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Pertussis is a real public health problem due to high neonatal morbidity rates and resurgence despite high vaccination coverage. The purpose of this study is to analyze the epidemiological profile of pertussis in infants hospitalized from 2012 to 2019. We conducted a retrospective, descriptive study over a 7-year and 8-month period from January 2012 to July 2019. It involved 500 infants admitted with clinical suspicion of pertussis. The average age of infants was 72 days, ranging from 28 days to 18 months; 75% of infants were less than 3 months old. The peak incidence was registered in 2012 and 2016, with a summer predominance (32%); 460 infants (92%) were not or incompletely vaccinated, 42.2% of whom were too young to be vaccinated. A probable contaminant in the entourage was found in 43,6% of cases. Whooping cough and cyanosis were the main reason for hospitalization (77.6%). Chest radiography objectified bronchial disease (25,4%) and alveolar foci (22.7%). Blood count performed in 410 infants showed hyperlymphocytosis in 67.5% of cases. Polymerase chain reaction (PCR) on nasopharyngeal sample collected from 206 infants was positive for Bordetella pertussis in 64% of cases; 118 PCR performed in mothers were positive in 47.7% of cases. All infants received Clarithromycin. Pertussis is a major cause of morbidity in infants in Casablanca. The prevention strategy is based on vaccination of family members of infants. However, vaccination of pregnant women appears to be more effective. [ABSTRACT FROM AUTHOR]

Whole-cell pertussis vaccine (wP) has been imperative and highly effective in preventing childhood deaths due to pertussis. Pertussis toxin is one of the virulence factors of Bordetella pertussis in all available pertussis vaccines. wP production in Razi Vaccine and Serum Research Institute is according to bioreactor culture of B. pertussis strains in B2 medium. The aim of this study was to evaluate B. pertussis strain 509 PT production in B2 and Thalen-IJssel (THIJS) media by Chinese Hamster Ovary (CHO) cell and enzyme-linked immunosorbent assay methods (ELISA). In the current study, B. pertussis strain 509 was cultured in B2 and THIJS media. Six samples were taken during the log growth phase within 2-3 h intervals (triplicate). The growth rate was calculated using opacity and the quantification of cell-associated and released PT measured by ELISA and CHO cell assays. THIJS medium was significantly showed an increase in the bacterial growth rate. During the first 29 h, bacterial concentrations in B2 and THIJS culture medium were 19 and 29 IOU, respectively. In THIJS medium, greater amount of pertussistoxin production was cell-associated. In B2 medium, maximum cell-associated toxin by ELISA and CHO cell assays were in the ODs of 1.1 and 0.9 and for THIJS medium in the ODs of 1.6 and 1.1, respectively. B. pertussis strain 509 in THIJS medium produced higher cell mass and cell-associated pertussis toxin than that of B2. It can be used for the production of whole-cell vaccine with higher pertussis toxin and accordingly using lower biomass per dose leading to the reduction of vaccine toxicity.

INTRODUCTION: On April 17/2017 Janamora district, Amhara regional state health officials reported an increasing number of people with a cough. Objectives: to investigate the outbreak, describe risk factors, and implement control measures. METHODS: We conducted a community based unmatched 1:1 case-control study April 22-May 10, 2017. We used a probable case definition (?2 weeks cough with vomiting, apnea, or inspiratory whoop) to identify suspected pertussis cases. Neighbors of cases were considered as controls. We conducted a door-to-door active case search and reviewed medical records, assessed vaccination status by parental interview or vaccination card. We implemented multivariable logistic regression to identify independent factors associated with the outbreak. RESULTS: We investigated 60 cases and 60 controls. Most (68.3%) of the cases were under the age of 15. The majority (86.6%) of pertussis suspected cases, and 83.4% controls had not received any pertussis vaccine. The overall attack rate was 0.13% and the case fatality rate was 3.3%. The age-specific attack rate for under-five children was 0.33%. Females were more likely to have pertussis (AOR: 2.91; 95% CI: 1.17-7.22), contact with pertussis suspected person (AOR: 6.29; 95% CI: 2.53-15.62) and living in a relatively poorly ventilated house (AOR: 3.01; 95% CI: 1.17-7.70) were also significant risk factors of pertussis. CONCLUSION: Weak supplementary immunization activities might have contributed to the outbreak. Treating household contacts and integration of diagnostic laboratory test of pertussis into the local health system is of paramount importance to detect outbreaks early on.

