Seroprevalence of Pertussis Antibodies and Infection Risk Among Female
Medical Students

Malay      Jhancy; Grisilda   Vidya   Bernhardt; Sureshkumar      Srinivasamurthy; Wardah   Mohammad   Akram; Aysha   Simran   Haris

Abstract

Objectives: Pertussis seroprotection among neonates depends on maternal antibodies before receiving their first childhood acellular pertussis (DTaP) vaccination. Therefore, childbearing women need to have adequate seroprotection, either before conception or during the antenatal period, to protect their neonates from contracting neonatal pertussis. Given the global rise in neonatal pertussis incidence, there is a need to address the importance of protection against this infection by promoting booster vaccinations among female medical students as a preventive measure for their future generation. This paper addresses a part of our study on the seroprevalence of anti-PT IgG antibodies in female medical students who are more prone to acquire infections from the patients during their clinical rotations.

Methods: A cross-sectional study was conducted for three months by recruiting female medical students of RAK Medical and Health Sciences University, Ras Al Khaimah, UAE. The antibody levels (IgG) of pertussis (anti-PT) in blood sera of the study population were quantitated by enzyme-linked immunoassay. A 60 – 125 IU/mL titer was considered the positive titer level (p-value <0.05 being statistically significant).

Results: Among 90 ethnically different student participants (mean age of 21 years), forty-four percent (n=40) showed detectable titers of anti-PT IgG antibodies. Whereas fourteen percent of participants (n=13) had high positive titers above 125U/mL, four percent (n=3) showed positive titers ranging from 60-125IU/mL. Two percent (n=2) were in borderline with 55 - <60IU/mL and twenty three percent (n=21) were < 55IU/mL titres. The mean ± SD of IgG titers was 42 ± 74.93 IU/mL with a range of 0-267 IU/mL.

Conclusion: Only forty-four percent had detectable titers of anti-PT IgG antibodies, among whom fourteen percent (n=13) had high positive titers indicating recent infection. The results signify a low level of seroprotection among female medical students that emphasizes the need to promote booster vaccination for the high-risk group who work in the health profession.

Keywords: Seroprevalence, Pertussis seroprotection, Neonate, DTP, Immunization, Antibodies. Article

[1]
Melvin JA, Scheller EV, Miller JF, Cotter PA. Bordetella pertussis pathogenesis: Current and future challenges. Nat Rev Microbiol  2014; 12(4): 274-88.
 [http://dx.doi.org/10.1038/nrmicro3235] [PMID: 24608338]

[2]
Greenberg DP, von König CHW, Heininger U. Health burden of pertussis in infants and children. Pediatr Infect Dis J  2005; 24(5) (Suppl.): S39-43.
 [http://dx.doi.org/10.1097/01.inf.0000160911.65632.e1] [PMID: 15876922]

[3]
Pertussis vaccines: WHO position paper - September 2015. Wkly Epidemiol Rec  2015; 90(35): 433-58.
 [PMID: 26320265]

[4]
CDC. Coronavirus Disease 2019 (COVID-19) Centres for Disease Control and Prevention 2020.https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html

[5]
Wood N, McIntyre P. Pertussis: Review of epidemiology, diagnosis, management and prevention. Paediatr Respir Rev  2008; 9(3): 201-12.
 [http://dx.doi.org/10.1016/j.prrv.2008.05.010] [PMID: 18694712]

[6]
Baxter R, Bartlett J, Fireman B, Lewis E, Klein NP. Effectiveness of vaccination during pregnancy to prevent infant pertussis. Pediatrics  2017; 139(5)e20164091
 [http://dx.doi.org/10.1542/peds.2016-4091] [PMID: 28557752]

[7]
Nooitgedagt JE, de Greeff SC, Elvers BH, et al. Seroprevalence of Bordetella pertussis infection during pregnancy measured by IgG antibodies against pertussis toxin. Clin Infect Dis  2009; 49(7): 1086-9.
 [http://dx.doi.org/10.1086/605575] [PMID: 19725791]

[8]
Storsaeter J, Hallander HO, Gustafsson L, Olin P. Low levels of antipertussis antibodies plus lack of history of pertussis correlate with susceptibility after household exposure to Bordetella pertussis. Vaccine  2003; 21(25-26): 3542-9.
 [http://dx.doi.org/10.1016/S0264-410X(03)00407-9] [PMID: 12922081]

[9]
Van Rie A, Wendelboe AM, Englund JA. Role of maternal pertussis antibodies in infants. Pediatr Infect Dis J  2005; 24(5) (Suppl.): S62-5.
 [http://dx.doi.org/10.1097/01.inf.0000160915.93979.8f] [PMID: 15876928]

[10]
Healy CM, Rench MA, Baker CJ. Implementation of cocooning against pertussis in a high-risk population. Clin Infect Dis  2011; 52(2): 157-62.
 [http://dx.doi.org/10.1093/cid/ciq001] [PMID: 21288837]

[11]
Crowe JE. CHAPTER 38 - Prevention of Fetal and Early Life Infections Through Maternal–Neonatal Immunization. In: Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA, eds. Infectious Diseases of the Fetus and Newborn (Seventh Edition)  2011; 1212-30.
 [http://dx.doi.org/10.1016/B978-1-4160-6400-8.00038-9]

