Pertussis in Latin America and the Hispanic Caribbean: a systematic review

ABSTRACT

Introduction: Pertussis in Latin America continues to cause periodic epidemics with substantial morbidity particularly among young children. The disease has persisted despite long-standing vaccination programs in the region.

Areas covered: We conducted a systematic review to characterize the recent epidemiology of pertussis in Latin America and Hispanic Caribbean. We undertook a holistic approach and attempted to include all available data concerning pertussis that may explain the changing dynamics of the disease.

Expert opinion: There are wide disparities in the reported annual incidence rates of pertussis both within and between countries in the region. General trends in pertussis incidence are difficult to ascertain due to the heterogeneity in the epidemiological data. Available data suggests that the disease burden has changed over the years such that now it predominantly affects those <1 year. Coverage with three doses of the pertussis vaccine has been highly variable, and very few countries have consistently achieved ≥90% coverage annually since 2000. There remain inequalities in vaccination coverage in some regions/localities and specific groups, which sustains the risk of pertussis dissemination. The WHO considers that maternal pertussis immunization provides protection to infants too young to be vaccinated; >10 Latin American countries currently recommend vaccination of pregnant women.

KEYWORDS:

• Pertussis
• surveillance
• whooping cough
• acellular
• whole-cell
• vaccine

Article Highlights

• Pertussis continues to be a cause of significant morbidity in Latin America and the Hispanic Caribbean, especially in children aged <1 year.

• The incidence of reported pertussis has been highly variable both within and between countries, which may be influenced by differences in surveillance performance and case definitions, and changes in laboratory methodologies in confirming cases.

• DTP3 coverage in the region has been highly variable between countries and very few have consistently achieved ≥90% coverage annually since 2000.

• Booster coverage rates in second year of life and for preschool aged children are low and need to be improved considering the limited duration of protection provided by both wP and aP vaccines.

• There remain inequalities in vaccination coverage in some regions/localities and specific groups (e.g. indigenous populations and immigrants) within countries, which sustain the risk of pertussis dissemination.

• Delays in DTP vaccination may overestimate the success of vaccination programs with regard to timeliness; the WHO recommends that pertussis vaccination should start no later than 8 weeks of age.

• Vaccines containing wP appear to be responsible for most AEFI reported through pharmacovigilance, but the impact of public perception and acceptability of the safety of these vaccines on uptake and coverage has not been assessed.

• Studies are required to assess the reasons for delayed vaccinations to allow for strategies to be developed that ensure timely pertussis vaccination.

• Maternal vaccination provides protection among infants too young to be vaccinated or receive the full three primary doses and is recommended in a number of countries in the region (Costa Rica, El Salvador, Panama, Mexico, Colombia, Argentina, Brazil, Chile, Paraguay, Uruguay and Suriname).

• Maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants.

• The cocooning strategy, to increase herd immunity, is recommended in few Latin American countries, but its impact and cost-effectiveness would be substantially lower than maternal immunization.

Acknowledgments

The authors also thank Burnedette Rose Hill for editorial assistance and manuscript coordination on behalf of Sanofi Pasteur.

Declaration of interest

L Brickes and E Sarti are employees of Sanofi Pasteur. RA Kfouri and R Ulloa-Gutierrez have received honorary fees from Sanofi Pasteur as invited speakers at pertussis related meetings. Writing assistance, provided by Richard E Glover (inScience Communications, Springer Healthcare), was utilized in the production of this manuscript and funded by Sanofi Pasteur. 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This paper was funded by Sanofi Pasteur.