Abstract: Objectives: Pertussis surveillance in the French general population was stopped in 1986. Pertussis was added to the list of illnesses surveyed by the military epidemiological surveillance network ecause of outbreaks having occurred among French servicepersons and in military high schools. This study had for aim to report the results of the first year of surveillance. Design: Pertussis declaration criteria were those recommended in 2006 by the French council for public hygiene. The data concerning active military servicepersons was collected by physicians of all military medical units. An anonymous declaration form was used for data collection. Results: In 2007, 66 cases of pertussis were reported in the military forces, 10 of which were excluded after a negative biological test. The classification of the 56 included cases was: 46% biologically confirmed cases, 20% clinically confirmed cases, 14% suspected cases, and 6% epidemiologically confirmed cases. The incidence density rate was 16.3 cases for 100,000 servicepersons-years. Age under 20 was associated with a 4.6 fold higher risk to develop pertussis. Conclusions: The high incidence rate observed in individuals under 20 years of age could reflect a shift of pertussis reservoir to young adults, as observed in industrialized countries after generalization of vaccination programs. However, several years of surveillance will be needed to confirm this hypothesis. Meanwhile, the military epidemiological network could constitute an important surveillance marker of pertussis among adults in France. [Copyright &y& Elsevier]

Summary: Whooping cough (pertussis) is a contagious disease caused by Bordetella pertussis that can be prevented by vaccination. The disease is particularly severe in infants who are less than 3 months old, who are not protected against the disease and are often contaminated by their parents. Atypical presentations are frequent and neonatal pertussis is rare. We report a case of malignant whooping cough in a newborn infant probably contaminated by her mother. Diagnosis was suspected clinically because of persistent coughing fits and was confirmed by serology. Treatment was successful. We discuss the diagnostic, therapeutic, and preventive issues of whooping cough in developing countries. In Africa, where complementary investigations such as PCR are seldom accessible, a careful clinical study and the analysis of the absolute rate of lymphocytes could be an alternative for the diagnosis of whooping cough. Vaccination of teenagers and adults is also problematic in poor countries. High-performance new vaccine candidates may contribute to a better control of whooping cough. [Copyright &y& Elsevier]

Abstract: Objective: A questionnaire was used on 44 public and private hospital physicians in Paris to evaluate their knowledge of and adherence to Vaccination Guidelines, three years after their introduction. Results: Eighty per cent of the physicians answered and 92.5% were aware of the vaccination guidelines but only 2 out of 4 respected the targeted vaccination in young adults even when the vaccine was available. A policy of pertussis vaccination was applied only in 12 institutions, but even in these, the rate of vaccinated healthcare workers remained low or was not documented. Conclusion: Pertussis is a potential risk to newborns not or partially vaccinated in France. Even if the vaccine is available, adherence to pertussis vaccination guidelines must be improved. Efforts should be made to better publicize and apply pertussis vaccination guidelines. [Copyright &y& Elsevier]

