Related Experiment Video
Updated: Aug 5, 2026
Evaluation of Host-Pathogen Responses and Vaccine Efficacy in Mice
Published on: February 22, 2019
Variability in the Diagnostic Criteria for Severe Pertussis: A Systematic Review
Pauline Labe1,2, Alexandre Meunier2, Pauline Leroux1
1Université Paris Cité, Institut Pasteur, Biodiversity and Epidemiology of Bacterial pathogens, Paris, France.
Insights
Severe pertussis (whooping cough) lacks a clear definition, hindering research and interventions. A consensus definition is crucial for better understanding and managing this infant illness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) poses a significant threat to infants.
- The definition of severe pertussis is inconsistently applied in medical literature.
- This lack of standardization impedes research and public health efforts.
Purpose of the Study:
- To analyze the variation in terminology and criteria used to define severe pertussis.
- To highlight the need for a standardized definition in scientific literature.
Main Methods:
- A systematic literature review was conducted using PubMed and Web of Science.
- Studies defining severe pertussis in infants were included from database inception to April 2025.
- Data on terminology, criteria, and study characteristics were extracted and analyzed.
Main Results:
- 78 studies met the inclusion criteria, revealing five distinct terms for severe pertussis.
- Twenty-two different criteria were used, categorized as clinical, biological, or outcome-based.
- Common criteria included respiratory failure, pulmonary hypertension, leukocytosis, death, and ICU admission.
Conclusions:
- Significant heterogeneity exists in the definition of severe pertussis.
- A consensus-based definition is urgently required.
- Standardization will improve understanding, clinical management, research, and public health decision-making.
Importance:
Pertussis, or whooping cough, can be life threatening in infants, yet the concept of severe pertussis remains poorly defined in the literature. Lack of standardization may impair research and public health interventions.
Objective:
To assess the variability in terminology and criteria used to define severe pertussis in the published literature.
Evidence Review:
A systematic review of the literature drawn from PubMed and Web of Science databases was performed. Studies involving infants with pertussis that provided a definition for severe pertussis and published from database inception to April 2025 were included without language restrictions. Study characteristics and detailed definitions of severe pertussis were extracted. Variations in terminology and criteria used across definitions were described.
Findings:
Of the 914 unique studies identified, 133 underwent full-text review, and 78 were included in the study, encompassing 49 observational studies, 22 case reports, 3 case-control studies, and 4 reviews; no randomized clinical trials were included. Five different terms used to define severe pertussis were identified: severe (44 of 78 studies [56%]), malignant (12 of 78 studies [15%]), critical (9 of 78 studies [12%]), fatal (9 of 78 studies [12%]), and fulminant (4 of 78 studies [5%]). Across studies, 22 different criteria were used to define clinical severity, which were classified into 3 categories (ie, clinical, biological, and outcome). The most commonly reported criteria included respiratory failure (40 of 78 studies [51%]), pulmonary hypertension (30 of 78 studies [38%]), leukocytosis (28 of 78 studies [36%]), death (29 of 78 studies [37%]), and intensive care unit admission (29 of 78 studies [37%]).
Conclusions And Relevance:
This systematic review revealed substantial heterogeneity in the definition of severe pertussis in the literature. A consensus-based definition of severe pertussis is urgently needed to improve the understanding of its pathophysiology and to enhance clinical management, clinical research, and public health decision-making.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:14Atypical Pneumonia
01:22Bacterial Meningitis I: Introduction
01:24Chronic Obstructive Pulmonary Disease III: Chronic Bronchitis Features
01:30Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...