Pertussis re-emergence in the post-vaccination era

Abstract

BackgroundResurgence of pertussis in the post-vaccination era has been reported in Western countries. A shift of cases from school-age children to adolescents, adults and children under 1 year of age has been described in the last decade, and mortality rates in infants are still sustained. We aimed to review and discuss the possible vaccination strategies which can be adopted in order to improve the pertussis control, by searches of Pubmed, and websites of US and European Centers for Disease Control and Prevention, between 1st January 2002, and 1st March 2013.DiscussionThe following vaccination strategies have been retrieved and analysed: the cocooning strategy, the immunization of pregnant women and newborns, vaccination programs for preschool children, adolescents, adults and health-care workers. Cost-effectiveness studies provide some contrasting data, mainly supporting both maternal vaccination and cocooning. Adolescent and/or adult vaccination seems to be cost-effective, however data from observational studies suggest that this vaccination strategy, used alone, leads to a reduced pertussis burden globally, but does not affect the disease incidence in infants. Moreover, substantial logistical and economic difficulties have to be overcome to vaccinate the largest number of individuals.SummaryThe simultaneous use of more than one strategy, including cocooning strategy plus vaccination of adolescents and adults, seems to be the most reasonable preventive measure. The development of new highly immunogenic and efficacious pertussis vaccines continues to be a primary objective for the control of pertussis.

Pertussis

“…From an epidemiological point of view, a major role is played by adolescents and adults, who are a significant source of infection for unvaccinated or incompletely immunized newborns/infants in whom the severity of the disease can be serious. [33][34][35][36] Notification-based surveillance of pertussis is affected by a number of limitations that are inherent in passive surveillance systems, including under or delayed reporting and under-diagnosis. Cases involving adolescents and adults are certainly underestimated as are mild/asymptomatic cases in immunized subjects.…”

Improving Immunization Rates in a Hospital-Based Primary Care Practice

“…4 Sporadic outbreaks of vaccine-preventable disease continue to occur, especially in underimmunized populations. [5][6][7] Increasing immunization rates therefore remains a perennial target for quality improvement (QI) in pediatrics. [8][9][10][11][12] Our practice began immunization improvement work in 1996 with the development of a home-grown immunization database.…”

Re: Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review

“…1 Nowadays, general pediatricians must go back to suspect pertussis in infants also in presence of atypical respiratory symptoms, as it occurs in adults more frequently. 3 Very recently, we achieved a diagnosis of pertussis thanks to our overall clinical impression, derived from the combination of clinical aspects, patient's age, vaccination status, and response to previous therapy. A 8-month-old infant was addressed to the Pediatric Department, as she had suffered a persistent/recurrent cough, leading to episodic asthmatic crisis (without significant respiratory distress nor apnea), despite previous therapies, including bronchodilator drugs, steroids, and ␤-lactam antibiotics.…”