Abstract: The origin of contamination in pertussis of young infants is generally the close relatives. From 2000 to 2004, only serology and culture were available in our hospital. The families of 16 young infants (age below one year) hospitalized for pertussis were screened using serological tests: 21/48 contacts were positive. After 2004, PCR was available for exploration of index cases and families: 35/85 contacts were positive. Of the mothers tested 23/46 were positive compared to 14/41 fathers. Only one parent presented with a typical paroxystic pertussis cough, 60% presented with a nonparoxystic cough having lasted for more than five days and 40% of positive adults did not present with cough. Despite official recommendations, none of these young parents had received an antipertussis booster vaccination. This study shows the high frequency of atypical or nonsymptomatic pertussis in adults in the close family of infected young infants. These adults contribute to spreading the disease. [Copyright &y& Elsevier]

Whooping-cough is one of the rare diseases for which vaccine prevention has been available for many years. However, in spite of good vaccine coverage in the infant, the pertussis infection remains a frequent disease in the teenagers and adults partially immunized. The missing diagnosis of the infection, added to its often clinical banal expression, contributes to support the circulation of Bordetella pertussis and explains the contamination of the young infants in whom the disease remains a true danger as the few declared deaths show it every year. Control of the disease must go through reinforcement of vaccination as a practitioner of booster vaccine in preadolescents, teenagers and adults. Instituted since 1998 in the French vaccine calendar, the 2nd booster in preadolescence between 11–13 years olds or 5th dose of vaccine is not enough carried out and must be encouraged like the installation of another additional vaccine dose for adults and certain professional categories. The protection of infants too young to have received the 3 doses goes through the vaccination of their entourage, family and socio-professional alike. The new recommendations thus preach to begin vaccination in children from the age of 2 months, a reinforcement of the vaccine boosters in preadolescents, in adults likely to become parents and in the medical and paramedical personnel in contact with very young infants. [Copyright &y& Elsevier]

Abstract: Universal vaccination of infants against pertussis has transformed the epidemiology of the disease. Pertussis has however become frequent, although not often diagnosed, in adolescents and adults and thus contributes to permanent transmission of Bordetella pertussis in France and contamination of young infants at risk of severe disease. Control of transmission of pertussis in France necessitates reinforcement of vaccination with late boosters in adolescents and adults and, in addition, education of physicians to recognize and treat early cases ofpertussis, especially in adolescents and adults with a persistant or chronic cough, and to take appropriate prophylactic measures (antibiotics and recall vaccination) of those in contact with confirmed cases. Effective treatment does little to reduce symptoms but it does reduce transmission. Macrolides are the recommended treatment for pertussis. [Copyright &y& Elsevier]

Abstract: Universal vaccination of infants against pertussis has transformed the epidemiology of the disease. Pertussis has however become frequent, although not often diagnosed, in adolescents and adults and thus contributes to permanent transmission of Bordetella pertussis in France and contamination of young infants at risk of severe disease. Control of transmission of pertussis in France necessitates reinforcement of vaccination with late boosters in adolescents and adults and, in addition, education of physicians to recognize and treat early cases of pertussis, especially in adolescents and adults with a persistant or chronic cough, and to take appropriate prophylactic measures (antibiotics and recall vaccination) of those in contact with confirmed cases. Effective treatment does little to reduce symptoms but it does reduce transmission. Macrolides are the recommended treatment for pertussis. [Copyright &y& Elsevier]

