Pertussis is a highly contagious respiratory disease that affects people of all ages. young infants and people with comorbidities are at higher risk of infection and may suffer more severe outcomes. 1-5
One infected person can infect up to 17 other individuals.2
Pertussis (R0= 15-17) is more contagious than other respiratory diseases like influenza (R0=1- 2)6 and covid-19 (R0=2-8).7*
*estimates vary in current dynamic pandemic setting
A vaccination coverage ≥90% in infants is needed to provide an adequate pertussis protection within the infant population.8
Young infants are at increased risk for serious complications of pertussis, including otitis media (middle ear infection), pneumonia, seizures, apnea (breathing problems), encephalopathy (brain disease), and pulmonary hypertension (high blood pressure that affects the arteries of the lungs and heart).2
Adults with comorbidities, such as chronic respiratory diseases, may also suffer from severe consequences. 3-5
Worldwide, cases of pertussis continue to be reported in all age groups during covid-19 pandemic.9-11
Despite a considerable reduction of pertussis transmission in 2020, probably due to the implementation of social distancing measures and high focus on covid-19 detection, pertussis cases were still reported. 9-11
- for example, in the US 5,402 cases of pertussis were reported in 2020 compared to 18,778 cases reported in 2019 where there were no social distancing measures.11
Pertussis cases reported in 2020 were primarily in adolescents and adults. 9-11
While co-infection with any other infectious diseases is very rare in pertussis patients, recent studies in France and China reported a few patients coinfected with covid-19 and pertussis. 12
Co-infection of covid and pertussis can complicate disease management and treatment of both diseases. 14
Immunization services against pertussis were disrupted during the pandemic, leading to a great number of missed vaccinations across all ages. 15,16,17,18-19
In 2020, DTP3 (diphtheria, tetanus toxoid and pertussis) vaccine coverage was around 76%. this was almost 8% less than the expected coverage before the covid-19 pandemic.15
It is estimated that during 2020, 8.5 million children missed doses of DTP3 vaccine for reasons related to the covid-19 pandemic.15
In the US, vaccination against pertussis decreased by 26% from January –September 2020 vs 2019 in children younger than 6 years old. 16
In the US, Tdap doses administered to adolescents aged 13–17 decreased a median of 61% during march-may 2020 compared to previous years. 17
The situation improved only partially after most social distancing measures had been lifted (median of 30% decrease).17
There has not been any increase in the number of doses administered above pre-pandemic levels, which indicates that adolescents that missed their vaccinations during lockdown periods remain unprotected.17
In the US, weekly vaccination rates among people aged ≥65 years dropped sharply during national lockdowns.18
During a survey conducted by the WHO more than one-third of 135 countries reported they were still experiencing disruptions to immunization services in Q1 2021.19
Due to the high transmission rates, a decrease in vaccination coverage can lead to pertussis outbreaks.16
A US study shows a 2.5 times higher risk of pertussis outbreaks occurring in under-vaccinated communities.20
Increases in pertussis cases may put at risk vulnerable individuals, such as young infants, and adults with chronic respiratory conditions.1-5
Infants are the most vulnerable to pertussis disease and can suffer the majority of severe complications. 21-22
Approximately half of infants under 3 months diagnosed with pertussis require hospitalization. 21-22
- > 80% of pertussis deaths occur in infants before they have completed their first immunizations. 23-26
- Asthma patients have up to 4 times greater risk of getting pertussis compared with people without asthma. 4,27
Patients with COPD have up to 3.5 times greater risk of getting pertussis compared with people without asthma. 4,27
From adult patients hospitalized with pertussis 26% had asthma and 19% COPD.5
Vaccinating pregnant women with Tdap is the most effective way to protect infants from birth until they complete their primary immunizations 28
There is a protection gap between birth until the completion of their primary immunizations, when young infants are most vulnerable to pertussis disease.28-29
When a pregnant woman gets vaccinated against pertussis, her body produces antibodies which are transferred through the placenta to the fetus. At birth, the antibodies developed during pregnancy help protect newborns from pertussis during their first months of life.30-31
Vaccinating women during pregnancy – in the 2nd or 3rd trimester - has been proven to reduce the rate of pertussis deaths by over 90% in infants up to 2 to 3 months of age.32-35
WHO recommends tetanus-diphtheria-acellular pertussis (Tdap) vaccination during the 2nd or 3rd trimesters of pregnancy to protect young infants from pertussis. 36 Large observational and database studies of mothers and infants show that Tdap vaccination during pregnancy demonstrates a favorable safety profile in both pregnant women and their newborns.37-40
Primary immunizations should continue without delay in the context of covid-19 to ensure the protection of infants against pertussis.41
WHO recommends a three-dose primary series diphtheria-tetanus-pertussis (DTP3) starting at 6 weeks of age.42
in case of disruption of primary immunizations due to covid-19, strategies must be implemented to catch up infants with their pertussis vaccinations.41
Maintaining the continuity of infant vaccination contributes to herd immunity against pertussis.
