Bordetella pertussis Infection in Infants and Young Children in Shanghai, China, 2016-2017: Clinical Features, Genotype Variations of Antigenic Genes and Macrolides Resistance
Bordetella pertussis Infection in Infants and Young Children in Shanghai, China, 2016-2017: Clinical Features, Genotype Variations of Antigenic Genes and Macrolides Resistance
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DOI：
10.1097/inf.0000000000002160
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发表时间：
2019-04-01
影响因子：
3.6
通讯作者：
Zeng, Mei
中科院分区：
文献类型：
--
作者：
Fu, Pan;Wang, Chuanqing;Zeng, Mei
背景：全球百日咳在疫苗接种覆盖率高的国家死灰复燃一直是公共卫生关注的问题。方法：收集疑似百日咳患儿鼻咽拭子进行百日咳杆菌培养。通过电子病历和免疫记录对临床和疫苗接种信息进行审查。采用e -试验评价红霉素、阿奇霉素、克拉霉素和磺胺甲恶唑/甲氧苄啶的药敏。采用聚合酶链反应扩增和测序方法，鉴定百日咳杆菌MLST基因型和7个抗原基因（ptxP、ptxA、ptxC、Prn、fim3、fim2和tcfA）。结果：2016年1月至2017年9月，共有141名1-48月龄儿童被培养确认为百日咳，其中98名（69.5%）小于6个月，25名（17.7%）已完成至少3剂DTaP， 75名（53.2%）明确暴露于持续咳嗽的家庭成员。充分接种疫苗的病例比未接种疫苗和未充分接种疫苗的病例表现出较轻的疾病。所有菌株均为MLST2。ptxP3/prn2/ptxC2高毒力菌株占41.1%(58/141)，均对大环内酯类药物敏感；ptxP1/prn1/ptxC1低毒力菌株分别占58.9%（83/141）和97.6%(81/83)，对大环内酯类药物高度耐药。结论：上海市婴幼儿百日咳再起，家庭传播是主要暴露途径。携带ptxP3/prn2/ptxC2的高毒力菌株和耐大环内酯的百日咳杆菌菌株相当普遍。这些问题引起了上海的公共卫生关注。我们的研究结果对修改中国百日咳百日咳疫苗接种策略和管理指南具有重要意义。
Background: The global resurgence of pertussis in countries with high vaccination coverage has been a concern of public health.Methods: Nasopharyngeal swabs were collected for Bordetella pertussis culture from children with suspected pertussis. Clinical and vaccination information were reviewed through electronic medical chart and immunization record. Antibiotics susceptibility was evaluated using E-test for erythromycin, azithromycin, clarithromycin and sulfamethoxazole/trimethoprim. The MLST genotypes and 7 antigenic genes (ptxP, ptxA, ptxC, Prn, fim3, fim2 and tcfA) of Bordetella pertussis were identified by polymerase chain reaction amplification and sequencing.Results: During January 2016 to September 2017, a total of 141 children 1-48 months of age were culture-confirmed with pertussis, of whom 98 (69.5%) were younger than 6 months, 25 (17.7%) had completed at least 3 doses of DTaP and 75 (53.2%) had a clear exposure to household members with persistent cough. Fully vaccinated cases manifested milder disease than unvaccinated and not-fully vaccinated cases. All strains were MLST2. High-virulent strains characteristic of ptxP3/prn2/ptxC2 constituted 41.1% (58/141) and were all susceptible to macrolides while low-virulent strains characteristic of ptxP1/prn1/ptxC1 constituted 58.9% (83/141) and 97.6% (81/83), respectively, were highly resistant to macrolides.Conclusions: Pertussis is resurging among infants and young children in Shanghai, and household transmission is the main exposure pathway. The high-virulent strains harboring ptxP3/prn2/ptxC2 and the macrolide-resistant Bordetella pertussis strains are quite prevalent. These issues impose a public health concern in Shanghai. Our findings are important to modify the DTaP vaccination strategy and the management guideline of pertussis in China.