Preventable Childhood Diseases Research Articles

Implementation science: Changing practice in oral health.

Caries remain the most common preventable chronic childhood disease. One state oral health program including fluoride varnish showed a decrease in presence of decay and improvement in overall oral health; however, early childhood caries did not improve. Implementation of an oral health preventive program during well-child medical visits may address this gap.

Evaluating the Relationship between Parental Dental Anxiety and Early Childhood Caries

Background Early Childhood Caries (ECC) is considered as the most prevalent childhood disease. Numerous factors have been mentioned for the formation of ECC. This study evaluated the relationship of parental dental anxiety and ECC in Iranian Children. Materials and Methods In this cross-sectional study, 340 parent-child dyads were divided into two groups: the first group consisted of 170 parents and their 3-6-year-old child with ECC (the case group), and the second group consisted of 170 parents and their 3-6-year-old child without ECC (the control group). Samples were selected using cluster random sampling from the kindergartens of Zahedan,Iran in 2019. A questionnaire containing parent’s information (age, education level, occupation and monthly income), and Corah Dental Anxiety Scale (CDAS) were used in this study. Data were analyzed using SPSS software version 20. Results The anxiety level of mothers and fathers of the case group was similar to the control group (P= 0.284 and P= 0.114, respectively). There was no statistically significant difference between the level of parental anxiety (mother and father), and dmft index in the case group (P= 0.154 and P= 0.255, respectively). Also, mothers who were equal or less than 30 years-old were more anxious than mothers with more than 30 years-old (P= 0.034). Conclusion Based on the results, there were no significant differences in the groups based on parental dental anxiety. In other words, parental dental anxiety cannot lead to ECC in children.

The role of research in the study and improvement of the health of the pediatric population

Purpose of the study. The important role of evidence-based research in improving the health of the infant population and decision-making in the field of child health are highlight.
 Methods. Bibliographic and analytical methods were used in the study.
 Results. Almost all academic institutions and institutions of higher medical education carry out a large amount of research work, including the study and improvement of children's health. They all have their own priorities for research. These studies address issues of children's behavior in relation to their health, determinants of health, inequalities in health, genetics problems, approaches to the treatment of hepatitis C and many others.
 Conclusions. Scientific research on the study and improvement of children's health is the basis for policy development in the field of health care for children, including measures to prevent childhood diseases.

Socio-Cultural Factors Associated with Incomplete Routine Immunization of Children _ Amach Sub-County, Uganda

Immunization is one of the worlds’s most cost-effective health interventions that help prevent childhood diseases. However, many infants are not usually fully vaccinated especially in developing countries. This contributes to the mortality of Vaccine-Preventable Diseases (VPD) in children. The study examined the socio-cultural factors that are associated with incomplete routine immunization of children aged 0–1 year old in Amach Sub-County, Lira District _ Uganda. An analytical cross-sectional-mixed study among a sample of 326 parents and three health workers were made. Simple random sampling and purposive techniques were used to select the respondents. In-depth interviews, focus group discussion and Interviewer administered questionnaires were used to collect data. A modified Poisson regression model was used to compute the prevalence ratios. Variables were analyzed at bivariate and multivariate levels for their association with incomplete immunization. Incomplete immunization was at 27.3%. Marital status (p = 0.05), wealth level (p = 0.001), and side effects of vaccines was found to be associated with incomplete routine immunization. Age, occupation, education, religion, utilization of other health services, family structure, and support, gender, accessibility, and health education were not found to be associated with incomplete routine immunization. Incomplete immunization rate is quite high in Amach Sub-county.

Epidemiology of measles in Oromia region, Ethiopia, 2007-2016.

