Bordetella pertussis Strains with Increased Toxin Production Associated with Pertussis Resurgence
Frits R. Mooi , Inge H.M. van Loo, Marjolein van Gent, Qiushui He, Marieke J. Bart, Kees J. Heuvelman, Sabine C. de Greeff, Dimitri Diavatopoulos, Peter Teunis, Nico Nagelkerke, and Jussi Mertsola
Author affiliations: National Institute for Public Health and the Environment, Bilthoven, the Netherlands (F.R. Mooi, M. van Gent, M.J. Bart, K.J. Heuvelman, S.C. de Greeff, D. Diavatopoulos, P. Teunis); Maastricht University Hospital, Maastricht, the Netherlands (I.H.M. van Loo); National Public Health Institute, Turku, Finland (Q. He); United Arab Emirates University, Al Ain, United Arab Emirates (N. Nagelkerke); University of Turku, Turku (J. Mertsola)
Figure 2. Relationship between the emergence of pertussis toxin promoter 3 (ptxP3) strains and the epidemiology of pertussis in the Netherlands, 1989–2004. A) Temporal trends in the frequencies of ptxP3 strains and notifications. In this period 99% of the strains harbored either ptxP1 or ptxP3. B) Shift in age-specific distribution of notifications.
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