• ptxP3
• ptxA1
• prn2
• pregnant women
• Pertussis
• strains
• vaccine

Pertussis or whooping cough is a bacterial disease that consists in severe infection of the respiratory tract mainly caused by Bordetella pertussis. The disease is especially dangerous for young infants and spreads easily from person to person, mainly through droplets produced by coughing or sneezing.
For a long time pertussis has been one of the most common childhood disease worldwide, but the introduction of infant whole-cell vaccination in 1950s led to a steep decline in the number of pertussis cases and deaths in children. Due to the presumption that the whole cell vaccine was not completely safe, from the 1980s many countries started to replace it with the acellular vaccine (APV).
Despite the fact that the vaccination schedule has little differences beteween countries, either in the timing of administraction of the vaccine or in the type of vaccine used, all the developed countries have high childhood primary immunization rates. Because of that, the resurgence of disease observed from the beginning of 1990s was unexpected.
As shown in Palazzo et al. studies, the pertussis cases are increasing also in Italy and changes to circulating B. pertussis strains seem to be one of the suggested causes. Indeed, the genome of the current circulating bacteria differ from the isolated used in the manufacture of vaccine component and in particular, has been shown that modification occurred in ptx and in prn, which elicit protective immunity and are two of the used components of the APV. The first aim of this thesis is to investigate on the strain circulating in Italy, in particular in Apulia.
Nowadays pertussis is one of the most prevalent vaccine-preventable diseases in Western countries and it is a very dangerous disease for infants, especially for those who are too young to be vaccinated. The persistent epidemic upsurges of pertussis and the potentially increased risk for infants in 2015 have led the Dutch Minister of Health, Welfare and Sport to request advice from the Health Council to answer some questions including: “Are additional measures useful and necessary in order to protect young infants?”
In order to answer the Minister’s questions the Health Council joined forces with the National Health Care Institute and together agreed on the fact that the current strategy is insufficient to protect the category at risk. From the published scientific literature, they identified the vaccination of expectant mothers during pregnancy as a cost-effective strategy for improving the infant protection against pertussis. The Health Council suggested that the understanding of the determinant factors that influence the acceptance of this intervention is fundamental in order to determine how education and public communication should be carried out in order to implement this strategy.
The second aim is to understand how to obtain as high as possible acceptance level of pertussis vaccine in pregnant women. In order to do that I have conducted a literature review, collected questionnaires from international experts and interviewed Dutch experts from the health care sector.