Bordetella pertussis in School-Age Children, Adolescents and Adults: A Systematic Review of Epidemiology and Mortality in Europe

Abstract

Pertussis (whooping cough) epidemics persist globally despite high vaccine coverage among infants and young children. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity, resulting in a pool of unprotected adolescents and adults. However, pertussis is generally less severe in adolescents and adults, and this difference in presentation means it can often be unrecognised by healthcare professionals, meaning that it is largely under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology and mortality in school-aged children, adolescents and adults in Europe. A formal statistical comparison (e.g. using meta-analyses) was not possible because of the mix of methodologies reported. There were 69 epidemiological studies and 19 mortality studies identified for review. Over the past decade, the reported incidence of notified pertussis cases varied widely between European countries, which is likely associated with differences in surveillance systems, diagnostic techniques and reporting regulations. However, several studies show that pertussis is circulating among adolescents and adults in Europe, and although pertussis-related morbidity and mortality are highest in infants, there is evidence that adults aged > 50 years are at increased risk. For example, in a hospital-based surveillance study in Portugal, between 2000 and 2015, 94% of hospitalised pertussis cases were infants aged < 1 year, with a case fatality rate (CFR) of 0.8%; however, among hospitalised adult cases of pertussis, the CFRs were 11.5% (aged 18–64 years) and 17.4% (aged > 65 years). Very few European countries currently include pertussis boosters for adults in the national immunisation strategy. In addition to increasing pertussis vaccination coverage in adolescents and adults, mitigation strategies in European countries should include improved diagnosis and treatment in these populations. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00520-9.

Long-Term Immunogenicity upon Pertussis Booster Vaccination in Young Adults and Children in Relation to Priming Vaccinations in Infancy

“…In the Netherlands, the number of reported cases in adolescents and young adults is quite low [ 6 , 34 ]. This might be an underestimation because pertussis generally presents less severe symptoms in adolescents and adults [ 42 ]. From a nationwide serosurveillance study in the Netherlands we know that serum infection prevalence in the studied age groups is approximately 200 times higher compared to the number of reported cases.…”

Control of COVID-19 in China likely reduced the burden of multiple other infectious diseases

“…Pertussis, which is also an IDMTTONR, increased significantly in its incidence in China during the years 2010−2019 (P<0.05 by the Mann-Kendall test), sharing the same resurging trend with many other countries. 5 The incidence declined significantly in 2020 by 56.9−85.1% compared with the numbers of the years 2017−2019 ( Figure 1 C).…”

Willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster – A pre-COVID-19 exploration among the older adult population

“…Additionally, the ability of the immune system to respond to pathogens decreases with age, which makes aging adults even more susceptible for adverse health outcomes [2] , [3] , [4] . Vaccine-preventable diseases such as influenza, pneumococcal disease, pertussis, and herpes zoster may result in severe morbidity, hospitalisation, and even death [5] , [6] , [7] , [8] . Of these infectious diseases, pneumococcal disease is the most prevalent cause of death with 118.300 estimated deaths annually in the European Union (EU), followed by influenza, with 72.000 estimated deaths in the EU [9] , [10] .…”