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Published on: February 22, 2019
Resurgence of pertussis: whopping the '100-day cough'
1Department of Child (Pediatrics) and Adolescent Health, (Pediatric Infectious Diseases, Epidemiology and Public Health), University of the West Indies.
Purpose Of Review:
Against the WHO's report of 84% diphtheria-pertussis-tetanus (DPT) primary vaccination coverage globally, the resurgence of pertussis (whooping cough), contributing factors and measures to control it are described.
Recent Findings:
USA and China, with 94-97% primary DPT immunization uptake, reported a 6-fold and 65-fold increase in pertussis between two time periods in 2023 and 2024. The global post-COVID-19 pertussis epidemic is trending towards a shift from infants towards older persons. Macrolide resistance is prevalent in 98% of Bordetella pertussis strains in China and is now reported from other countries. Pertactin-deficient mutant acellular pertussis vaccine-evasive strains are now transmitted in older children and adults. Pertactin-producing B. pertussis is causing fulminant pertussis in newborns whose mothers were not immunized in pregnancy and in under-immunized infants. Circulating epidemic strains of B. pertussis were discordant to those contained in whole-cell (Bp137) pertussis vaccine. The pertussis resurgence maybe explained by increased case ascertainment and reporting, mutant B. pertussis strains with immune escape from acellular and whole cell vaccines, and/or macrolides, waning natural, or vaccine-induced immunity and COVID-19 pandemic factors.
Summary:
Pertussis maybe curtailed with public education, active clinical and microbiological surveillance, appropriate antimicrobial treatment and prophylaxis, public health reporting, infection control and optimized immunizations to reduce attributable morbidity and mortality.
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