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Pertussis in Italy: how to protect the "unprotectable"?
Fabiana Fiasca1, Stefano Necozione1, Antonella Mattei1
1Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Insights
Whooping cough (pertussis) hospitalizations are rising in infants under 3 months old in Italy. This vulnerable group faces the highest risk, highlighting the need for enhanced infant immunization strategies.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Whooping cough (pertussis) remains a significant public health concern globally.
- Despite high vaccination rates with acellular pertussis vaccines, young infants are particularly vulnerable.
- Limited infant-specific pertussis data in Italy necessitated this study.
Purpose of the Study:
- To analyze hospitalization trends for pertussis in Italian infants under 12 months.
- To identify age-specific risks and temporal patterns of pertussis in infants.
- To inform public health strategies for pertussis prevention in vulnerable populations.
Main Methods:
- Retrospective observational study of infant hospitalizations for pertussis (2007-2018).
- Analysis of temporal trends stratified by age groups relevant to vaccination schedules.
- Statistical analysis of hospitalization rates and seasonal patterns.
Main Results:
- A significant increasing trend in pertussis hospitalizations was observed in infants under 3 months (9 per 100,000 infants/year).
- Infants under 3 months had the highest hospitalization rates (169 per 100,000 infants).
- A distinct seasonal pattern with a summer peak was identified for pertussis hospitalizations.
Conclusions:
- Infants too young for vaccination are at the highest risk of pertussis.
- The rising trend in hospitalizations underscores the need for improved infant protection.
- Strategies like maternal vaccination during pregnancy should be considered alongside adolescent boosters.
Abstract:
Whooping cough continues to be an important public health issue despite high levels of vaccination coverage with acellular pertussis vaccine. Young unimmunized infants represent the most vulnerable group with the highest rates of complications and death. As infant-specific pertussis epidemiologic data, especially among neonates, in Italy were limited, a retrospective observational study of hospitalizations for whooping cough in Italian infants aged <12 months between 2007 and 2018 was conducted to address this knowledge gap. The temporal trend of rates, also stratified for age classes according to the expected age for the administration of vaccine doses, were analyzed by the slope of the regression line. The mean age at the time of admission was 92 d (±64). A clear seasonal pattern in the occurrence of pertussis hospitalizations with a summer peak was observed. Infants younger than 3 months old had the highest hospitalization rates (169 x 100000 infants on average), with a significant rising trend of 9 x 100000 infants on average per year. Limiting the analysis to Bordetella pertussis-related hospitalizations such trend was even more evident. In the other age classes, hospitalization rates were considerably lower and gradually decreased with increasing age. This study demonstrated that pediatric populations, too young to be protected by vaccination, had a greater risk of contracting pertussis. Thus, it is necessary to promote additional immunization strategies besides one booster dose in adolescents, including vaccination during pregnancy.
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