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Whooping Cough is Back. Here’s the Global Collaboration to Fight It.

In the last two decades, the world has seen a large resurgence of Pertussis, or whooping cough, making it a leading cause of death due to infectious disease for children under a year old and among the top causes of vaccine-preventable deaths. In the newly published book, Pertussis: Epidemiology, Immunology, and Evolution, co-editor and Northeastern Marine and Environmental Sciences and Physics Professor Samuel V. Scarpino and his colleagues explore pertussis and the disputed reasons behind the disease’s growing prevalence.

“There hasn’t been anything like this published about Pertussis in 30 years. The field has moved far in that time – we weren’t sequencing the pertussis bacteria and we’ve continued to see resurgence of the disease,” said Scarpino. “Because it is a huge cause of morbidity and mortality, globally and in the US, we also wanted to raise awareness around what is a largely underappreciated impact of Pertussis.”

There’s no scientific consensus on Whooping Cough’s big comeback, but researchers suspect evolved bacterial resistance, as well as social factors such as the anti-vaccine movement.

Pertussis is a respiratory disease caused by the bacterium Bordetella pertussis. There are several vaccine variations used around the globe for different age groups to prevent infection. It is a serious cause for global concern, with increasing cases every year despite widespread vaccine coverage.

In countries like the US, UK, Australia, and Japan, huge rises in pertussis have been seen across the last two decades. Although there is no scientific consensus for the resurgence, several possible mechanisms have been recognized, including the anti-vaccine movement, the deterioration of herd immunity, and evolved bacterial resistance.

“The controversy is not so much whether or not there is evidence for the different proposed explanations for pertussis resurgence, because there is for all of them,” said Scarpino. “Rather, the disagreement centers on what is the relative importance of these mechanisms – in different countries, different time periods and age groups? Do we need a new vaccine? What is the role of the anti-vaccine movement? What is the role of evolution in bacteria?”

Scarpino’s study of pertussis began as a post doc at the Santa Fe Institute in 2015. Along with principal researcher at the Institute for Disease Modeling, Ben Althouse, he wrote a paper on the potential role of asymptomatic transmission in pertussis resurgence following a study in baboons. The research showed that the currently used acellular vaccine protected against the symptomatic disease, but wouldn’t prevent bacteria from colonizing in asymptomatic baboons and passing to other naïve baboons.

As the best non-human animal model for pertussis, Scarpino and Althouse looked to apply these results to humans. They concluded that asymptomatic transmission in humans was responsible for the resurgence in pertussis in the US and the UK, despite much controversy with other experts in the field.

These scientific disagreements led to a large workshop at the Santa Fe Institute for experts from all over the world in pertussis – from microbiologists, to public health officials, mathematical modelers, and clinicians – to come together and synthesize the competing ideas around Pertussis resurgence. As a result of the meeting, Pertussis: Epidemiology, Immunology, and Evolution was written as a collaboration amongst about 50 scientific experts to deepen understanding around all of the different implications of pertussis.

Co-edited by Scarpino and University of Georgia Department of Infectious Diseases Professor Pejman Rohani, each chapter is co-authored by meeting attendees, bringing together different fields and opinions on pertussis.  This book is for an advanced audience with exposure to topics like immunology and population biology, for those interested in learning more about pertussis and working in the field of future pertussis research.

Scarpino and his colleagues hope to answer many open questions surrounding pertussis, as well as encourage the next generation of young researchers to study pertussis and its global impacts. By opening up this conversation on pertussis, Scarpino also hopes it will advocate for more international collaboration for sharing epidemiological data, pertussis genome sequencing, and specific vaccine information across countries.

Scarpino is hopeful that this book will have an impact on the field of pertussis and other contentious research areas. “It’s pretty special to convene a group of researchers who disagree with each other and have a productive conversation around evidence for or against different hypotheses,” he said. “And then to produce a book that has opinions from people who actively disagree with each other – as we all might imagine, the world could use more productive conversation and meaningful disagreement instead of just bluster.”

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