Introductionmeasles is the leading vaccine preventable childhood disease designated for elimination by WHO. More than 20 million people are affected by measles each year, particularly in Africa and Asia. With annual outbreaks reported from Ethiopia´s Oromia region. We analyzed measles containing vaccine coverage (MCV), measles cases and measles deaths over a 10-year period (2007-2016).Methodswe reviewed Oromia measles surveillance data and first-dose measles containing vaccine (MCV1) administrative coverage. Descriptive statistics and multivariable logistic regression were performed to assess variables associated with measles death. Additional spatial mapping was performed to visually display key areas of measles case distribution in Oromia.Resultsa total of 26,908 measles suspect cases were identified, of which 18,223 (68%) were confirmed. A median age of 6 years (IQ range 0.5-71 years) and 288 deaths were observed. Among the total cases, 29% were unvaccinated and 46% had unknown vaccination status. The highest IR was seen in Guji zone (IR=190/100,000 population) among 1-4 years, with a majority from rural areas. Risk factors associated with death include age <5 years (AOR=1.82, CI: 1.42-2.33), unvaccinated status (AOR=1.44, CI: 1.06-1.95) and inpatient treatment (AOR=2.12, CI: 1.58-2.85). Of 8,732 measles IgM negative/indeterminate specimens, 10.5% tested positive for rubella specific IgM.Conclusionoutbreaks of measles are an ongoing public health concern in the Oromia region. Children aged 1-15 years remain at high risk for contracting measles in the region. We recommend strengthening routine immunization to reach all children, especially in rural areas and that the measles-rubella (MR) vaccine be considered.

Lung Function, Dietary Intake, and Weight Status in Children with Persistent Asthma from Low-Income, Urban Communities.

Objective: Asthma and obesity are prevalent chronic childhood diseases that commonly co-occur in youth from low-income, minority backgrounds. Diet is a known risk factor for obesity; however, its role in asthma/obesity comorbidity is not well established. This analysis examined the association between diet and lung function and effect modification by weight status. Methods: Lung function (FEV1 % predicted), anthropometric, and dietary data were collected from 95 children, ages 7–9 years old with persistent asthma, from low-income, urban communities in the United States. Associations between lung function, diet and weight status were examined using multivariable linear regression. Results: There were no significant differences in dietary intake between children with persistent asthma with and without obesity; however, >85% of participants did not meet recommendations for fruit, vegetable, and whole grain intake for their age and sex. Only intake of fruit (whole fruit and juice) was significantly associated with FEV1 % predicted (−3.36; 95% CI: −6.5 to −0.2). Conclusions: Diet quality was poor in this sample, independent of weight status. More research is needed to understand the relationship between diet, lung function, and weight status, so that interventions can be developed to concurrently address obesity and weight.

Strong effect of Ecuador\u2019s conditional cash transfer program on childhood mortality from poverty-related diseases: a nationwide analysis

BackgroundThe mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections.MethodsMortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates.ResultsOur research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953–0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984–0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea.ConclusionsA conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.

A National Action Plan to Eliminate Vaccine Preventable Childhood Diseases.

A National Action Plan to Eliminate Vaccine Preventable Childhood Diseases.

Mapping inequality: Childhood asthma and environmental injustice, a case study of St. Louis, Missouri

As a geographic continuum of poverty and affluence has emerged, so too has a geographic continuum of good and poor health. Asthma is currently one of the most prevalent chronic childhood diseases. Over the past three decades, the greatest increases in asthma rates have been in urban areas and have disproportionately affected youth in poverty and those in racial and ethnic minority groups. Neighborhoods serve as a mechanism fostering environmental injustice and perpetuating these disparities in health outcomes and life opportunity for our most vulnerable populations. Using Geographic Information Systems (GIS) methods in a case study of St. Louis Missouri, this study examines local environmental risk by identifying ‘hotspots,’ or statistically significant spatial clustering of high or low levels of childhood asthma, and associations with neighborhood characteristics, socio-demographic characteristics, and access to healthcare resources within these hotspots. Results revealed statistically significant clustering of high asthma rates in areas with more non-White and poor residents, higher rates of public housing, deteriorating housing, and violent crime. High asthma hotspots were also located in areas with limited physical access to healthcare resources, such as physicians and medication, and lower school attendance rates. Residents of these high asthma hotspots experience greater environmental risk, and significant disparities in health and education outcomes, physical and financial healthcare resources, and overall well-being. This study demonstrates these place-based inequalities and presents clear evidence of environmental injustice, supporting the need for investments and interventions to improve the environments, health, and economic resources of our most vulnerable youth.

