B ordetella pertussis is the main causative agent of pertussis, an acute upper respiratory tract infection of humans. The most effective strategy for preventing and controlling this disease is vaccination. In Spain during 1998-2005, pertussis vaccination with whole-cell vaccine (WCV) was progressively replaced by vaccination with acellular pertussis vaccine (ACV), which contains a combination of several antigens. Although vaccines and vaccination programs might differ among countries, the 3-component ACV containing pertussis toxin (PT), filamentous hemagglutinin (FHA), and pertactin is largely used for pertussis vaccination in many countries, including Spain. Specifically, the pertactin component has been included in most vaccines used throughout the history of pertussis vaccination in Spain (Table 1).Despite extensive vaccination campaigns and high vaccination rates, pertussis has resurged in the past 20 years, and outbreaks have occurred worldwide. One of the main causes postulated for the change in pertussis epidemiology is evolution of circulating bacteria to vaccine/immunity-evasive phenotypes (1-4). In 2007, after the introduction of ACV,

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