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Pertussis Epidemiology in Children: The Role of Maternal Immunization
Nicola Principi1, Sonia Bianchini2, Susanna Esposito3
1Università degli Studi di Milano, 20122 Milan, Italy.
Insights
Maternal immunization with Tdap vaccine significantly protects infants from pertussis (whooping cough), reducing severe disease by up to 90%. Increasing vaccination coverage is vital to protect vulnerable newborns.
Area of Science:
- Public Health
- Immunology
- Epidemiology
Background:
- Global pertussis (whooping cough) cases have surged, with infants under three months facing the highest risk of severe illness and death.
- Maternal immunization with the Tdap vaccine during pregnancy is recommended for passive immunity transfer to newborns.
- Suboptimal Tdap vaccine coverage in pregnant individuals hinders effective infant protection.
Purpose of the Study:
- To review the current epidemiology of pertussis and the critical need for infant protection.
- To evaluate the effectiveness of maternal immunization in preventing pertussis in newborns.
- To identify barriers to maternal Tdap vaccination and propose strategies for improvement.
Main Methods:
- This study is a review of existing literature on pertussis epidemiology and maternal immunization.
- Analysis of data on pertussis incidence, severity, and vaccine effectiveness.
- Examination of factors influencing maternal Tdap vaccine uptake.
Main Results:
- Maternal Tdap vaccination is highly effective, preventing up to 90% of pertussis cases in infants.
- Despite proven benefits, maternal Tdap vaccination coverage remains suboptimal globally.
- Low vaccine uptake is attributed to hesitancy, safety concerns, access barriers, and pandemic disruptions.
- Increased pertussis activity may also stem from disease cycles, adult transmission, and evolving Bordetella pertussis strains.
Conclusions:
- Enhancing maternal Tdap vaccination coverage is crucial for protecting vulnerable infants from pertussis.
- Addressing vaccine hesitancy and access barriers is essential to improve uptake.
- Increased maternal immunization can significantly reduce infant pertussis incidence, hospitalizations, and mortality.
Abstract:
In the last twelve months, a significant global increase in pertussis cases has been observed, particularly among infants under three months of age. This age group is at the highest risk for severe disease, hospitalization, and death. Maternal immunization with the Tdap vaccine during pregnancy has been recommended to protect newborns by transferring maternal antibodies transplacentally. This review examines the current epidemiology of pertussis, the importance of preventing it in young children, and the effectiveness of maternal immunization. Despite the proven benefits of maternal vaccination, which has been found effective in pertussis prevention in up to 90% of cases, coverage remains suboptimal in many countries. Factors contributing to low vaccination rates include vaccine hesitancy due to low trust in health authority assessments, safety concerns, practical barriers to vaccine access, and the impact of the COVID-19 pandemic, which disrupted routine vaccination services. The recent increase in pertussis cases may also be influenced by the natural cyclic nature of the disease, increased Bordetella pertussis (Bp) activity in older children and adults, and the genetic divergence of circulating Bp strains from vaccine antigens. Given the high efficacy of maternal vaccination in preventing pertussis in infants, increasing coverage rates is crucial. Efforts to improve vaccine uptake should address barriers to access and vaccine hesitancy, ensuring consistent immune protection for the youngest and most vulnerable populations. Enhanced maternal vaccination could significantly reduce the incidence of whooping cough in infants, decreasing related hospitalizations and deaths.
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