The pertussis enigma: reconciling epidemiology, immunology and evolution
The pertussis enigma: reconciling epidemiology, immunology and evolution
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DOI：
10.1098/rspb.2015.2309
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发表时间：
2016-01-13
影响因子：
4.7
通讯作者：
Rohani, Pejman
中科院分区：
文献类型：
--
作者：
de Celles, Matthieu Domenech;Magpantay, Felicia M. G.;Rohani, Pejman
百日咳是一种高度传染性的呼吸道感染，尽管疫苗已有70年的历史，但它仍然是公共卫生的重点问题。百日咳仍然是发展中国家死亡的主要原因，在一些疫苗接种覆盖率高的发达国家重新出现。在这些国家，百日咳死灰复燃通常归因于对该病的认识提高、疫苗保护不完善或成人感染率高。在这篇综述中，我们首先介绍了1980-2012年来自63个国家的发病率数据，并表明百日咳死灰复燃并不普遍。我们进一步认为，趋势的巨大地理差异可能排除了一个简单的解释，例如从全细胞到非细胞百日咳疫苗的转变。回顾现有证据，我们提出百日咳流行病学的主流观点与历史和当代数据不一致。事实上，我们总结了流行病学证据，表明自然感染和疫苗接种似乎都能提供长期保护，防止传播和疾病，因此，以前感染或接种疫苗的成年人对人口水平的总体传播贡献很小。最后，我们确定了几个有希望的途径，可能导致全球百日咳流行病学的一致解释和更有效的控制策略。
Pertussis, a highly contagious respiratory infection, remains a public health priority despite the availability of vaccines for 70 years. Still a leading cause of mortality in developing countries, pertussis has re-emerged in several developed countries with high vaccination coverage. Resurgence of pertussis in these countries has routinely been attributed to increased awareness of the disease, imperfect vaccinal protection or high infection rates in adults. In this review, we first present 1980-2012 incidence data from 63 countries and show that pertussis resurgence is not universal. We further argue that the large geographical variation in trends probably precludes a simple explanation, such as the transition from whole-cell to acellular pertussis vaccines. Reviewing available evidence, we then propose that prevailing views on pertussis epidemiology are inconsistent with both historical and contemporary data. Indeed, we summarize epidemiological evidence showing that natural infection and vaccination both appear to provide long-term protection against transmission and disease, so that previously infected or vaccinated adults contribute little to overall transmission at a population level. Finally, we identify several promising avenues that may lead to a consistent explanation of global pertussis epidemiology and to more effective control strategies.