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Pediatrics

Severe Macrolide-Resistant Bordetella pertussis Infections in Japanese Infants Highlight Public Health Concerns

Strategic Insights

— 1 min read

Severe cases of macrolide-resistant Bordetella pertussis (MRBP) infection in two unvaccinated infants in Okinawa, Japan, have raised public health concerns and highlighted the need for enhanced surveillance and prevention. The infants, who tested positive via LAMP and failed initial macrolide therapy, required intensive care, including mechanical ventilation and a switch to trimethoprim-sulfamethoxazole. Whole-genome sequencing identified ptxP3-positive MRBP strains with high virulence potential, and phylogenetic analysis showed relatedness to the MT28-ptxP3 lineage from China.

Key Takeaways:

  • Severe MRBP cases in Japanese infants are a new concern, with the first reported cases requiring intensive care.
  • The ptxP3 allele-carrying MRBP strains involved in these cases have high virulence potential and are related to the MT28-ptxP3 lineage from China.
  • Whole-genome sequencing identified 8-11 SNP differences among strains, suggesting independent introductions and possible prolonged circulation in Okinawa.
  • The cases highlight the need for enhanced surveillance and prevention efforts, as the MRBP strains involved have a high potential for causing severe illness.
  • The report provides evidence of the importance of monitoring and controlling MRBP infections, particularly in regions with a high potential for circulation, such as Okinawa.
  • The research suggests that the use of trimethoprim-sulfamethoxazole as a treatment may be effective against MRBP infections.
  • The cases also emphasize the need for vaccination efforts to prevent MRBP infections and their severe complications.

Statistics:

  • 2 unvaccinated infants required intensive care due to severe MRBP infections.
  • The ptxP3 allele-carrying MRBP stains involved in these cases had a high virulence potential.
  • 8-11 SNP differences were found among the strains, suggesting independent introductions.
  • The MT28-ptxP3 lineage from China was related to the strains involved in the Japanese cases.

Sources:

  • International Journal of Infectious Diseases, Severe macrolide-resistant Bordetella pertussis (ptxP3) infection in Japanese Infants: first report of cases requiring intensive care. International Journal of Infectious Diseases, 2025:107960.
  • Seisho Nakamura, Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Centre & Children's Medical Centre, Okinawa, Japan.

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