Contrasting ecological and evolutionary signatures of whooping cough epidemiological dynamics
The enigmatic global pattern of whooping cough incidence presents a unique set of challenges for controlling the disease and uncovering the mechanisms underlying its epidemiological dynamics. In countries experiencing an increase in cases, five hypotheses have been proposed to explain the resurgence: (1) there has been an increase in Bordetella pertussis reporting rates, (2) waning of protective immunity from vaccination or natural infection over time, (3) evolution of B. pertussis to escape protective immunity, (4) vaccines that fail to induce sterilizing (mucosal) immunity to B. pertussis, and (5) asymptomatic transmission from individuals vaccinated with the currently used acellular B. pertussis vaccines. Each of these five hypotheses can leave contrasting signatures in both epidemiological and genomic data; however, these hypotheses must also be evaluated against data from locations that are either not experiencing a resurgence or are witnessing a declining incidence. This chapter discusses how to—and whether it is possible to—disentangle the various mechanisms proposed for whooping cough’s resurgence. It identifies a pathological lack of data sufficient for testing hypotheses and demonstrates how detailed, high-resolution data (in geography, time, and age) are required to distinguish even the most basic models. The chapter further discusses how approaches linking genomic and epidemiological data, (i.e. phylodynamic models) may prove beneficial. The results suggest that while evidence exists for each of the five proposed hypotheses, it is unlikely that any single mechanism can account for the global pattern of whooping cough incidence and that determining the relative importance of each mechanism remains uniquely challenging.