Abstract: The evolution of the epidemiology of pertussis, new licensed macrolides and vaccines, new recommendations for vaccination among adolescents and adults need an update of the French guidelines for prevention of the disease around one or grouped cases of the disease. A particular attention should be raised to the diagnosis of whooping cough in adults who are presently the main reservoir of Bordetella pertussis. Whooping cough in adults presents as an unexplained prolonged cough with nocturnal exacerbation witch accounts for most of the contaminations of young infants. A bacteriological confirmation of pertussis should be provided before implementation of preventive measures: culture and PCR are presently the gold standard for the diagnosis of pertussis in infants, children and even adults who have been coughing for less than 20 days. Later on, serology (Elisa, immuno-empreinte) is the only technique available, but cannot be interpreted if the patient has been vaccinated less than one year ago. Infants under three months should be admitted to hospital and every case submitted to respiratory isolation. Eviction from the community should be pronounced within the five first days following the onset of an effective antibiotic treatment. New macrolides should be favoured: clarithromycine for seven days or azithromycine for five days. Household contacts should be given the same prophylactic antibiotic treatment: children and adolescent not correctly immunized, parents of the index case as adults parents of not or not completely immunized infants. The vaccination program of the household should be updated. The same measures should be applied in case of grouped cases (at least two contemporary or consecutive cases in the same area). In that case, the Public Health System doctors should be involved in the investigation and the classification of the cases. The close contacts not or not completely immunized should be prescribed and antibiotic prophylaxis and an update of their vaccination program. Among the occasional contacts, high-risk people only should be treated. In the day care centres an antibioprophylaxis should be given to children who have received less than four vaccine shots against pertussis and to the personnel contact to the cases as well. In the schools, the antibiotic prophylaxis should be prescribed to all children of the classroom(s) not completely vaccinated and to the teacher(s) as well. In the boarding schools and institutions with handicapped children, antibiotic prophylaxis could be applied to every member if the pertussis vaccine coverage is at less than 50%. In hospitals, coughing personnel should wear masks and investigations towards pertussis should be performed in people with a more than seven day unexplained cough. Preventive measures should be applied in case of confirmation of pertussis. [Copyright &y& Elsevier]

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Whooping cough is a respiratory infection particularly severe for infants. The agents of the disease are the bacteria Bordetella pertussis and B. parapertussis. Before vaccination, the disease affected majority of the children. Due to the high circulation of the bacteria, adolescents and adults were regularly in contact with the bacteria and had natural boosters. Forty years after generalized vaccination in some countries, a change in the transmission of the disease is observed. Children between 2 and 5–10 years of age are not infected (depending of the vaccine used and the vaccine calendar) because they were vaccinated in their infancy. However, adolescents and adults are becoming susceptible because they do not receive any vaccinal or natural boosters. They can be infected and contaminated infants are too young to be vaccinated. Clinical symptoms in adolescents and adults, previously vaccinated or infected, are very variable and for this reason biological diagnosis are now necessary to confirm the infection. These diagnostics are culture, PCR and serology. [Copyright &y& Elsevier]

Objectives. – The resurgence of whooping cough observed in France convinced us to develop a specific PCR assay to detect B. pertussis in nasopharyngeal secretions in parallel of the culture. The aim of our study was to show the value of the PCR in routine diagnosis.Material and methods. – From November 1996 to August 2000, in two hospitals located in the Yvelines (France), the children consulting for a cough compatible with the diagnosis of whooping cough were included in this study. A questionnaire including clinical, biological and radiological items was completed for each one of these patients. A culture of Bordetella and a detection by PCR of B. pertussis were carried out on each nasopharyngeal aspirate. The diagnosis of whooping cough was retained if the detection was positive in PCR and/or culture.Results. – Among the 215 investigated children with suspected cases of whooping cough, the diagnosis was positive for 45 (20.9%), of which 39 were less than one year old (median: three months). Sixteen (35.5,%) were positive at the same time for both the PCR and the culture, 26 (57.8%) for only PCR and three (6.7%) for only culture. The PCR was positive in 93.3% of the cases. The results were obtained with an average time of 48 hours. The culture was positive in 61.2% of the cases with an average time of six days. The monthly distribution of the cases of whooping cough was very inhomogeneous and of epidemic appearance. The majority of the cases was located between two periods: 42% between November 1996 and September 1997 and 40% between November 1999 and August 2000. Among the infected children, 15 were less than two months old and were not yet vaccinated ; among the 24 others infants, a delay in the vaccine calendar was noted in 50% of the cases. Four children between six and 14 years old were correctly vaccinated. The evolution was favourable in all the children.Conclusion. – The PCR due to its sensitivity, its specificity and its rapidity offers to the clinician a powerful tool for the diagnosis of whooping cough. Nevertheless, the culture must be associated with the PCR, in order to follow the epidemiology and the sensitivity to antibiotics of B. pertussis. [Copyright &y& Elsevier]

