Management and prevention of pertussis infection in neonates

Abstract

Despite the fact that universal immunization against pertussis led to a dramatic decrease in the incidence and mortality in high-income countries, it has left a window of vulnerability for newborns. Although specific guidelines concerning management of neonatal whooping cough have not yet been developed, the present review summarizes the main available recommendations on diagnostic work-up and treatment of neonatal pertussis. Additionally, new prevention strategies are explored, including the use of an additional booster dose of vaccine to adolescents and adults, vaccination of healthcare workers, immunization of household contacts and caregivers (cocooning strategy), vaccination of pregnant women and, finally, neonatal immunization with novel vaccines. These strategies are analyzed and discussed in terms of efficacy, safety and cost–effectiveness.

Keywords::

• cocooning
• diagnosis
• healthcare workers
• maternal immunization
• newborns
• pertussis
• pregnancy
• treatment
• vaccine
• whooping cough

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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

Key issues

• Although universal vaccination against pertussis has caused a significant reduction of overall pertussis incidence and mortality, it leaves a window of vulnerability for newborns.

• Considering the immaturity of the neonatal immune system, several preventive strategies have been proposed to protect newborns. All of these are under debate.

• Vaccinating healthcare workers was found to be effective in reducing nosocomial B. pertussis circulation and preventing pertussis outbreaks in neonatal intensive care unit setting.

• There is no evidence that adding a booster dose of tetanus, diphtheria, acellular pertussis vaccine in adolescents and adults has a significant impact on neonatal pertussis rates.

• Cocooning strategy is limited by suboptimal adherence from families and logistic and financial barriers, and it is difficult to implement. Also, considering the time gap from the contact vaccination to the antibody response development, it might not be effective in preventing pertussis in newborns during their early days of life.

• Maternal vaccination during pregnancy represents the main strategy currently available to prevent neonatal pertussis through maternal specific IgG transferred across the placenta.

• Evidence from clinical trials and preliminary surveillance data suggests that maternal vaccination is safe for pregnant women, fetuses and newborns. It also appears to be effective in protecting newborns against pertussis.

• Surveillance studies on immunization during pregnancy must continue to analyze vaccine effectiveness and safety, the impact on neonatal morbidity and mortality, and serologic interference with infant response to primary immunization.

• Currently, new vaccines are being explored to induce early-life immunity and long-lasting immunological memory starting from birth.