Original report| Volume 3, ISSUE 3, P140-146, March 1999

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Parapertussis and pertussis: Differences and similarities in incidence, clinical course, and antibody responses

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      Objectives: To compare the incidence, clinical course, and serologic response to Bordetella antigens in patients with parapertussis and pertussis.
      Design: Two studies were performed in Sweden during the 1990s, when pertussis vaccines were used only in clinical trials. Study I was a retrospective study of patients with positive Bordetella cultures obtained in clinical routine, and study II involved an active search for patients with Bordetella infections during a placebo-controlled trial of a pertussis toxoid vaccine.
      Results: Study I includes 58, and study 11 23 patients with parapertussis. In study I, the incidence of parapertussis was 0.016 cases per 100 person years in children 0 to 6 years old and 0 in older children and adults. In study II, the incidence rates of parapertussis and pertussis were 0.2 and 16.2 per 100 person years, respectively, in children followed from 3 months to 3 years of age. The median number of days with cough was 21 in parapertussis and 59 in pertussis. The proportions of children with whooping and vomiting were lower in parapertussis than in pertussis. Geometric mean serum filamentous hemagglutinin IgG increased from 6 to 63, and pertactin IgG from 4 to 12 units/mL in parapertussis patients, which was similar to increases in children with pertussis.
      Conclusions: Disease caused by Bordetella parapertussis is diagnosed less commonly and is milder and of shorter duration than disease caused by Bordetella pertussis. Parapertussis induced serum IgG against filamentous hemagglutinin and pertactin of similar magnitude as does pertussis, and did not induce serum IgG against pertussis toxin.



        • Lautrop H.
        Epidemics of parapertussis. 20 years'observation in Denmark.
        Lancet. 1971; i: 1195-1198
        • Heininger U.
        • Stehr K.
        • Schmitt-Grohe S.
        • et al.
        Clinical characteristics of illness caused by Bordetella parapertussis compared with illness caused by Bordetella pertussis.
        Pediatr Infect Dis J. 1994; 13: 306-309
        • Mastrantonio P.
        • Stefanelli P.
        • Giuliano M.
        • et al.
        Bordetella parapertussis infection in children: epidemiology, clinical symptoms, and molecular characteristics of isolates.
        J Clin Microbiol. 1998; 36: 992-1002
        • Wirsing v König C.H.
        • König C.H.
        Role of pertussis toxin in causing symptoms of Bordetella parapertussis infection.
        Eur J Clin Microbiol Infect Dis. 1994; 13: 455-458
        • Novotny P.
        Pathogenesis in Bordetella species.
        J Infect Dis. 1990; 161: 581-582
        • Arico B.
        • Rappuoli R.
        Bordetella parapertussis and Bordetella bronchiseptica contain transcriptionally silent pertussis toxin genes.
        J Bacteriol. 1987; 169: 2847-2853
        • Khelef N.
        • Danve B.
        • Quentin-Millet M.T.
        • Guiso N.
        Bordetella pertussis and Bordetella parapertussis: two immunologically distinct species.
        Infect Immun. 1993; 61: 486-490
        • He Q.
        • Edelman K.
        • Arvilommi H.
        • Mertsola J.
        Protective role of immunoglobulin G antibodies to filamentous hemagglutinin and pertactin of Bordetella pertussis in Bordetella parapertussis infection.
        Eur J Clin Microbiol Infect Dis. 1996; 15: 793-798
        • Isacson J.
        • Trollfors B.
        • Hedvall G.
        • Taranger J.
        • Zackrisson G.
        Response and decline of serum IgG antibodies to pertussis toxin, filamentous hemagglutinin, and pertactin in children with pertussis.
        Scand J Infect Dis. 1995; 27: 273-277
        • Stehr K.
        • Cherry J.D.
        • Heininger U.
        • et al.
        A comparative efficacy trial in Germany in infants who received either the Lederle/Takeda acellular pertussis component DTP (DTAP) vaccine, the Lederle whole-cell component DTP vaccine, or DT vaccine.
        Pediatrics. 1998; 101: 1-11
        • Isacson J.
        • Trollfors B.
        • Taranger J.
        • Zackrisson G.
        • Lagergård T.
        How common is whooping cough in a nonvaccinating country?.
        Pediatr Infect Dis J. 1993; 12: 284-288
        • Trollfors B.
        • Taranger J.
        • Lagergard T.
        • et al.
        A placebo-controlled trial of a pertussis toxoid vaccine.
        N Engl J Med. 1995; 333: 1045-1050
        • Taranger J.
        • Trollfors B.
        • Lagergård T.
        • et al.
        Unchanged efficacy of a pertussis toxoid vaccine throughout the two years after the third vaccination of infants.
        Pediatr Infect Dis J. 1997; 16: 180-184
      1. WHO Meeting on Case Definitions of Pertussis, Geneva, Switzerland, January 10–11, 1991 World Health Organization, Geneva1991 (Issue No. MIM/EPI/PERT/91.1.)
        • Regan J.
        • Lowe E.
        Enrichment medium for the isolation of Bordetella.
        J Clin Microbiol. 1977; 6: 303-309
        • Houard S.
        • Hackel C.
        • Herzog A.
        • Bollen A.
        Specific identification of Bordetella pertussis by the polymerase chain reaction.
        Res Microbiol. 1989; 140: 477-487
        • van der Zee A.
        • Agterberg C.
        • van Agterveld M.
        • Peeters M.
        • Mooi F.R.
        Characterization of IS1001, an insertion sequence element of Bordetella parapertussis.
        J Bacteriol. 1993; 175: 141-147
        • Reizenstein E.
        • Hallander H.-O.
        • Blackwelder W.C.
        • Kühn I.
        • Ljungman M.
        • Möllby R.
        Comparison of five calculation modes for antibody ELISA procedures using pertussis serology as a model.
        J Immunol Methods. 1995; 183: 279-290
        • Gustafsson L.
        • Hallander H.O.
        • Olin P.
        • Reizenstein E.
        • Storsater J.
        A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine.
        N Engl J Med. 1996; 334: 349-355
        • Kwantes W.
        • Joynson D.H.M.
        • Williams W.O.
        Bordetella pertussis isolation in general practice: 1977–1979 whooping cough epidemic in West Glamorgan.
        J Hygiene. 1993; 90: 149-158
        • Greco D.
        • Salmaso S.
        • Mastrantonio P.
        • et al.
        A controlled trial of two acellular and one whole-cell vaccine against pertussis.
        N Engl J Med. 1996; 334: 341-348
        • He Q.
        • Viljanen M.K.
        • Arvllommi H.
        • Aittanen B.
        • Mertsola J.
        Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population.
        JAMA. 1998; 280: 635-637
        • Kawai H.
        • Aoyama T/
        • Murase Y.
        • Tamura C.
        • Imaizumi A.
        A causal relationship between Bordetella pertussis and Bordetella parapertussis infections.
        Scand J Infect Dis. 1996; 28: 377-381
        • Mertsola J.
        Mixed outbreak of Bordetella pertussis and Bordetella parapertussis infection in Finland.
        Eur J Clin Microbiol. 1985; 4: 123-128
        • Taranger J.
        • Trollfors B.
        • Lagergård T.
        • Zackrisson G.
        Parapertussis infection followed by pertussis infection.
        Lancet. 1994; 344: 1703