Analytical chemistry and clinical chemistry have come closer together over the past thirty years and increasingly profit from each other. Advances in elucidating the human genome and the genomes of viruses and microorganisms have made it possible to track down a disease to the level of the nucleic acids and the genetic code, and to identify a disease on the molecular level. Examples are given of the diagnosis of a complex of inherited diseases, the porphyrias, on a molecular basis and of the identification of a virus infection referred to as Bordetella Pertussis. In addition, the trend to on-site analysis, which can provide immediate information about the state of a patient, is contrasted with high-throughput analysis in central laboratory units. The second contribution deals with the logistics of point-of-care testing (POCT) and its technological prerequisites in Sweden.In clinical chemistry, novel technologies are not primarily rated according to their originality but rather according to logistic considerations. These include economic factors, the time-elapse to information, the ease of quality assessment and the consequences of a positive result, i.e. of a result which exceeds the decision limit separating sick patients from the population of healthy individuals. During the past 30 years, since 1968, the technical equipment used in clinical chemistry has been revolutionized and it has become much more widespread. Currently major advances are being made in Point-of-Care Testing (POCT) and Home Care Testing where Laboratory Information Technology (LIMS) and global exchanges via the Ethernet and Internet have become important links in the information chain. Automation has been driven forward so that it is now possible to automate the separation steps, the sample pretreatment and sample distribution steps at high throughput. When performing special analyses where the analytical procedure cannot be implemented using high-throughput instruments, it has been beneficial to apply advances in analytical chemistry to clinical chemistry. Such advances include analytical techniques such as mass spectrometry, gas chromatography, and HPLC. In some special domains where analytical technologies are applied to provide specific information based on, for example, the separation and identification of peptides and proteins via, for instance, two-dimensional electrophoresis, blotting techniques or PCR-relied analyses, clinical chemistry is even more advanced than analytical chemistry. However, in clinical chemistry, using an analytical technique is only justified if a positive result can lead to a useful medical treatment and to an improvement in the state of health of the patient.At the same time, the work that aims to describe the entire human genome by the year 2003 [1] has stimulated, and continues to stimulate, practices and techniques that allow gains in information to be tracked down to the source of a disease. It has also become possible in some cases to predict the probability of being affected by an 'illness', which is based on a genetic predisposition, before symptoms break out. This means that prevention can be more effective, so that people liable to be affected by a hereditary disease can be trained to adjust their everyday behavior and to try to prevent the illness. In microbiology, it is now possible with PCR and electrophoresis to identify microorganisms in a timeframe of single days instead of the days and weeks needed to cultivate microorganisms.In the following, the authors provide insights into the organization of point-of-care testing (POCT) and describe some specific techniques which should solve some problems currently facing clinical chemistry.

Objective: Since July 2006, it has been recommended to give a booster of a pertussis vaccine to women just after delivery, if they have received their last dose more than 10 years before. The aim of this study was to evaluate the pertussis vaccine coverage in a cohort of women just after delivery. Patients and methods: All patients (n =31) hospitalized in the postpartum unit on the 15th of September 2006 were included in the study. They were given a questionnaire and medical records available in the department were reviewed. Results: The vaccination coverage was not indicated in any medical records. Only six patients claimed they knew their pertussis vaccination status (less than five years: two patients, between five and 10 years: two patients, more than 10 years: two patients). Two patients had their vaccination booklet. The pertussis vaccine coverage is probably very low. Discussion and conclusion: The information about pertussis vaccine status in postpartum women is not available currently because it is not recorded by medical teams and is unknown by patients themselves. An effort in educating obstetricians and corrective actions are necessary if we want the recent vaccine schedule to be followed. [Copyright &y& Elsevier]