Renewal of whooping cough: strategies and challenges to combat it in Spain

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Introduction

Whooping cough is a respiratory disease caused by Bordetella pertussis that has become a public health problem since the 1990s, with the number of cases increasing significantly worldwide. Although vaccination rates in Spain are high, exceeding 95% for the first three doses, coverage drops to 88.6% for revaccination after 6 years, with some autonomous communities below 80%.

One reason for the resurgence of whooping cough is the limited duration of immunity provided by both the disease itself and vaccination, especially acellular vaccines, which are less effective than whole-cell vaccines.

Vaccination of pregnant women, introduced in 2014 in Catalonia and extended to the rest of Spain in 2016, has proven effective in reducing the risk of serious complications in newborns. However, the final months of 2023 and 2024 saw a significant increase in whooping cough cases, particularly among children aged 10 to 14 years, coinciding with similar increases in the rest of Europe.

Another key issue discussed in the paper is the antigenic evolution of B. pertussis bacteria, which has resulted in mutant strains, some of which lack pertactin, reducing the effectiveness of existing vaccines. These strains can evade the immune response, which has led to recent outbreaks largely associated with the spread of new pertactin-producing strains.

Strategies and challenges for the control of whooping cough in Spain

The authors of the article emphasize the importance of improving vaccination strategies. It is proposed to increase coverage with revaccination at age 6 years and add a new dose in adolescence, around 10-11 years. In addition, it is considered important to assess the need for revaccination in young and older people, especially those at risk, such as people with respiratory diseases or immunodeficiencies, and to provide occupational vaccination for professionals in contact with vulnerable populations.

Finally, the need for research into new vaccines that not only prevent disease but also reduce B. pertussis infection and transmission is emphasized. Vaccines in development, such as BPZE1, administered intranasally, have shown promising results.

Controlling whooping cough requires a comprehensive approach with improved surveillance and education about the importance of vaccination, as well as the implementation of lifelong vaccination strategies to keep this preventable disease under control.

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More information on this website

• CAV-AEP 27 March 2024 Severe whooping cough in newborns and infants is preventable.
• CAV-AEP March 18, 2024 Whooping cough is on the rise: 85% more in two months in 2024 than in all of 2023.
• CAV-AEP, 21 March 2024. Vaccination against whooping cough in Spain.
• KAV-AEP. Pertussis vaccination in AEP’s online immunization guide.
• KAV-AEP. Vaccines during pregnancy in AEP’s online immunization guide.
• KAV-AEP. Whooping cough, under “immune-preventable diseases.”
• KAV-AEP. The whooping cough vaccines in the One by One Vaccines section are intended for families.
• KAV-AEP. Other news about whooping cough and vaccination against it.
• KAV-AEP. Immunizing Health Care Personnel in the AEP Online Immunization Guide.

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