The need for pertussis vaccination among older adults and high-risk groups: a perspective from advanced economies of the Asia Pacific region

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© 2021 GlaxoSmithKline Biologicals SA. Published by Informa UK Limited, trading as Taylor & Francis Group.

Table 1. Pertussis vaccination schedules in children and adolescents in 6 countries of the Asia-Pacific region

Country	Age											Year of switch from Pw to Pa
	2 months	3 months	4 months	5 months	6 months	12–15 months	18 months	4 years	6–7 years	10–11 years	12–13 years
Australia	DTaP (D1)^1		DTaP (D2)		DTaP (D3)		DTaP (B1)	DTaP (B2)			Tdap (B3)	1997–1999
Hong Kong	DTaP (D1)		DTaP (D2)		DTaP (D3)		DTaP (B1)		DTaP (B2)		Tdap (B3)	2007
New Zealand	DTaP (D1)^2	DTaP (D2)		DTaP (D3)				DTaP (B1)		Tdap (B2)		2000
Singapore	DTaP (D1)		DTaP (D2)		DTaP (D3)		DTaP (B1)			Tdap (B2)		After 2005^4
South Korea	DTaP (D1)		DTaP (D2)		DTaP (D3)	DTaP (B1)		DTaP (B2)		Tdap (B3)^3		1982
Taiwan	DTaP (D1)		DTaP (D2)		DTaP (D3)		DTaP (B1)		DTaP (B2)		1996

¹Can be given from 6 months of age onwards; ²At 6 months of age; ³At 11-12 years of age; ⁴Both DTPw and DTPa were available in Singapore in 2005. No further information available. D1/2/3: dose 1/2/3; B1/2: booster 1/2; DTaP: diphtheria, tetanus and pertussis (for infants and young children); Pa: acellular pertussis; Pw: whole-cell pertussis; Tdap: tetanus, diphtheria and pertussis (for adolescents and adults)

Figure 1. Pertussis notification data from 6 countries in the Asia-Pacific region Pertussis notification data (number of notifications) from 2001 onwards from government websites of Australia [48], New Zealand [49], Hong Kong [50,63], Singapore [51], South Korea [52] and Taiwan [53,54]. Data presented by age-group where available

Table 2. Prospective studies investigating prolonged cough in adults in South Korea

Reference	Study population	Study year	Diagnosis method	Case definition	% with pertussis
Lee et al., 2015 [72]	Prospective study in adolescents and adults with persistence cough presenting to hospital pediatric or pulmonary departments	2009–11	PCR, culture, serology	Laboratory-confirmed case	76/310 (24.5%) cases 22.4% of cases were aged 61 or older
Park et al., 2012 [73]	Prospective study of adults with ‘bothersome’ cough. 31 primary care clinics and secondary and tertiary referral hospitals nationwide	2009–11	PCR, culture	US CDC case definition	509 clinical cases: 5 (0.7%) confirmed 504 (83.0%) probable
Kwon et al., 2012 [74]	Prospective hospital-based study of household contact of infants with confirmed pertussis	2009–11	PCR, culture, serology	Laboratory- confirmedLaboratory-confirmed case	38/72 (52.8%) of family members laboratory confirmed pertussis
Park et al., 2014 [75]	Prospective study in 22 hospitals of adolescents and adults with ‘bothersome’ cough of ≤30 days duration	2011–12	PCR, culture	US CDC case definition (with no minimum cough duration)	34/490 (6.9%) cases plus 25.0% (5/20) of household contacts of cases. 18.1% of cases were in 60+ year-olds

PCR: polymerase chain reaction;

US CDC: United States Centers for Disease Control and Prevention.

Table 3. Tdap booster recommendations in 6countries of the Asia-Pacific region

Region	Tdap recommendation
Australia [84]	Any adult
	Any adult who needs a tetanus-containing vaccine
	Adults ≥65 years 1 dose if they have not had one in the past 10 years
	Adults who work with children <4 years, all healthcare workers: every 10 years
	Travelers if they have not had a pertussis dose in the past 10 years Pregnant women
Hong Kong [65]	Pregnant women only
Korea [111]	Adults ≥18 years single dose booster if they have not had Tdap Pregnant women between week 27–36 of each pregnancy
New Zealand [88]	Pregnant women, immunocompromised and adults at age 45 (only if they have not previously received 4 tetanus-containing vaccines) and 65 years.
Singapore [112]	Pregnant women only
Taiwan [113]	1 dose of Td every 10 years; 1 dose can be replaced by Tdap Pregnant women between week 28–36 of each pregnancy

Tdap: reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine

Figure 2. Current barriers and suggested solutions to improve Tdap vaccination amongst healthy adults

Figure 3. Plain Language Summary

BOX 1 Conclusions and recommendations of the Expert Advisory Panel

Pertussis is circulating among older adults in countries in Asia Pacific region. Despite data gaps, it is clear that burden of pertussis is underestimated. The current level of evidence is considered strong enough to have ‘individual’ recommendations (physician to patient) for pertussis vaccination of adults aged 65+ years Existing evidence is not strong enough to support recommendation of Tdap vaccination among all adults/high-risk groups. More data are required in terms of Incidence/notification of pertussis, especially in specific populations Cost of hospitalization and social economic impact Impact on frailty and antibiotic resistance Complications of pertussis including cardiac events, cerebral hemorrhage Discussions with patients about Tdap vaccination can be combined with those on influenza and pneumococcal disease vaccination. It is reasonable to consider that patients with chronic respiratory diseases might be at higher risk of severe pertussis disease and of exacerbations of underlying disease. It would be reasonable to implement pertussis vaccination in these patients. Cancer patients on chemotherapy and patients with cardiovascular disease and chronic kidney disease could be the next priorities. Key factors for successful implementation could include: Providing Tdap vaccine to older adult patients as the standard of care by GPs as a starting point Establishing an Immunization Registry for adult vaccinees. Formulation of a ‘Healthy Aging Vaccination Package.’.

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