Adaptation of Bordetella pertussis to vaccination: A cause for its reemergence?

In the Netherlands, as in many other western countries, pertussis vaccines have been used extensively for more than 40 years. Therefore, it is conceiv able that vaccine-induced immunity has affected the evolution of Bordetella pertussis. Consistent with this notion, pertussis has reemerged in the Net herlands, despite high vaccination coverage. Further, a notable change in t he population structure of B. pertussis was observed in the Netherlands sub sequent to the introduction of vaccination in the 1950s. Finally, we observ ed antigenic divergence between clinical isolates and vaccine strains, in p articular with respect to the surface-associated proteins pertactin and per tussis toxin. Adaptation may have allowed B. pertussis to remain endemic de spite widespread vaccination and may have contributed to the reemergence of pertussis in the Netherlands.