Resurgence of Pertussis and Its Laboratory Diagnosis

Prevention of whooping cough by vaccination has been one of the outstanding successes in modern medical history. However, despite the great efforts made to improve vaccine safety and efficacy, as well as campaigns for immunization, there has been a worldwide resurgence of pertussis since the early 1990s. These outbreaks occur independently of the vaccine coverage rates or economic standards of the affected region. The Morbidity and Mortality Weekly Report (MMWR) of the U.S. Centers for Disease Control and Prevention (CDC) has documented statewide outbreaks, such as "Pertussis Outbreak-Vermont, 1996," "Notes from the Field: Pertussis-California, 2010," "Pertussis Epidemic-Washington, 2012," and, most recently, "Pertussis Epidemic-California, 2014." This review summarizes the pathogenesis of a strict human pathogen, Bordetella pertussis; CDC guidelines for clinical diagnosis, rapid molecular tests, and the test design principles supporting clinical diagnostics; and the importance of culture and submission of isolates to the local public health laboratory. Finally, we discuss the evolution of a host niche-specialized pathogen and the implications of a vaccination that does not attain complete host immunity.