The Present and Future Aspects of Life-Long Pertussis Prevention: Narrative Review with Regional Perspectives for Türkiye

Clinical and Epidemiological Characteristics of Pediatric Pertussis Cases: A Retrospective Study from Southeast Romania

Background/Objectives: Pertussis remains a significant cause of respiratory illness in children, particularly in regions with suboptimal vaccination coverage. This retrospective study analyzes the clinical presentations, co-infections, treatment, and outcomes of pediatric patients diagnosed with Bordetella pertussis at the Constanța County Clinical Emergency Hospital "St. Apostle Andrew" between 1 January and 30 September 2024. Methods: Thirty-eight children, predominantly under the age of 3 years (81.58%), were included. Demographic data, clinical features, coinfecting pathogens, antimicrobial regimens, and hospital outcomes were reviewed. Results: Only 7 out of 38 children (18.42%) had received pertussis vaccination, and none benefited from maternal immunization. The highest incidence occurred in infants under 1 year (44.74%). Intensive care was required in 18.42% of cases, and macrolides were the most frequently used antibiotics (68.42%). Co-detection of respiratory pathogens-particularly Streptococcus pneumoniae, enteroviruses, and human rhinoviruses-was common. Severe cases often exhibited hyperleukocytosis, which was associated with complications such as heart failure. Conclusions: These findings underscore the need for timely recognition and management of pertussis and its complications. Although macrolides remain the first-line therapy, adjunctive treatments like leukoreduction may be considered in critical cases. The persistence of pertussis despite vaccination efforts highlights the challenges posed by waning immunity and diagnostic limitations, reinforcing the need for strengthened public health strategies.

Evaluation of anti-Pertussis antibody levels in Iranian infants and children: Is it time to include booster acellular Pertussis Vaccines in the immunization schedule?

INTRODUCTION

The prevalence of anti-pertussis antibodies among infants and children in Iran has not been thoroughly investigated. Given that recommendations for booster vaccines are based on national disease epidemiology, we aimed to evaluate the seroprevalence of pertussis antibodies among infants and children in an Iranian referral hospital.

MATERIALS AND METHODS

A total of 1012 infants and children were included in the study. Serum samples were stored at -20 °C until analysis. Demographic characteristics of patients, including age, sex, trivalent diphtheria, tetanus, and whole-cell pertussis (DTwP) vaccination status, and time since DTwP vaccination were collected. Anti-pertussis IgG antibodies were measured using a commercial ELISA kit.

RESULTS

In this cross-sectional study, the median age of the participants was 35 months (IQR:9-72 months). In infants ≤2 months, only 15 % had positive anti-pertussis antibodies. This increased to 28 % in the 3 to 4 months group and 55 % in the 5 to 6 months group. The highest positivity rates (63 % and 66 %) were seen in the 7 to 18 months and 19 to 36 months age groups, respectively. Positivity declined to 45 % in the 37 to 72 months group, and 47 % in those over 72 months. A significant relationship was found between the time elapsed since vaccination and anti-pertussis IgG levels (p = 0.005).

CONCLUSION

Our study highlights a concerning prevalence of low anti-pertussis, especially among infants aged ≤2 months, where the majority displayed negative results. This situation underscores the vulnerability of newborns to pertussis due to insufficient immunity and emphasizes the urgent need for effective maternal vaccination strategies. Additionally, we observed a decline in anti-pertussis IgG levels after 36 months, raising concerns about waning immunity in older children. Continued research is crucial to evaluate the long-term efficacy of booster vaccines and to develop optimal vaccination strategies to protect infants and children from pertussis.

Real-Life Insights into Pertussis Diagnosis: High Yield of PCR Testing and Clinical Outcomes-An Emerging Old Enemy or Just a Sign of PCR Times?

Background/Objectives: Pertussis remains a significant public health concern despite effective vaccines due to diagnostic challenges and symptom overlap with other respiratory infections. This study assesses the prevalence of Bordetella pertussis using advanced polymerase chain reaction (PCR) testing and examines the clinical outcomes over a one-month follow-up. Methods: We conducted a cross-sectional study at the University Hospital of Larissa, Greece, from April to June 2024, collecting 532 nasopharyngeal swabs from patients with respiratory symptoms. Diagnostic testing utilized the BioFire® Respiratory 2.1 Plus Panel. Demographics, clinical presentations, vaccination histories, and clinical outcomes were systematically recorded and analyzed. Results: Of 532 patients, 47 (8.8%) were diagnosed with pertussis. The mean age was 61.87 ± 13.4 years; 57.4% were female. Only 12.8% had contact with known pertussis patients. Regarding vaccination history, 36.2% had received diphtheria, tetanus, and pertussis vaccines, with the last dose administered an average of 46 years prior to this study. The primary symptom was cough (100%), with additional symptoms including fever (36.2%) and paroxysmal cough (34%). Six patients (12.8%) required hospitalization due to pneumonia and severe respiratory failure. All patients received successful treatment; however, 23.4% reported persistent post-infectious cough at the one-month follow-up. Conclusions: PCR testing significantly improved the diagnosis of pertussis among adults presenting with respiratory symptoms. The findings highlight the need for updated vaccination strategies and improved diagnostic protocols to effectively manage pertussis and reduce its public health impact.

Development and validation of a diagnostic prediction model for children with pertussis

To develop and validate a diagnostic prediction model based on blood parameters for predicting the pertussis in children. A retrospective study of 477 children with suspected pertussis at Zigong First People's Hospital was performed between January 2020 and December 2021. The patients were randomly divided into training cohort and validation cohort. Stepwise regression and R software was performed to develop and validate the model. Stepwise regression analysis showed that white blood cell (WBC), hematocrit (HCT), lymphocyte (LYMPH), C-reactive protein (CRP) and platelet distribution width to mean platelet volume ratio (PDW-MPV-R) were found to be independent factors associated with pertussis. The model containing WBC, CRP and PDW-MPV-R had the best performance. The area under curve (ROC, 0.77 for the training cohort and 0.80 for the validation cohort) of the model indicated satisfactory discriminative ability. The sensitivity and specificity of the model were 72.1% and 72.6% in training cohort and 74% and 72.1%, respectively, in validation cohort. Based on the ROC analysis, calibration plots, and decision curve analysis, we concluded that the model exhibited excellent performance. A model based on blood parameters is sufficiently accurate to predict the probability of pertussis in children, and may provide some reference for clinical decisions.

Pertussis outbreak in neonates and young infants across Italy, January to May 2024: implications for vaccination strategies

Since January 2024, Italy experiences a pertussis outbreak, primarily affecting neonates and unvaccinated infants at high risk of severe complications and mortality; 11 major paediatric centres noted 108 hospitalisations and three deaths by 10 May. The outbreak reflects increased circulation of Bordetella pertussis and non-adherence to immunisation recommendations during pregnancy. Public health interventions, including maternal immunisation, vaccination of infants as early as possible and post-exposure prophylaxis, are critical for reducing the burden of pertussis and preventing further mortality.