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Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in
Rui Shen1, Jiawei Xu2, Yugang Li1
1Public Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China.
Objectives:
Despite high vaccination coverage, pertussis resurgence in megacities challenges conventional control strategies. We investigated epidemiological patterns and policy impacts in a densely populated urban setting in Chongqing, China.
Methods:
Using population-based surveillance data (2005-2024) from Chongqing (population 32.1 million; DTP3 coverage >97%), we conducted hierarchical Bayesian spatial modeling and age-structured Susceptible-Infected-Recovered-Vaccinated transmission analysis. We assessed four sequential policy transitions and simulated four vaccination strategies over three years (2025-2027) to evaluate their potential impact.
Results:
Annual pertussis incidence increased from 0.25 to 70.82/100,000. Infants showed highest absolute risk, while children aged 6-7 years demonstrated elevated risk (RR: 0.55 and 0.54, respectively). Urban areas showed marginally elevated risk (RR: 1.04, 95% CI: 1.00-1.07). Molecular diagnostics implementation revealed substantial hidden transmission (RR: 82.65, 95% CI: 73.47-92.99). Modeling projected extended school-age boosters (ages 5-7 years) would reduce incidence by 47.93%, targeted vaccination of ages 6-7 years achieved 36.64% reduction, and the national benchmark with 6-year booster reduced incidence by 19.09%. All strategies provided substantial indirect protection to infants without direct intervention.
Conclusion:
Enhanced molecular surveillance uncovered substantial hidden transmission in urban settings. Strategic school-age targeted vaccination could effectively disrupt urban transmission chains while protecting vulnerable infants.
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