Immunological insights into why pertussis continues to be endemic.

Publication date: Dec 01, 2026

Pertussis (whooping cough) is a vaccine-preventable bacterial disease caused by Bordetella pertussis. Despite widespread vaccination, cases have increased globally since the 1990s, with notable outbreaks in 2012, 2016, and following the COVID-19 pandemic. Persistent endemicity and periodic epidemics are driven by limited prevention of nasal colonization, waning immunity after vaccination or natural infection, and pathogen adaptation. Differences between acellular (aP) and whole-cell (wP) vaccines reflect distinct immune profiles, with aP vaccines favoring Th2 responses and wP vaccines inducing Th1/Th17 responses and tissue-resident memory T cells. Circulating strains have evolved under vaccine pressure, including shifts in ptxP, ptxA and prn alleles, increasing pertussis toxin production, emergence of pertactin-deficient variants, and rising macrolide resistance linked to 23S rRNA mutations. Optimizing current vaccine strategies and developing next-generation vaccines that improve durable, Th1/Th17-polarized immunity and reduce transmission are essential for enhanced pertussis control.

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Concepts Keywords
1990s acellular
Pandemic antigenic variation
Vaccines booster
Whooping Bordetella pertussis
Endemic Diseases
Humans
immunity
Pertussis
Pertussis Vaccine
Pertussis Vaccine
strain evolution
Th1 Cells
Th17 Cells
Th2 Cells
vaccines
Vaccines, Acellular
Vaccines, Acellular
whole-cell
Whooping Cough

Semantics

Type Source Name
disease MESH pertussis
pathway KEGG Pertussis
disease MESH bacterial disease
disease MESH COVID-19 pandemic
disease MESH infection
disease MESH strains
drug DRUGBANK Bordetella pertussis pertactin antigen
drug DRUGBANK Coenzyme M
disease MESH FHA
pathway REACTOME Reproduction
disease MESH included
disease MESH MSD
disease MESH Polio
disease MESH diphtheria
disease MESH hepatitis
disease MESH tetanus
disease MESH vaccine preventable disease
drug DRUGBANK Nitric Oxide
pathway REACTOME Apoptosis
pathway REACTOME Adaptive Immune System
disease MESH chronic infection
disease MESH re infection
disease MESH death
disease MESH asymptomatic infection

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