The authors thank Dr. Carlo Giannelli for his critical reading of the manuscript. “
“Many countries experience increasing incidences of pertussis in spite of a high vaccine coverage [1]. The reasons for this increase are multifactorial as improved diagnostics, increased awareness, demographic changes, genetic adaptation of the causative bacteria Bordetella

pertussis and vaccine failure, all may contribute [1] and [2]. The resurgence seems to coincide with the shift from the use of whole cell (wP) to acellular pertussis (aP) vaccines [3] although many clinical studies CB-839 of aP and wP vaccines indicate that both types of vaccines induce comparable immunity [4] and [5]. However, studies comparing aP and wP vaccination that depend on immunogenicity data and non-inferiority criteria of antibody levels measured against the aP vaccine antigens rather than efficacy studies, must be interpreted

with care as such studies may favour the aP vaccines. More recent studies suggest that the duration of protection following DTaP immunisation in the first year of life is lower than with DTwP [1], [6], [7] and [8]. Norway has been one of the countries with the highest number of reported pertussis cases in Europe, in spite of approximately 95% vaccination coverage. The incidence has been particularly high in the age groups 5–19 years. From 1998, a DTaP vaccine containing three-component pertussis antigens has been implemented in a three dose regimen at 3, 5 and 12 months in the first year of life instead of the DTwP vaccine. In 2006 a two-component pertussis

DTaP booster to children at the age of 7–8 years was implemented BAY 73-4506 in the Childhood Immunisation Program. Sodium butyrate This resulted in a drop in the incidence of pertussis particularly within the immunised group. However, previous studies indicate that the decay of antibodies against pertussis antigens both after primary and booster immunisation is rapid [9], [10], [11] and [12]. High anti-pertussis toxin (PT) IgG levels in the absence of recent vaccination may be used as a diagnostic test for recent or active pertussis [13]. The use of serology with detection of high levels of anti-PT IgG may thus be a valuable tool for the diagnosis of pertussis even though polymerase chain reaction (PCR) now becomes more widespread in use and about 60% of recorded cases in Norway in 2012 were based on PCR. On the other hand, vaccination against pertussis in different age groups may complicate interpretation of serological diagnosis, particularly if the vaccine induced antibody levels are high. It is recommended not to use serology for diagnosis within the first 2 years after pertussis immunisation [14]. We have performed a cross-sectional study to measure the antibody immune response against pertussis in 498 children aged 6–12 years who were scheduled to receive a DTaP booster vaccine at the age of 7–8 years.