[12]
Black S. Epidemiology of pertussis. Pediatr Infect Dis J  1997; 16(4) (Suppl.): S85-9.
 [http://dx.doi.org/10.1097/00006454-199704001-00003] [PMID: 9109162]

[13]
Hashemi SH, Ranjbar M, Hajilooi M, Seif-Rabiei MA, Bolandi M, Moghimi J. Seroprevalence of Immunoglobulin G antibodies against pertussis toxin among asymptomatic medical students in the west of Iran: A cross sectional study. BMC Infect Dis  2009; 9(1): 58.
 [http://dx.doi.org/10.1186/1471-2334-9-58] [PMID: 19426546]

[14]
Arav-Boger R, Ashkenazi S, Gdalevich M, Cohen D, Danon YL. Seroprevalence of pertussis antibodies among adolescents in Israel. Isr Med Assoc J  2000; 2(2): 174-7.
 [PMID: 10804947]

[15]
Mink CM, Cherry JD, Christenson P, et al. A search for Bordetella pertussis infection in university students. Clin Infect Dis  1992; 14(2): 464-71.
 [http://dx.doi.org/10.1093/clinids/14.2.464] [PMID: 1554832]

[16]
Narchi H, Osman W, George JA, Almekhaini LA, Souid AK, Alsuwaidi AR. Pertussis seronegativity in pregnant women in the city of Al Ain, United Arab Emirates. Int J Infect Dis  2019; 89: 96-101.
 [http://dx.doi.org/10.1016/j.ijid.2019.08.031] [PMID: 31493522]

[17]
Hashemi SH, Zamani M, Mamani M, Javedanpoor R, Rahighi AH, Nadi E. Seroprevalence of Bordetella pertussis antibody in pregnant women in Iran. J Res Health Sci  2014; 14(2): 128-31.
 [PMID: 24728747]

[18]
Wendelboe AM, Van Rie A, Salmaso S, Englund JA. Duration of immunity against pertussis after natural infection or vaccination. Pediatr Infect Dis J  2005; 24(5) (Suppl.): S58-61.
 [http://dx.doi.org/10.1097/01.inf.0000160914.59160.41] [PMID: 15876927]

[19]
Mazzilli S, Tavoschi L, Lopalco PL. Tdap vaccination during pregnancy to protect newborns from pertussis infection. Ann Ig  2018; 30(4): 346-63.
 [http://dx.doi.org/10.7416/ai.2018.2226] [PMID: 29895052]

[20]
Sedighi I, Sadrosadat T. Comment on: Seroprevalence of Bordetella pertussis Antibody in Pregnant Women in Iran. J Resn Health Sci  2014; 14(3): 236-7.

[21]
Wang CQ, Zhu QR. Seroprevalence of Bordetella pertussis antibody in children and adolescents in China. Pediatr Infect Dis J  2011; 30(7): 593-6.
 [http://dx.doi.org/10.1097/INF.0b013e31820eaf88] [PMID: 21422963]

[22]
Rendi-Wagner P, Tobias J, Moerman L, et al. The seroepidemiology of Bordetella pertussis in Israel—Estimate of incidence of infection. Vaccine  2010; 28(19): 3285-90.
 [http://dx.doi.org/10.1016/j.vaccine.2010.02.104] [PMID: 20226250]

[23]
Zhang Q, Zheng H, Liu M, et al. The seroepidemiology of Immunoglobulin G antibodies against pertussis toxin in China: A cross sectional study. BMC Infect Dis  2012; 12(1): 138.
 [http://dx.doi.org/10.1186/1471-2334-12-138] [PMID: 22892100]

[24]
Wanlapakorn N, Ngaovithunvong V, Thongmee T, Vichaiwattana P, Vongpunsawad S, Poovorawan Y. Seroprevalence of Antibodies to Pertussis Toxin among Different Age Groups in Thailand after 37 Years of Universal Whole-Cell Pertussis Vaccination. PLoS One  2016; 11(2): e0148338.
 [http://dx.doi.org/10.1371/journal.pone.0148338] [PMID: 26837004]

[25]
Liang JL, Tiwari T, Moro P, et al. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep  2018; 67(2): 1-44.
 [http://dx.doi.org/10.15585/mmwr.rr6702a1] [PMID: 29702631]

[26]
Zhang L, Prietsch SOM, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Libr 2014; (9): CD001478
 [http://dx.doi.org/10.1002/14651858.CD001478.pub6] [PMID: 25228233]

[27]
Eberhardt CS, Blanchard-Rohner G, Lemaître B, et al. Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis. Clin Infect Dis  2016; 62(7): 829-36.
 [http://dx.doi.org/10.1093/cid/ciw027] [PMID: 26797213]

[28]
Swamy GK, Wheeler SM. Neonatal pertussis, cocooning and maternal immunization. Expert Rev Vaccines  2014; 13(9): 1107-14.
 [http://dx.doi.org/10.1586/14760584.2014.944509] [PMID: 25075629]