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Interpretation of guidelines for diagnosis, management, and prevention of pertussis in China (version 2024)
Mei Zeng1, Zhujun Shao2, Jun Xia3
1Department of Infectious Disease, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
Insights
China faces a pertussis resurgence, with underestimations due to poor surveillance and diagnosis. New guidelines address pertussis (whooping cough) management, treatment, and prevention, including crucial immunization practices.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
- Public Health Policy
Background:
- Pertussis (whooping cough) is resurging in China, with incidence and burden underestimated.
- Challenges include limited surveillance, insufficient laboratory diagnosis, and rising macrolide-resistant Bordetella pertussis.
- Existing practices for diagnosis, treatment, and prevention require updated guidance.
Purpose of the Study:
- To develop the first clinical practice guidelines for pertussis in China.
- To address critical issues in pertussis diagnosis, treatment, prevention, and immunization.
- To provide evidence-based recommendations for healthcare professionals and policymakers.
Main Methods:
- A multidisciplinary Guideline Development Group (GDG) was formed, comprising experts in relevant fields.
- The WHO's Grading of Recommendations Assessment, Development and Evaluation Evidence-to-Decision (GRADE-EtD) framework was utilized.
- Good Practice Statements were developed for areas lacking conventional evidence, incorporating expert experience.
Main Results:
- Comprehensive guidelines were formulated addressing 12 priority clinical questions on pertussis management.
- Recommendations and suggestions were developed considering both Chinese and international contexts.
- Implementation suggestions were tailored to the national situation and policy landscape.
Conclusions:
- The guidelines offer crucial direction for managing the pertussis resurgence in China.
- They aim to improve diagnosis, treatment, and prevention strategies, particularly immunization.
- The target audience includes clinicians, laboratory staff, public health professionals, and policymakers.
Abstract:
The resurgence of pertussis in China has recently attracted much attention. The incidence and burden of pertussis are largely underestimated in China owing to the lack of active pertussis surveillance and insufficient laboratory diagnosis. The high prevalence of macrolide-resistant Bordetella pertussis imposes a major challenge for the management of pertussis cases. To address a series of practice issues regarding pertussis diagnosis, treatment, and prevention, especially immunization practices, a multidisciplinary guideline development group (GDG) consisting of experts in the fields of infectious diseases, pediatric critical care medicine, clinical microbiology, epidemiology, and immunization planning jointly developed the first clinical practice guidelines for pertussis in China. Utilizing the Grading of Recommendations Assessment, Development and Evaluation Evidence-to-Decision framework recommended by the World Health Organization, the GDG formulated corresponding recommendations and suggestions. Good Practice Statements were created for issues not suitable for conventional evidence rating through the presentation of evidence and expert experience. The implementation suggestions for the 12 priority clinical questions given in this paper fully considered Chinese and international experiences as well as the national situation and policy. The primary target audience of these guidelines includes clinicians, microbiology laboratory staff, public health professionals, and policymakers.
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