Commentary: resolving pertussis resurgence and vaccine immunity using mathematical transmission models

The epidemiology of pertussis—a vaccine-preventable respiratory infection typically caused by the bacterium Bordetella pertussis—remains puzzling. Indeed, the disease seems nowhere close to eradication and has even re-emerged in certain countries—such as the US—that have maintained high vaccination coverage. Because the dynamics of pertussis are shaped by past vaccination and natural infection rates, with the relevant timescale spanning decades, the interpretation of such unexpected trends is not straightforward. In this commentary, we propose that mathematical transmission models play an essential role in helping to interpret the data and in closing knowledge gaps in pertussis epidemiology. We submit that recent advances in statistical inference methods now allow us to estimate key parameters, such as the nature and duration of vaccinal immunity, which have to date been difficult to quantify. We illustrate these points with the results of a recent study based on data from Massachusetts (Domenech de Cellès, Magpantay, King, and Rohani, Sci. Transl. Med. 2018;10: eaaj1748. doi:10.1126/scitranslmed.aaj1748), in which we used such methods to elucidate the mechanisms underlying the ongoing resurgence of pertussis. In addition, we list a number of safety checks that can be used to critically assess mathematical models. Finally, we discuss the remaining uncertainties surrounding pertussis vaccines, in particular the acellular vaccines used for teenage booster immunizations.