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Pertussis in Sweden after the cessation of general immunization in 1979

V Romanus, R Jonsell, S O Bergquist

    The Pediatric Infectious Disease Journal
    |April 1, 1987
    PubMed

    Insights

    Pertussis (whooping cough) outbreaks surged in Sweden after immunization was discontinued. Unvaccinated children faced significantly higher infection rates and severe complications, highlighting the importance of pertussis vaccination.

    Area of Science:

    • Epidemiology
    • Infectious Diseases
    • Public Health

    Background:

    • Pertussis (whooping cough) immunization was implemented in Sweden in the 1950s and halted in 1979.
    • Following discontinuation, pertussis incidence remained low for three years before gradually increasing, leading to outbreaks in 1983 and 1985.

    Purpose of the Study:

    • To analyze the epidemiology and impact of pertussis in Sweden after the cessation of routine immunization.
    • To estimate the true incidence of pertussis in preschool children and assess the severity of the disease.

    Main Methods:

    • Analysis of confirmed pertussis cases (culture or serology) from 1980-1985.
    • Estimation of total pertussis frequency using data from child health centers.
    • Evaluation of hospitalized pertussis patients (1981-1983) for complications and outcomes.

    Main Results:

    • Over 36,000 pertussis cases were confirmed between 1980-1985, with children aged 0-6 years being highly affected.
    • Annual incidence in children aged 0-6 years increased from 700 to 3200 per 100,000 population between 1981 and 1985.
    • Cumulative incidence by age 4 was 16% in unimmunized cohorts versus 5% in immunized cohorts. Hospitalized infants (<12 months) comprised 48%, with 4% experiencing neurologic complications and 14% developing pneumonia.

    Conclusions:

    • The cessation of pertussis immunization in Sweden led to a significant resurgence of the disease, particularly in young children.
    • Unimmunized children experienced substantially higher cumulative incidence rates of pertussis compared to immunized children.
    • Pertussis poses a serious threat, especially to infants, with notable rates of hospitalization, severe complications like pneumonia and neurologic issues, and fatal outcomes.

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