Pertussis in Africa: Findings and recommendations of the Global Pertussis Initiative (GPI)
Rudzani Muloiwa1, Nicole Wolter2, Ezekiel Mupere3
1Department of Paediatrics and Child Health, University of Cape Town, 7701 Cape Town, South Africa.
Insights
Pertussis (whooping cough) significantly impacts infants and children, especially in Africa. Improving vaccination coverage and surveillance are key to reducing this preventable disease burden.
Area of Science:
- * Global Health
- * Vaccinology
- * Pediatric Infectious Diseases
Background:
- * Pertussis (whooping cough) continues to cause significant illness and death globally, particularly in infants and young children.
- * The disease burden is disproportionately high in low- and middle-income countries (LMICs), with Africa experiencing a severe impact due to factors like inadequate surveillance and diagnostic limitations.
- * While most African nations utilize whole-cell pertussis (wP) vaccines, vaccination coverage often falls below the WHO's recommended 90% target.
Purpose of the Study:
- * To outline strategies for preventing pertussis-related infant and child mortality and reducing the global disease burden.
- * To provide recommendations for pertussis control, particularly in resource-limited settings like Africa.
- * To highlight the need for improved surveillance and further research on vaccine efficacy and implementation.
Main Methods:
- * Systematic evaluation and prioritization of pertussis prevention strategies by the Global Pertussis Initiative (GPI).
- * Review of existing vaccination guidelines and coverage data.
- * Analysis of factors contributing to the high pertussis burden in African LMICs.
Main Results:
- * For countries using wP vaccines, the GPI recommends prioritizing improved primary and booster vaccination coverage.
- * When resources and acellular pertussis (aP) vaccines become available, vaccination during pregnancy is recommended to protect newborns.
- * Subsequent priorities include boosters for older children, adolescents, healthcare workers, and adults.
Conclusions:
- * Enhanced pertussis surveillance in African LMICs is crucial for accurately assessing disease burden and vaccine effectiveness.
- * Continued efforts to improve vaccination coverage with existing wP vaccines are essential.
- * Further research is needed to optimize the use, safety, and efficacy of both wP and aP vaccines and associated strategies.
Abstract:
Pertussis remains a major cause of morbidity and mortality, particularly in infants and young children, and despite the availability of vaccines and pertinent national and international guidelines. The disease burden is more severe in low- and middle-income countries (LMICs), especially in the African continent. Pertussis is more prevalent among young infants in Africa. Poor or no pertussis surveillance, lack of disease awareness, diagnostic limitations, and competing health priorities are considered key contributory factors for this high pertussis burden in Africa. Most African countries use whole-cell pertussis (wP) vaccines, but coverage with three primary doses of diphtheria-tetanus-pertussis vaccines falls short of the World Health Organization's recommended goal of >90%. The Global Pertussis Initiative (GPI) works toward developing recommendations through systematic evaluation and prioritization of strategies to prevent pertussis-related infant and child deaths, as well as reducing global disease burden to acceptable national, regional, and local levels. For countries using wP vaccines, the GPI recommends continuing to use wP to improve primary and toddler booster vaccination coverage. Vaccination during pregnancy is the next priority when acellular pertussis (aP) vaccines and other resources are available that directly protect newborns too young to be vaccinated, followed by, in order of priority, booster doses in older children, adolescents, healthcare workers and finally, all adults. Improved surveillance should be a high priority for African LMICs assessing true disease burden and vaccine effectiveness to inform policy. More research is warranted to evaluate the safety and efficacy of wP and aP vaccines and strategies, and to determine their optimal use.
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