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[Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?]
Fernando A Moraga-Llop1, Natàlia Mendoza-Palomar2, Antoni Muntaner-Alonso2
1Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
Insights
Despite high vaccination rates, pertussis (whooping cough) remains a concern, especially for infants. This study highlights the need for broader vaccination strategies beyond childhood immunization to protect vulnerable populations.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health
Context:
- Pertussis (whooping cough) cases have seen a significant rise.
- Infants under six months represent a vulnerable demographic, accounting for 36.8% of cases.
- The study reviewed pertussis cases in children under 16 years from 2009-2011.
Purpose:
- To analyze the vaccination status of children diagnosed with pertussis.
- To compare clinical manifestations between fully vaccinated and unvaccinated/incompletely-vaccinated children.
- To evaluate the effectiveness of current vaccination schedules against pertussis.
Summary:
- Out of 212 pertussis cases, 57% were fully vaccinated, with 76.9% receiving their last dose within four years.
- Non-vaccinated children showed a higher frequency of cyanosis and increased hospitalization risk.
- Cyanosis was more prevalent in unvaccinated or incompletely vaccinated children.
Impact:
- The findings underscore the limitations of current childhood vaccination schedules in preventing pertussis.
- The study advocates for enhanced vaccination strategies, including adolescent, adult, and maternal immunization, and cocooning.
- Development of more effective pertussis vaccines is crucial for infant protection.
Objective:
To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children.
Methods:
The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011.
Results:
Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P<.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%.
Conclusions:
The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed.
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