013 Feb.

Abstract

Background: During 9 May 2010-7 May 2011, an outbreak of pertussis-like illness (incidence, 80 cases per 100 000 persons) occurred in Franklin County, Ohio. The majority of cases were identified by IS481-directed polymerase chain reaction (PCR), which does not differentiate among Bordetella species. We sought to determine outbreak etiology and epidemiologic characteristics.

Methods: We obtained demographic, clinical, and vaccination-related data from the Ohio Disease Reporting System and Impact Statewide Immunization Information System. We tested sera from 14 patients for anti-pertussis toxin (PT) antibodies and used species-specific PCR on 298 nasopharyngeal specimens.

Results: Reported cases totaled 918. IS481 results were available for 10 serologically tested patients; 5 of 10 had discordant anti-PT antibody and IS481 results, suggestive of Bordetella holmesii, which lacks PT and harbors IS481. We identified specific Bordetella species in 164 of 298 specimens tested with multitarget PCR; B. holmesii and Bordetella pertussis were exclusively detected among 48 (29%) and 112 (68%), respectively; both were detected in 4 (2%). Among 48 patients with B. holmesii infections, 63% were aged 11-18 years, compared with 35% of 112 patients with B. pertussis infections (P = .001). Symptoms were similar among B. holmesii- and B. pertussis-infected patients. Adolescent pertussis ("Tdap") booster vaccinations were more effective against B. pertussis than B. holmesii (effectiveness: 67% and 36%, respectively; 95% confidence intervals, 38%-82% and -33% to 69%, respectively).

Conclusions: We report the first documented mixed outbreak of B. pertussis and B. holmesii infections. Bordetella holmesii particularly affected adolescents. Although laboratory capacity limitations might inhibit routine use of multitarget PCR for clinical diagnosis, focused testing and enhanced surveillance might improve understanding the burden of B. holmesii infection.

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Comment in

• The "how" of polymerase chain reaction testing for Bordetella pertussis depends on the "why".
  McIntyre PB, Sintchenko V. McIntyre PB, et al. Clin Infect Dis. 2013 Feb;56(3):332-4. doi: 10.1093/cid/cis897. Epub 2012 Oct 19. Clin Infect Dis. 2013. PMID: 23087394 No abstract available.

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