af76b2070470d0d36d3c64bea03c87a0 pmc_11511359.pdf 6e07088a57e1a90e09deeb3f985aad3dd1d084a2 pmc_11511359.pdf f1b27a624955c6e8c1ebc8d4d1e3bb35db14fa1f77e2d2659f8946468eeca0a3 pmc_11511359.pdf Title: Pertussis Outbreak During 2023 in Gipuzkoa, North Spain Subject: Background: Pertussis has re-emerged in many countries despite the wide use of vaccines for over 60 years. During 2023, we observed an increase in the incidence of pertussis in Gipuzkoa, north of Spain (with a population of 657,140 inhabitants), mainly affecting children between 11 and 15 years of age. Methods: This study included all confirmed cases diagnosed by PCR in nasopharyngeal swab samples. The genome of seven isolates collected in 2023 was sequenced. Results: Between 2018 and 2023, 884 cases of whooping cough were diagnosed. Pertussis incidence (in cases per 100,000 inhabitants) decreased from 36.7 in 2018 to no cases in 2021, increasing again to 56.8 in 2023. In 2023, the age group of 11–15 years old had the highest incidence rate of 409.3. Only 2 of the 56 children < 6 years old required hospitalization, and there were no deaths. The seven isolates collected in 2023 showed the same BPagST-4 (ptxA1/ptxP3/prn2/fim2-1/fim3-1 allelic combination), with all of them expressing the pertactin antigen. Conclusions: Immunity waning after the last dose of vaccination at 6 years old, together with the lack of circulation of Bordetella pertussis during the COVID-19 pandemic, were probably the main reasons for the high increase in the incidence of pertussis in Gipuzkoa in 2023. Keywords: Bordetella pertussis; vaccination; outbreak Author: José María Marimón, Milagrosa Montes, Nahikari Vizuete, Lorea Alvarez Guerrico, Adrian Hugo Aginagalde, Alba Mir-Cros, Juan José González-López and Diego Vicente Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Fri Oct 18 15:18:08 2024 CEST ModDate: Fri Oct 18 16:00:17 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 830034 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 VDSPUK+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 PZEFHC+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 UKOYIY+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 HBLXEW+VnURWPalladioL Type 1 Custom yes yes yes 32 0 AHSHLD+CMSY10 Type 1 Builtin yes yes yes 65 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 70 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-08 02:53:19 CET RepresentationInformation: pmc_11511359.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-02-06 02:51:54 CET Size: 830034 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 233 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Material and Methods Destination: section.2 Children: Item: Title: Case Definition Destination: subsection.2.1 Item: Title: Sampling Destination: subsection.2.2 Item: Title: Vaccination Status Destination: subsection.2.3 Item: Title: Microbiological Test Destination: subsection.2.4 Item: Title: Antigen Production Destination: subsection.2.5 Item: Title: Whole Genome Sequencing Destination: subsection.2.6 Item: Title: Ethics Destination: subsection.2.7 Item: Title: Results Destination: section.3 Children: Item: Title: Epidemiology Destination: subsection.3.1 Item: Title: Erythromycin Resistance Destination: subsection.3.2 Item: Title: Vaccination Status of Cases Destination: subsection.3.3 Item: Title: Vaccine Antigen Expression and WGS Analysis Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Pertussis Outbreak During 2023 in Gipuzkoa, North Spain Author: José María Marimón, Milagrosa Montes, Nahikari Vizuete, Lorea Alvarez Guerrico, Adrian Hugo Aginagalde, Alba Mir-Cros, Juan José González-López and Diego Vicente Subject: Background: Pertussis has re-emerged in many countries despite the wide use of vaccines for over 60 years. During 2023, we observed an increase in the incidence of pertussis in Gipuzkoa, north of Spain (with a population of 657,140 inhabitants), mainly affecting children between 11 and 15 years of age. Methods: This study included all confirmed cases diagnosed by PCR in nasopharyngeal swab samples. The genome of seven isolates collected in 2023 was sequenced. Results: Between 2018 and 2023, 884 cases of whooping cough were diagnosed. Pertussis incidence (in cases per 100,000 inhabitants) decreased from 36.7 in 2018 to no cases in 2021, increasing again to 56.8 in 2023. In 2023, the age group of 11 15 years old had the highest incidence rate of 409.3. Only 2 of the 56 children < 6 years old required hospitalization, and there were no deaths. The seven isolates collected in 2023 showed the same BPagST-4 (ptxA1/ptxP3/prn2/fim2-1/fim3-1 allelic combination), with all of them expressing the pertactin antigen. Conclusions: Immunity waning after the last dose of vaccination at 6 years old, together with the lack of circulation of Bordetella pertussis during the COVID-19 pandemic, were probably the main reasons for the high increase in the incidence of pertussis in Gipuzkoa in 2023. 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