Rapid behavioral assessment of barriers and opportunities to improve vaccination coverage among displaced Rohingyas in Bangladesh, January 2018

BackgroundIn November 2017, the World Health Organization received initial reports of suspected diphtheria cases in camps established for displaced Rohingyas in Cox’s Bazar district, Bangladesh. By January 11, 2018, over 4,000 suspected cases of diphtheria and 30 deaths were reported. The Bangladesh government and partners implemented a diphtheria vaccination campaign in December 2017. Outbreak response staff reported anecdotal evidence of vaccine hesitancy. Our assessment aimed to understand vaccination barriers and opportunities to enhance vaccine demand among displaced Rohingyas in Bangladesh. MethodsIn January 2018, we conducted a qualitative assessment consisting of nine focus group discussions and 15 key informant interviews with displaced Rohingyas in three camps. Participants included mothers and fathers with under five-year-old children, community volunteers, majhis (camp leaders), Islamic religious leaders, traditional and spiritual healers, and teachers. We recruited participants using purposive sampling, and analyzed the data thematically. ResultsAcross focus groups and in-depth interviews, trusted information sources cited by participants included religious leaders, elders, village doctors, pharmacists, majhis, and mothers trained by non-governmental organizations to educate caregivers. Treatment of diphtheria and measles was usually sought from multiple sources including traditional and spiritual healers, village doctors, pharmacies, and health clinics. Major barriers to vaccination included: various beliefs about vaccination causing people to become Christian; concerns about multiple vaccines being received on the same day; worries about vaccination side effects; and, lack of sensitivity to cultural gender norms at the vaccination sites. ConclusionAlthough vaccination was understood as an important intervention to prevent childhood diseases, participants reported numerous barriers to vaccination. Strengthening vaccine demand and acceptance among displaced Rohingyas can be enhanced by improving vaccination delivery practices and engaging trusted leaders to address religious and cultural barriers using community-based channels.

Does tonsillar hypertrophy contribute to speech disorders in children?

Introduction. Hypertrophy of the pharyngeal and/or palatine tonsils as well as otitis media with effusion are the most prevalent childhood diseases leading to the referral of children to the ENT specialist. Adenoidectomy is the most commonly performed surgical procedure among paediatric patients. The main indications to adenoidectomy include sleep apnoea, frequent infections of the upper respiratory tract, and otitis media with effusion (OME). OME is defined as the presence of fluid in the middle ear without coexisting symptoms of ear infection. Aim. The aims of the study were to perform a clinical analysis of patients undergoing surgery on tonsils, and to evaluate the effect of tonsillar hypertrophy on speech disorders. Material and methods. The prospective study involved a group of 92 patients subjected to surgical procedures including adenoidectomy, adenotonsillotomy and adenotonsillectomy. Results. The study was carried out in a group of 92 patients aged 4.5-18 years who underwent tonsil surgery in two of Poland’s specialist medical centres. A total of 63 patients treated in the Warsaw centre, and 29 patients receiving treatment in the Elbląg centre, were included. The vast majority of the study group comprised children aged 5 to 9 years. Hearing impairment and the need to turn up the volume of the TV before the procedure were reported by 42 (45.7%) of the respondents. A total of 37 (40.2%) patients reported having to ask about the same thing several times. Among the patients who presented with hearing problems, 28 (30.4%) reported speech disorders, and 4 (4.3%) had slurred speech. Conclusions. Correct and early diagnosis and appropriate treatment of OME in children is necessary. An improvement of hearing in children contributes to an improvement in pronunciation.

Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia

BackgroundDental caries is a preventable childhood disease, but public health efforts are hampered due to limited information on associated factors in vulnerable populations. Our study was aimed at estimating the prevalence of dental caries and identifying key associated factors in four major risk domains, including socioeconomic factors, child oral health behavior and practices, child feeding practices, and dietary habits among primary school children in Saudi Arabia.MethodsA cross-sectional study design was used to recruit 578 male Saudi primary school children, aged 6–8 years, from 12 primary schools in five different regions of Riyadh. Children were clinically screened to detect carious lesions in primary teeth according to World Health Organization’s criteria. Structured self-administered questionnaire was used to collect information on social and individual factors from the parents. The odds ratios and 95% confidence intervals of associated factors for dental caries were computed using logistic regression models; key factors were identified by systematic selection process that accounted for multicollinearity and bias correction.ResultsDental caries was prevalent among children (83%, 95% confidence interval 79.7–86.0%). Individual factors, including irregular brushing, late adoption of brushing habit, consulting dentist for symptomatic treatment, lack of breast feeding, sleeping with a bottle in mouth, habit of snacking between meals, low consumption of fruits, and frequent consumption of soft drinks and flavored milk, were predominantly associated with dental caries in children, instead of socioeconomic factors (p < 0.05, adjusted R-square 80%).ConclusionDental caries were prevalent in school children, and individual factors were predominantly associated with the disease.

Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania.

Childhood undernutrition is a global health challenge impacting child growth and survival rates. This deficit in nutritional status contributes to the increasing chronic disease prevalence and economic burden in individuals and throughout developing contexts. A community‐based cross‐sectional study was conducted in Arusha District of Tanzania to determine the prevalence and predictors of undernutrition in 436 children. A structured questionnaire was used to collect data on demographic and socio‐economic factors as well as feeding practices and prevalence of preventable childhood diseases. Anthropometric data were collected through the measurement of length/height and weight of all children. The prevalence of undernutrition was estimated based on Z‐scores indices below −2SD of the reference population for weight for age (underweight), height for age (stunting), and weight for height (wasting). Fifty percent, 28%, and 16.5% of the children were stunted, underweight, and wasted, respectively. The age above 2 years and being a male were associated with stunting. The age above 2 years, nonexclusive breastfeeding children, and living at Seliani and Oturumeti were associated with being underweight. Similarly, morbidity, none exclusively breastfed children, living at Oturumeti, and being born to a mother 35 years and above were associated with wasting. In this study, we found the prevalence of child undernutrition in Arusha District is high in comparison with national and regional trends and appears to be associated with being a male. It is recommended that nutritionists and health planners should focus on these key predictors when planning nutrition interventions to address the problem of undernutrition among underfive children in Arusha District.

Optimal public health intervention in a behavioural vaccination model: the interplay between seasonality, behaviour and latency period.

Hesitancy and refusal of vaccines preventing childhood diseases are spreading due to 'pseudo-rational' behaviours: parents overweigh real and imaginary side effects of vaccines. Nonetheless, the 'Public Health System' (PHS) may enact public campaigns to favour vaccine uptake. To determine the optimal time profiles for such campaigns, we apply the optimal control theory to an extension of the susceptible-infectious-removed (SIR)-based behavioural vaccination model by d'Onofrio et al. (2012, PLoS ONE, 7, e45653). The new model is of susceptible-exposed-infectious-removed (SEIR) type under seasonal fluctuations of the transmission rate. Our objective is to minimize the total costs of the disease: the disease burden, the vaccination costs and a less usual cost: the economic burden to enact the PHS campaigns. We apply the Pontryagin minimum principle and numerically explore the impact of seasonality, human behaviour and latency rate on the control and spread of the target disease. We focus on two noteworthy case studies: the low (resp. intermediate) relative perceived risk of vaccine side effects and relatively low (resp. very low) speed of imitation. One general result is that seasonality may produce a remarkable impact on PHS campaigns aimed at controlling, via an increase of the vaccination uptake, the spread of a target infectious disease. In particular, a higher amplitude of the seasonal variation produces a higher effort and this, in turn, beneficially impacts the induced vaccine uptake since the larger is the strength of seasonality, the longer the vaccine propensity remains large. However, such increased effort is not able to fully compensate the action of seasonality on the prevalence.