High DTaP vaccination coverage has been demonstrated to provide protection to vaccinated and under-vaccinated individuals. 43
After their primary and toddler booster immunizations it is recommended that children receive a pertussis containing booster vaccine at school-entry to remain protected and avoid the spread of the disease to younger infants. 42,44-45
Vaccination against pertussis for adolescents and adults should remain a priority during the covid-19 period.41
Even though childhood vaccines are effective against pertussis, adolescents and adults need to be up to date with their booster vaccinations to remain protected. 3
The best way to reduce the burden of pertussis disease is by vaccination with a Tdap vaccine, which induces a booster immune response in the majority of adults.46-47
Pertussis prevention may prevent an extra burden in the healthcare systems since severe cases during the pandemic can lead to the use of resources that would be otherwise used in the fight against covid-19.41
- World Health Organization. Pertussis Vaccines - WHO Position Paper Weekly Epidemiological Record. 2015;90:433-460.
- Kilgore Pe, Salim Am, Zervos Mj, Schmitt Hj. Pertussis: Microbiology, Disease, Treatment, And Prevention. Clin Microbiol Rev. 2016;29:449-486. Mat-glb-2103026.v1. October 2021
- De Serres G, Shadmani R, Duval B, Et Al. Morbidity Of Pertussis In Adolescents And Adults. J Infect Dis. 2000;182:174-179.
- Jenkins VA, Savic M, Kandeil W. Pertussis in High-Risk Groups: An Overview of the Past Quarter Century. Hum Vaccin Immunother. 2020:1-9.
- Mbayei SA, Faulkner A, Miner C, et al. Severe Pertussis Infections in the United States, 2011- 2015. Clinical Infectious Diseases. 2018:ciy889-ciy889.
- ECDC. Questions and answers on seasonal influenza. Available at https:// www.ecdc.europa.eu/en/seasonal-influenza/facts/questions-and-answers-seasonalinfluenza
- Yi. Liu, J. Rocklöv. The reproductive number of the Delta variant of SARS-CoV-2 is far higher compared to the ancestral SARS-CoV-2 virus. Journal of Travel Medicine, 2021, 1–3
- Plans-Rubió, P. Vaccination Coverage for Routine Vaccines and Herd Immunity Levels against Measles and Pertussis in the World in 2019. Vaccines 2021, 9, 256. https://doi.org/10.3390/vaccines9030256
- Public Health England. Laboratory confirmed cases of pertussis in England: October to December 2020. Health Protection Report. 2021; 15(8)
- Australian Government Department of Health. Number of notifications of Pertussis, Australia, in the period of 1991 to 2020 and year-to-date notifications for 2021. Accessed June 2021 http://www9.health.gov.au/cda/source/rpt_3.cfm
- CDC. Nationally Notifiable Infectious Disease and Conditions, United States: Weekly Tables. Available at: https://wonder.cdc.gov/nndss/nndss_weekly_tables_menu.asp?comingfrom=202052&saved mode=&mmwr_year=2020&mmwr_week=53 (Accessed September 2021).
