Reducing the risk of pertussis in newborn infants.

Abstract

Pertussis (whooping cough) is a respiratory tract infection characterised by a paroxysmal cough, caused by Bordetella pertussis, a gram negative coccobacillus. The disease can affect individuals of all ages, even though the most severe complications and mortality occur more frequently in early infancy. Bordetella pertussis is an exclusively human pathogen; hence elimination of the disease by mass vaccination should theoretically be an achievable objective, even though neither natural infection nor vaccination confer permanent immunity. The implementation of well-conducted vaccination strategies in various countries has not prevented the re-emergence of pertussis [1, 2] particularly in 2 age groups: those over 10 years and infants aged less than 5 months [3]. This is the reason why many countries, including Italy, have introduced antipertussis vaccinations for adolescents into the national immunisation schedule. Among the strategies proposed to control pertussis and decrease pathogen circulation, with the aim of reducing the burden of disease in children that have not yet been vaccinated, the international literature presents a number of strategies. Besides the vaccination of adolescents and the replacement of decennial antitetanus and antidiphtheria booster vaccinations with a trivalent diphtheria, tetanus and pertussis vaccine, the “cocoon” strategy is proposed, with the aim to indirectly protect newborn infants through the immunisation of a target population of adults, represented by parents and other potential close contacts, such as grandparents and healthcare workers [4-6]. The goal of this paper is to evaluate the rationale and potential of “cocooning” as a complementary strategy to universal infant and adolescent’s antipertussis vaccination in order to reduce the risk of pertussis in newborn infants, highlighting which healthcare providers are expected to be involved in its implementation.