Pertussis re-emergence in the post-vaccination era.

Elena Chiappini,Alessia Stival,Luisa Galli,Maurizio de Martino

doi:10.1186/1471-2334-13-151

Elena Chiappini, Alessia Stival + Show 2 more

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https://doi.org/10.1186/1471-2334-13-151

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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.

Highlights

Resurgence of pertussis in the post-vaccination era has been reported in Western countries
The development of new highly immunogenic and efficacious pertussis vaccines continues to be a primary objective for the control of pertussis
Aim of the present study is to review and discuss the possible vaccination strategies which can be adopted in Western countries in order to improve the pertussis control

Summary

Introduction

Resurgence of pertussis in the post-vaccination era has been reported in Western countries. Pertussis is still a major public health concern in Western countries where, despite high vaccination coverage, yearly incidence continues to increase and mortality in children under 6 months of age reaches 0.2% [1]. This trend has been reported in Canada, the United States and Australia since the 1980s and in Europe some years later [2]. In the UK in 2012 the highest mortality rate was registered since 1982, with 10 deaths, all occurred in infants under 12 months old [6]. In Europe, 27 countries currently provide national surveillance data for pertussis under

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