- He F et al. Respiratory bacterial pathogen spectrum among COVID-19 infected and non-COVID19 virus infected pneumonia patients. Diagn Microbiol Infect Dis. 2020;98(4)
- Hussain M et al. Co-infection et surinfection bactérienne chez les patients hospitalisés pour COVID-19: une étude rétrospective monocentrique. Med Mal Infect. 2020;50(6S)
- Kow CS & Hassan SS. Macrolides for patients with COVID-19 and concurrent pertussis infection. Diagn Microbiol Infect Dis. 2021 Feb; 99(2)
- Causey K, Fullman N, et al. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet. 2021 Jul 14:S0140-6736(21)01337-4. doi: 10.1016/S0140-6736(21)01337-4.
- Feldman, A.G., O’Leary, S.T. and Isakov, L.D. (2021). The Risk of Resurgence in Vaccine Preventable Infections Due to COVID-Related Gaps in Immunization. Clinical Infectious Diseases.
- US Department of Health and Human Services/Centers for Disease Control and Prevention. Morbidity and mortality weekly report. June 11, 2021 / Vol. 70 / No. 23
- US Department of Health and Human Services/Centers for Disease Control and Prevention. Morbidity and mortality weekly report. February 19, 2021 / Vol. 70 / No. 7
- WHO. Pulse survey on continuity of essential health services during the COVID-19 pandemic. April 2021. https://www.who.int/docs/default-source/coronaviruse/finalupdate_22-april2021_summary-ppt_ehs-pulse-survey_second-round.pdf?sfvrsn=a965e121_8. Accessed October 2021.
- Atwell JE, Van Otterloo J, Zipprich J, Winter K, Harriman K, Salmon DA, Halsey NA, Omer SB. Nonmedical vaccine exemptions and pertussis in California, 2010. Pediatrics. 2013 Oct;132(4):624-30. doi: 10.1542/peds.2013-0878. Epub 2013 Sep 30. PMID: 24082000.
- Choe YJ, Park YJ, Jung C, Bae GR, Lee DH. National Pertussis Surveillance in South Korea 1955- 2011: Epidemiological and Clinical Trends. Int J Infect Dis. 2012;16:e850-854.
- Centers for Disease Control and Prevention. 2016 Final Pertussis Surveillance Report. https://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2016.pdf. Last updated: 5 Jan 2018. Accessed 12 May.
- Straney L, Schibler A, Ganeshalingham A, et al. Burden and Outcomes of Severe Pertussis Infection in Critically Ill Infants. Pediatr Crit Care Med. 2016;17:735-742.
- Kaczmarek MC, Ware RS, McEniery JA, Coulthard MG, Lambert SB. Epidemiology of PertussisRelated Paediatric Intensive Care Unit (Icu) Admissions in Australia, 1997–2013: An Observational Study. 2016;6:e010386.
- Murray EL, Nieves D, Bradley JS, et al. Characteristics of Severe Bordetella Pertussis Infection among Infants ≤90 Days of Age Admitted to Pediatric Intensive Care Units - Southern California, September 2009-June 2011. J Pediatric Infect Dis Soc. 2013;2:1-6.
- Winter K, Zipprich J, Harriman K, et al. Risk Factors Associated with Infant Deaths from Pertussis: A Case-Control Study. Clin Infect Dis. 2015;61:1099-1106.
- Buck PO, et al. Epidemiol Infect. 2017;145(10):2109-2121.
- Forsyth K, Plotkin S, Tan T, Wirsing von Konig CH. Strategies to Decrease Pertussis Transmission to Infants. Pediatrics. 2015;135:e1475-1482.
- Rocha G, Flor-de-Lima F, Soares P, et al. Severe Pertussis in Newborns and Young Vulnerable Infants. Pediatr Infect Dis J. 2013;32:1152-1154.