Evaluating scenarios of locations and capacities for vaccine storage in Nigeria

Many developing countries still face the prevalence of preventable childhood diseases because their vaccine supply chain systems are inadequate by design or structure to meet the needs of their populations. Currently, Nigeria is evaluating options in the redesign of the country’s vaccine supply chain. Using Nigeria as a case study, the objective is to evaluate different regional supply chain scenarios to identify the cost minimizing optimal hub locations and storage capacities for doses of different vaccines to achieve a 100% fill rate. First, we employ a shortest-path optimization routine to determine hub locations. Second, we develop a total cost minimizing routine based on stochastic optimization to determine the optimal capacities at the hubs. This model uses vaccine supply data between 2011 and 2014 provided by Nigeria’s National Primary Health Care Development Agency (NPHCDA) on Tuberculosis, Polio, Yellow Fever, Tetanus Toxoid, and Hepatitis B. We find that a two-regional system with no central hub (NC2) cut costs by 23% to achieve a 100% fill rate when compared to optimizing the existing chain of six regions with a central hub (EC6). While the government’s leading redesign alternative – no central three-hub system (Gov NC3) – reduces costs by 21% compared with the current EC6, it is more expensive than our NC2 system by 3%. In terms of capacity increases, optimizing the current system requires 42% more capacity than our NC2 system. Although the proposed Gov NC3 system requires the least increase in storage capacity, it requires the most distance to achieve a 100% coverage and about 15% more than our NC2. Overall, we find that improving the current system with a central hub and all its variants, even with optimal regional hub locations, require more storage capacities and are costlier than systems without a central hub. While this analysis prescribes the no central hub with two regions (NC2) as the least cost scenario, it is imperative to note that other configurations have benefits and comparative tradeoffs. Our approach and results offer some guidance for future vaccine supply chain redesigns in countries with similar layouts to Nigeria’s.

Comparative effectiveness of treatments to prevent dental caries given to rural children in school-based settings: protocol for a cluster randomised controlled trial

IntroductionDental caries is the most prevalent childhood disease in the world and can lead to infection, pain and reduced quality of life. Multiple prevention agents are available to arrest and...

Autoimmune Nature of Type I Diabetes Mellitus

Type 1 diabetes Mellitus (T1DM) is a chronic autoimmune disease in which pancreatic β‐cell destruction results in loss of endogenous insulin production. Already one of the most prevalent chronic childhood diseases, the incidence of T1DM in children and young adults is projected to continue to increase over the next several decades. Although advances in technology have allowed for improved glucose monitoring and insulin delivery, no curative therapy is currently available for this growing patient population. Moreover, patients continue to experience long‐term complications such as blindness and kidney failure, even with the most intensive insulin regimens currently available.T1DM predominantly originates when insulin‐producing beta (β)‐cells in the pancreas are destroyed or suppressed due to an autoimmune response caused by the auto‐reactive T‐helper 1 (Th1) cells. Interestingly, the antigens responsible for this immune response, glutamic acid decarboxylase, are normally present in β‐cells; however, their destructive capabilities are restrained by the regulatory mechanisms of the body. When a person has certain genetic factors (e.g. the absence of certain protective histocompatibility locus antigen) and exposure to certain environmental factors, they are predisposed to immunologic injury of β‐cells. Furthermore, the odds of presenting with T1DM diminish with treatment with immune‐suppressive regimens that specifically target T‐cells. As a result, Th1 cells dominate the protective regulatory T‐cells. In turn, Th1 cells secrete cytokines, interleukin 2, and interferon gamma, which initiate inflammation of the islet cells that appears to result in the development of T1DM.In 2001 it was found that diabetes might be the first disease for which stem cell therapy is an option, when insulin‐producing embryonic stem cells of R1‐mice were transplanted into streptozotocin‐induced diabetic animals and normal blood glucose levels were achieved, and in other studies implantation of embryonic Sertoli cells into diabetic db mice also resulted in amelioration of the diabetic state. In contrast, infusion of cord blood derived stem cells in the absence of immunomodulation was without lasting effect on the diabetic state. Minor complications in R1‐mice aside, this event once again renewed the quest to find more practical and functional means to create human islets to treat diabetes.Can pancreatic stem cell transplant be used as a cure for T1DM, an autoimmune disease, and how does it stand against other cell transplants and other treatment modalities in the US? The bulk of preliminary evidence to date suggests encouraging potential for such approaches in the treatment of T1DM.Support or Funding InformationSupported by Institutional Resources of USAT, the Einstein Institute, and the University of Massassachusetts.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Comparative effectiveness of school-based caries prevention: a prospective cohort study

