Abstract
In March 2019, a pertussis outbreak occurred in children in a junior school (7–11 years) in England who had been offered pertussis-containing booster vaccine at 40 months of age. In a case–control investigation, we assessed the extent of transmission and any difference in protection afforded to those who had previously received a booster 3- or 5-component acellular pertussis vaccine (aP). We took oral fluid specimens from the students to determine IgG antibodies against pertussis toxin (anti-PT). Parents of students attending the school were sent a questionnaire on pertussis symptoms and vaccination status was retrieved from general practitioner records for all students. Of 381 students, 134 (35.2%) were classified as pertussis cases, 133 by demonstration of significant anti-PT IgG titres and one clinically. There was no significant difference in the risk of pertussis between students receiving 3-component (33.7%) or 5-component (32.3%) aP boosters. However, pertussis infection differed significantly in school year 4, with 22.9%, 50.0%, 23.7% and 38.1% pertussis cases in years 3, 4, 5 and 6, respectively. The proportion of students with incomplete vaccinations recorded was higher than the proportion of those not covered according to the national reported coverage, possibly contributing to sustained transmission within the school.
Highlights
Whooping cough is a highly contagious bacterial infection caused by a Gram-negative bacterium Bordetella pertussis that is transmitted by aerosol droplets
Oral fluid samples were offered to all students in the junior school and were collected by the local Health Protection Team (HPT) and sent to the pertussis National Reference Laboratory to test for IgG antibodies against pertussis toxin at Public Health England (PHE)’s National Infection Service in Colindale, London
Of these 427 students, 384 completed the clinical questionnaire, had an oral fluid test, and vaccination history was obtained from their general practitioner (GP) records (Figure 1)
Summary
Whooping cough (pertussis) is a highly contagious bacterial infection caused by a Gram-negative bacterium Bordetella pertussis that is transmitted by aerosol droplets. Pertussis symptoms typically last up to 3 months and include low-grade fever, coughing with ‘whooping’ sound in some infants and vomiting [1,2]. There are an estimated 50 million cases of pertussis annually with the highest incidence rate and a high number of pertussis-related deaths in infants younger than 4 months [1]. In an attempt to improve the control of pertussis, a number of countries have included additional booster doses beyond preschool [3]. Despite offering booster vaccinations before school entry and in adolescence, outbreaks in primary schools have been noted in such countries, including China, Germany and the United States [4,5,6]
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