Pertussis in Adults: The Hidden Problem in Europe

Pertussis, more commonly known as whopping cough, is a highly infectious respiratory disease transmitted through airborne droplets. The Bordetella pertussis is the causative agent producing toxins that damage the mucous membrane, causing the most common symptom, severe coughing episodes that can last on average 44 days.

Globally there were 150, 000 cases of pertussis in 2018, and in Europe the incidence of pertussis varies from 0.01 to 50 per 100, 000 person- years. Fortunately, pertussis is a vaccine preventable disease and since the introduction of pertussis vaccinations in national immunisation plans, outbreaks started to decrease yet in more recent time there is a need for caution and concern.

A recent study conducted by the University of Turku in Finland found that cases of pertussis among adults aged 40 – 59 years is more common that originally thought. DTP antibodies (diphtheria, tetanus, and pertussis) were collected from participants in 18 European countries to determine vaccine-induced protection. Findings revealed tetanus protection was sufficient, however, data for diphtheria and pertussis indicated severe under protection.

Of the 18 countries studied, pertussis was most commonly found in Norway, France, and Denmark, with the lowest cases in Finland and Hungary. According to Professor Qiushui He the low levels of antibodies indicate that “herd immunity in middle-aged adults is decreasing” and a problem that needs to be addressed by the entire European continent.

Higher rates of pertussis among adults are concerning because pertussis tends to present in an atypical manner in adults and often with greater complications (hemoptysis, pneumonia, rib fractures, etc.), especially for those aged 65 years and over as well as those with chronic obstructive pulmonary disease (COPD).

Traditionally pertussis is commonly referred to as a children’s disease, yet it is clear from emerging trends globally that adults are at risk of contracting this disease with dire consequences. Alarmingly, many countries do not include adult pertussis vaccines as part of national immunisation schedules despite evidence that vaccine-induced protection is not life long.

In line with the Decade of Healthy Ageing, it is important countries introduce policies that work to protect the health of older persons underpinned through a life-course approach. As the findings of this study illustrate, pertussis in adults is a problem that cannot be ignored, and countries need to re-evaluate existing plans to prevent and protect all age groups against this preventable disease.

To learn more about vaccine preventable diseases and adult vaccination please contact:

• Dr Paolo Bonanni, Director of the Specialization School for MDs in Hygiene and Preventative Medicine

• Dr Mine Durusu-Tanriover, Professor of Internal Medicine, Hacettepe University

• Dr Ian Philip, Founder, Age Care Technologies