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Pertussis disease burden in the household: how to protect young infants
S C de Greeff1, F R Mooi, A Westerhof
1Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. sabine.de.greeff@rivm.nl
Insights
Household contacts frequently transmit pertussis to infants. Improving parental immunity and developing better pertussis vaccines are crucial for preventing infant infections and transmission.
Area of Science:
- Infectious Diseases
- Epidemiology
- Immunology
Background:
- Pertussis (whooping cough) poses a significant risk to infants.
- Identifying the source of pertussis in infant cases is critical for prevention strategies.
Purpose of the Study:
- To determine the primary source of pertussis transmission within households of hospitalized infants.
- To assess the duration of vaccine-induced immunity against pertussis in children.
Main Methods:
- A prospective, population-based study was conducted in the Netherlands from 2006-2008.
- Household contacts of 164 hospitalized infants were tested for Bordetella pertussis using PCR, culture, and serology.
- Clinical data and vaccination history were collected via questionnaires.
Main Results:
- Over half (53%) of household contacts had laboratory-confirmed pertussis.
- Siblings (41%), mothers (38%), and fathers (17%) were the most likely sources of infection for infants.
- Vaccine effectiveness waned, with significant pertussis cases occurring 1-3 years post-vaccination, particularly with acellular vaccines.
Conclusions:
- Boosting parental immunity could prevent 35%-55% of infant pertussis cases.
- Current pertussis vaccines (both whole-cell and acellular) may not provide long-lasting protection.
- Improved vaccine formulations and vaccination strategies are needed to enhance long-term immunity and reduce transmission.
Background:
We conducted a population-based, nation-wide, prospective study to identify who introduced pertussis into the household of infants aged 6 months admitted to the hospital for pertussis in the Netherlands.
Methods:
During the period 2006-2008, a total of 560 household contacts of 164 hospitalized infants were tested by polymerase chain reaction, culture, and serological examination to establish Bordetella pertussis infection. Clinical symptoms and vaccination history were obtained by a questionnaire submitted during sample collection and 4-6 weeks afterwards.
Results:
Overall, 299 household contacts (53%) had laboratory-confired pertussis; 159 (53%) had symptoms compatible with typical pertussis infection, and 42 (14%) had no symptoms. Among children vaccinated with a whole-cell vaccine, 17 (46%) of 37 had typical pertussis 1-3 years after completion of the primary series, compared with 9 (29%) of 31 children who had been completely vaccinated with an acellular vaccine. For 96 households (60%), the most likely source of infection of the infant was established, being a sibling (41%), mother (38%), or father (17%).
Conclusions:
If immunity to pertussis in parents is maintained or boosted, 35%-55% of infant cases could be prevented. Furthermore, we found that, 1-3 years after vaccination with whole-cell or acellular vaccine, a significant percentage of children are again susceptible for typical pertussis. In the long term, pertussis vaccines and vaccination strategies should be improved to provide longer protection and prevent transmission.
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