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Global Incidence of Pertussis After the COVID-19 Pandemic
Andrew Gorringe1, Breeze Cavell1, Frank Beard2
1UK Health Security Agency, Porton Down, Salisbury, United Kingdom.
Insights
Pertussis outbreaks are rising globally, especially in adolescents, despite COVID-19 pandemic lows. New vaccines are needed to combat Bordetella pertussis, including resistant strains, and reduce transmission.
Area of Science:
- Infectious Diseases
- Bacteriology
- Vaccinology
Background:
- Pertussis (whooping cough), caused by Bordetella pertussis, is a severe respiratory illness, particularly dangerous for infants.
- Recent global pertussis incidence decreased during the COVID-19 pandemic but has since surged, notably in adolescents.
- Pre-pandemic, some countries observed Bordetella pertussis strains lacking pertactin, an acellular vaccine antigen, though recent isolates express it.
Purpose of the Study:
- To summarize recent trends in Bordetella pertussis incidence and characteristics.
- To highlight the emergence of macrolide-resistant strains.
- To underscore the need for improved pertussis vaccination strategies and novel vaccine development.
Main Methods:
- Data synthesis from an International Bordetella Society online workshop (November 12, 2024).
- Review of reported pertussis incidence and Bordetella pertussis isolate characteristics from participating countries.
- Analysis of trends in vaccine antigen expression and antibiotic resistance.
Main Results:
- Most countries reported very low pertussis incidence during and immediately after the COVID-19 pandemic.
- Since the pandemic, many countries have experienced significant pertussis outbreaks, particularly among adolescents.
- Several countries reported an increase in macrolide-resistant Bordetella pertussis isolates.
Conclusions:
- The resurgence of pertussis necessitates maintaining and increasing vaccination coverage in pregnant individuals, infants, and children.
- Emerging Bordetella pertussis strains with altered antigen expression and antibiotic resistance pose challenges to current vaccines.
- Development of new pertussis vaccines offering broader protection against disease, infection, and transmission is crucial.
Importance:
Pertussis, or whooping cough, is caused by the Bordetella pertussis bacterium. It induces prolonged cough in all age groups and is a severe, life-threatening disease in young infants.
Observations:
In an online workshop organized by the International Bordetella Society on November 12, 2024, most participating countries reported very low pertussis incidence during and immediately following the COVID-19 pandemic. Since that time, many countries have seen large outbreaks of pertussis, particularly in adolescents. Before the pandemic, several countries, especially those using acellular pertussis vaccine in infants, reported circulating B pertussis isolates that lacked the acellular vaccine antigen pertactin. However, most recent isolates have been found to express this antigen. A rise in macrolide-resistant B pertussis isolates was also reported by several countries.
Conclusions And Relevance:
The potential for large outbreaks of pertussis highlights the importance of maintaining or increasing vaccine coverage in pregnancy and in infants and children. The data presented herein suggest a need for new pertussis vaccines that protect against both disease and infection and that reduce transmission.
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