- Munoz FM, Jamieson DJ. Maternal Immunization. Obstet Gynecol. 2019;133:739-753. MATGLB-2100736-v.1.0-06/2021
- Halperin SA, Langley JM, Ye L, et al. A Randomized Controlled Trial of the Safety and Immunogenicity of Tetanus, Diphtheria, and Acellular Pertussis Vaccine Immunization During Pregnancy and Subsequent Infant Immune Response. Clin Infect Dis. 2018;67:1063-1071.
- Amirthalingam G, Campbell H, Ribeiro S, et al. Sustained Effectiveness of the Maternal Pertussis Immunization Program in England 3 Years Following Introduction. Clin Infect Dis. 2016;63:S236-S243.
- Baxter R, Bartlett J, Fireman B, Lewis E, Klein NP. Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis. Pediatrics. 2017;139.
- Dabrera G, Amirthalingam G, Andrews N, et al. A Case-Control Study to Estimate the Effectiveness of Maternal Pertussis Vaccination in Protecting Newborn Infants in England and Wales, 2012-2013. Clin Infect Dis. 2015;60:333-337.
- Skoff TH, Blain AE, Watt J, et al. Impact of the Us Maternal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Program on Preventing Pertussis in Infants >2 MONTHS OF AGE: A CASE-CONTROL Evaluation. Clin Infect Dis. 2017;65:1977-1983.
- WHO SAGE pertussis working group. Report from the Sage Working Group on Pertussis Vaccines. SAGE, 2014.
- DeSilva M, Vazquez-Benitez G, Nordin JD, et al. Maternal Tdap Vaccination and Risk of Infant Morbidity. Vaccine. 2017;35:3655-3660.
- Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Evaluation of the Association of Maternal Pertussis Vaccination with Obstetric Events and Birth Outcomes. JAMA. 2014;312:1897-1904.
- Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Maternal Tdap Vaccination: Coverage and Acute Safety Outcomes in the Vaccine Safety Datalink, 2007-2013. Vaccine. 2016;34:968-973.
- Layton JB, Butler AM, Li D, et al. Prenatal Tdap Immunization and Risk of Maternal and Newborn Adverse Events. Vaccine. 2017;35:4072-4078.
- World Health Organization, United Nations Children’s Fund (UNICEF). Immunization in the context of COVID-19 pandemic. Frequently Asked Questions (FAQ). Accessed April 16, 2021. https://lion.app.box.com/file/801347593827
- World Health Organization. Summary of WHO Position Papers - Recommendations for Routine Immunization. September 2020. Accessed June 2021 immunization-routine-table1.pdf (who.int)
- Rane MS, Halloran ME. Estimating population-level effects of the acellular pertussis vaccine using routinely collected immunization data. Clin Infect Dis. 2021 Apr 21:ciab333. doi: 10.1093/cid/ciab333.
- Jardine A, Conaty SJ, Lowbridge C, Thomas J, Staff M, Vally H. Who gives pertussis to infants? Source of infection for laboratory confirmed cases less than 12 months of age during an epidemic, Sydney, 2009. Commun Dis Intell QRep. 2010;34(2):116
- Skoff TH, Kenyon C, Cocoros N, et al. Sources of Infant Pertussis Infection in the United States. Pediatrics.2015;136(4):635-41. doi: 10.1542/peds.2015-1120
- Blatter M, Friedland LR, Weston WM, Li P, Howe B. Immunogenicity and Safety of a Tetanus Toxoid, Reduced Diphtheria Toxoid and Three-Component Acellular Pertussis Vaccine in Adults 19-64 Years of Age. Vaccine. 2009;27:765-772.
- Pichichero ME, Rennels MB, Edwards KM, et al. Combined Tetanus, Diphtheria, and 5- Component Pertussis Vaccine for Use in Adolescents and Adults. Jama. 2005;293:3003-3011.