BackgroundDental caries is the world’s most prevalent childhood disease. School-based caries prevention can reduce the risk of childhood caries by increasing access to care. However, the optimal mix of treatment services, intensity, and frequency of care is unknown.MethodsData were derived from two prospective cohorts of US children participating in two caries prevention programs with different treatment intensities. One program provided primary and secondary prevention (glass ionomer sealants and interim therapeutic restorations) and one primary prevention only (glass ionomer sealants), both given twice yearly in six-month intervals. Primary study outcomes included untreated decay and the total observed caries experience. Analysis used generalized additive models to estimate nonlinear effects and trends over time. Results were compared to those estimated using generalized estimating equations and mixed-effects multilevel Poisson regression.ResultsPrimary and secondary prevention combined did not significantly reduce total caries experience compared to primary prevention alone, but did reduce the risk of untreated decay on permanent dentition. Additionally, the rate of new caries experience was slower in the primary and secondary prevention group. Nonlinear trends for dental caries across both programs were statistically significant from zero (p < .001).ConclusionCaries prevention consisting of primary and secondary prevention agents may be more effective than primary prevention alone in reducing the risk of tooth decay over time. Results suggest that the impact of caries prevention may not be constant over the medium- and long-term, suggesting reduced effectiveness with continued treatments.

Cytokine and Chemokine Profiling in Patients with Hand, Foot and Mouth Disease in Singapore and Malaysia

Hand, foot and mouth disease (HFMD) is a prevalent contagious childhood disease typically associated with fever, oral lesions and limb exanthema. While HFMD is caused by a plethora of serotypes of viruses under the genus Enterovirus within the Picornaviridae family, Coxsackievirus A16 (CV-A16) and Enterovirus 71 (EV-A71) are considered the main etiological agents. In recent years however, other viruses have also been isolated in considerable numbers from infected individuals in many regions, joining the legion commonly associated with HFMD. The present study investigated the cytokine and chemokine profiles of HFMD patients from Singapore and Malaysia for the first time. Comparative cohort studies of EV-A71-associated HFMD cases revealed that the Malaysia cohort had a distinct profile from the Singapore cohort, and this could be partly attributed by different EV-A71 genotypes. As the isolation of CV-A6, instead of CV-A16, had become prevalent in the Singapore cohort, it was also of particular interest to study the differential cytokine and chemokine profiles. Our data revealed that overlapping as well as unique profiles exist between the two major causative clinical isolates in the Singapore cohort. Having a better understanding of the respective immunological profiles could be useful for more accurate HFMD diagnosis, which is imperative for disease transmission control until multi-valent vaccines and/or broad-spectrum anti-viral drugs become available.

Construction and evaluation of Bordetella pertussis live attenuated vaccine strain BPZE1 producing Fim3

Pertussis or whooping cough is currently the most prevalent vaccine-preventable childhood disease despite >85% global vaccination coverage. In recent years incidence has greatly increased in several high-income countries that have switched from the first-generation, whole-cell vaccine to the newer acellular vaccines, calling for improved vaccination strategies with better vaccines. We have developed a live attenuated pertussis vaccine candidate, called BPZE1, which is currently in clinical development. Unlike other pertussis vaccines, BPZE1 has been shown to provide strong protection against infection by the causative agent of pertussis, Bordetella pertussis, in non-human primates. BPZE1 is a derivative of the B. pertussis strain Tohama I, which produces serotype 2 (Fim2) but not serotype 3 fimbriae (Fim3). As immune responses to fimbriae are likely to contribute to protection, we constructed a BPZE1 derivative, called BPZE1f3, that produces both serotypes of fimbriae. Whereas nasal vaccination of mice with BPZE1 induced antibodies to Fim2 but not to Fim3, vaccination with BPZE1f3 elicited antibodies to both Fim2 and Fim3 at approximately the same level. In mice, both BPZE1 and BPZE1f3 provided equal levels of protection against clinical isolates that either produce Fim2 alone, both Fim2 and Fim3, or no fimbriae. However, vaccination with BPZE1f3 provided significantly stronger protection against Fim3-only producing B. pertussis than vaccination with BPZE1, indicating that immune responses to fimbriae contribute to serotype-specific protection against B. pertussis infection.