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Diagnostic Performance and Clinical Outcomes of Pertussis in Hospitalized Children in Relation to Available
Dominika Lachowicz1,2, Barbara Jastrzębska3, Ewa Bukowska4,5
1Microbiological Laboratory, University Center for Laboratory Medicine, University Medical Center, Medical University of Warsaw, Warsaw, Poland. dominika.lachowicz@wum.edu.pl.
Insights
Pertussis (whooping cough) remains a concern in children, even after vaccination. Continued surveillance is crucial for effective pertussis prevention strategies, especially in Poland where whole-cell vaccines are used.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Global resurgence of *Bordetella pertussis* infections presents significant public health challenges, particularly for pediatric populations.
- Poland uniquely utilizes the whole-cell pertussis vaccine (wP) in its routine immunization schedule.
- Understanding pertussis epidemiology and diagnostic utility is vital for effective management.
Purpose of the Study:
- To evaluate the vaccination status of pediatric pertussis patients.
- To assess the diagnostic performance of PCR and serological testing for *Bordetella pertussis*.
- To correlate clinical presentation and management with vaccination history.
Main Methods:
- Retrospective cohort study of 269 children diagnosed with *Bordetella pertussis* between January and December 2024.
- Confirmation of infection via real-time PCR and/or serological ELISA testing.
- Data collection included clinical characteristics and vaccination histories through medical records and interviews.
Main Results:
- Pertussis was confirmed in 28% (76/269) of tested children, with PCR being the primary diagnostic tool.
- Infants under one year had the highest proportion of cases (32.9%); cases decreased with age but occurred across all pediatric age groups.
- Severe pertussis was observed in both vaccinated and unvaccinated children, with a trend towards more severe symptoms correlating with the time elapsed since the last vaccine dose.
Conclusions:
- The persistence of pertussis cases years post-vaccination underscores the need for ongoing surveillance to enhance prevention.
- Further population-based and molecular research is warranted for pertussis cases within five years of wP vaccination to investigate waning immunity or evolving bacterial strains.
Introduction:
Bordetella pertussis infections have resurged globally, posing notable public health challenges, particularly in pediatric populations. Poland remains the only EU country that continues to use the whole-cell pertussis vaccine (wP) in routine immunization. This study evaluated the vaccination status and diagnostic value of available testing modalities in relation to the clinical presentation and management of pertussis in pediatric patients.
Methods:
A retrospective cohort study of 269 children was conducted between January and December 2024. Patients with B. pertussis infection confirmed by real-time polymerase chain reaction (PCR; PCR-Fluorescence Probing Kit, Sansure, China) and/or serological testing (NovaLisa B. pertussis ELISA, Gold Standard Diagnostic, Germany) were included. Clinical characteristics and vaccination histories of confirmed cases were obtained from electronic medical records and telephone interviews with parents.
Results:
Pertussis was laboratory-confirmed in 76 of the 269 tested children (28%). PCR accounted for the majority of laboratory-confirmed cases and remained positive in some children during the fifth and sixth week of coughing. The highest proportion of cases was observed in infants under 1 year of age (n = 25, 32.9%). In older age groups, the proportion of cases reached 17% in children aged 1-5 years, 19% in those aged 6-11 years, and 10% in children aged 12-15 years. Adolescents over 15 years of age accounted for only two cases (2.6%). Twelve patients met criteria for severe pertussis (PSS > 5), which occurred in both vaccinated and unvaccinated children. The interval between disease onset and the last vaccine dose ranged from 1 month to 12 years, and a trend toward more pronounced clinical manifestations with longer time since the last booster was observed. No differences in clinical symptoms were found between children vaccinated with wP and acellular (aP) vaccines.
Conclusions:
The occurrence of cases several years after vaccination highlights the importance of continued surveillance to strengthen pertussis prevention strategies. Pertussis cases occurring within 5 years of wP vaccination warrant further population-based and molecular studies to evaluate potential factors such as waning immunity or antigenic changes in circulating B. pertussis strains.
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