Pertussis in Latin America: epidemiology and control strategies

Abstract

Pertussis is a serious respiratory disease in infants that can also affect children and adults. Vaccination against pertussis was introduced in the 1950s and in the 1990s a resurgence of pertussis was observed worldwide. The aim of this work is to summarize the recent data concerning pertussis disease in different countries of Latin America. In this geographic region, pertussis is nationally notifiable and cases should be reported to the appropriate health department/Ministry. Though the surveillance systems are not the same among Latin America countries, over recent decades an increasing number of cases have been detected. Most of these cases correspond to patients younger than 6 months old who received fewer than three doses of vaccine. However, cases in adolescent and adults have also been detected. For this situation, which is not peculiar to Latin America countries, several explanations have been proposed.

Keywords::

• Bordetella pertussis
• epidemiology
• Latin America
• vaccination
• whooping cough

Acknowledgements

The authors would like to thank RU Rodriguez for his critical reading of the manuscript. Daniela Flavia Hozbor is a member of the Scientific Career of CICBA.

Financial & competing interests disclosure

This study was supported by an unrestricted grant from the Americas Health Foundation. LH Falleiros Arlant, ML Avila-Agüero, A de Colsa and J Brea have been invited to lectures and advisory Board meetings by the following industries, in issues related to Vaccines: MSD, Novartis, Sanofi Pasteur, Pfizer, GSK. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Though the surveillance systems differ among Latin American countries, an increasing number of pertussis cases have been detected over the last decades.

• In most of Latin American countries, whole-cell vaccines are used for the primary series. Only Mexico and Costa Rica use acellular vaccines for such doses. The DTP3 coverage was improved in all countries of the region, but there are still some populations with coverage below 80%.

• The strengthening of immunization coverage is essential to control the disease. This strengthening should also focus on avoiding delays in the application of the dose, as these delays have been predicted to have a negative impact on controlling the disease.

• In Latin America, as in other countries, infants younger than 1 year old and particularly those younger than 6 months, bear the largest disease burden.

• Immunization during pregnancy would be the most effective strategy to reduce the impact of pertussis disease in infants. Vaccination during the mothers’ postpartum period may also be an alternative, although possibly with less impact on newborns.

• A new generation of vaccines capable of overcoming the deficiencies reported for current vaccines (low duration of the induced protective immunity, high number of doses needed to achieve adequate protection level, inability to subvert the phenomenon of pathogen adaptation) would improve the control of the disease.

Notes