Given the whooping cough boom, should booster vaccinations be added?

Whooping cough is highly contagious and can be dangerous, especially to newborns. But despite best efforts to vaccinate (the only way to stop cases), cases are rising in our country and abroad. From January 2023 to April 2024, EU countries reported almost 60,000 cases (more than 25,000 in 2023 and 32,000 between January and March 2024). That is, cases that existed in 2021 and 2022 have increased 10-fold, as the European Center for Disease Prevention and Control (ECDC) warns in its latest report. It says that in our country in 2023, the highest incidence was among infants, but at the beginning of 2024, the highest incidence was among children from 10 to 14 years old.

According to a report on the situation of whooping cough in Spain published in April by the National Center of Epidemiology, 9,785 cases (and four deaths: two infants and two elderly people) have been reported since the beginning of 2024, representing an increase in the incidence of whooping cough in Spain. 252% compared to 2023

a year in which 2,780 cases (one death) were reported.

Whooping cough causes epidemics even in countries with high vaccination rates. For this reason, ECDC called on health authorities to strengthen vaccination programs to achieve adequate coverage of the child population, which involves timely provision of primary immunization, as well as the provision of booster doses in accordance with national immunization schedules.

However, booster dose recommendations for adolescents and adults vary by country. Thus, while Croatia, Denmark, Malta, the Netherlands, Portugal and Spain are not considering giving a booster dose to adolescents, while other countries recommend it for adolescents (10-16 years).

Except, 14 countries recommend booster vaccination for adults. In particular, Austria, Belgium, Cyprus, Greece, Italy, Luxembourg, Norway and Poland recommend revaccination every 10 years for adults. In France, on the other hand, people aged 25 to 39 are recommended to receive one dose and then a repeat dose every 10 years. In Liechtenstein and Finland, revaccination is recommended for adults over 25 years of age. In the Czech Republic and Germany, revaccination is recommended for adults.

Given these scattered recommendations, are the recommendations of the current vaccination program in Spain sufficient? According to Javier Alvarez Aldean, pediatrician and member of the Vaccine Committee of the Spanish Association of Pediatrics (AEP), “essentially Spain should not change the current recommendations, although in part it should. That is, not because current recommendations protect the most vulnerable groups by vaccinating pregnant women and at 2, 4, 11 months and 6 years. Now AEP for many years required inclusion of a booster dose in preadolescence.

, since 40% of cases occur in adolescent children. And if possible”at 12 years oldbecause, as the pediatrician explains, this is when they are also vaccinated against the human papillomavirus (HPV) and trevalent against meningococcus.

The vaccines, which have been used in Spain since 2007 to prevent whooping cough, are usually given between the ages of two months and 6 years in four doses. The vaccine is immunogenic and effective, but its protection declines significantly over a period of 5 to 10 years and it has no effect on nasopharyngeal colonization.

When asked whether this would also be recommended for adults, he explains that “in the United States, for example, at least one dose is recommended in adulthood, but this has not yet been considered in Spain.”

According to Jaime Perez, president of the Spanish Association of Vaccinologists, there is no need to change the current recommendations for vaccination against whooping cough in either minors or adults, since “in all countries the incidence has increased significantly and extremely, and this is not the case.” “It depends a lot on your vaccination program.” “There is not a single European country that has not recorded an increase in the number of cases,”

This expert emphasizes for whom vaccination every five or ten years is impossible, because they really are not going to do this, and for whom install single reinforcement (fifth) (in adults or adolescents) “it’s useless.”

Regarding the possibility that the problem is with the vaccine itself, the president of the Spanish Association of Vaccinologists said: “A better pertussis vaccine than the current one is neededwhich does not prevent outbreaks or epidemics.

In this sense, it is worth remembering that acellular vaccines, unlike the first approved vaccines which were whole cell vaccines, only prevent disease and not infection, so they are less effective but have fewer incidences of adverse reactions.

Now, “this step cannot be repeated,” adds Aldean, who explains that “there are other vaccines in the research phase that seem to be better in the medium term, but they are still in the research phase.”