Resurgence of Pertussis: Innovative Strategies to Address New Outbreaks in the Pediatric Population

Abstract

Introduction: In recent years, pertussis has resurged despite high childhood vaccination coverage, with disease burden shifting toward adolescents and adults who transmit infection to unimmunized infants. This pattern is linked to waning immunity after acellular vaccines and to genetic changes in Bordetella pertussis.

Objective: To synthesize evidence on prevention, diagnosis, treatment and control of pertussis in children, with emphasis on maternal vaccination and rapid diagnostics.

Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Studies from 2000 onward were searched in major databases and included if they enrolled children, adolescents or pregnant women with infant pertussis outcomes. Two reviewers independently selected studies, extracted data, assessed risk of bias and synthesized findings narratively.

Results: Twenty-three studies were included. The effectiveness of DTaP/Tdap declined progressively after the booster dose and was associated with outbreaks among adolescents. Several studies described circulating lineages with antigenic variation and macrolide resistance. Maternal Tdap vaccination consistently reduced pertussis and related hospitalizations in young infants. Immunochromatographic tests, multiplex PCR panels and LAMP assays showed good performance for rapid diagnosis, but their clinical impact has been little studied.

Conclusions: Control of new pediatric pertussis outbreaks requires an integrated strategy that combines systematic maternal Tdap vaccination, rational booster schedules, stepwise diagnostic algorithms adapted to the level of care, and sustained microbiological and molecular surveillance, together with evaluation of next-generation vaccines aimed at reducing colonization and transmission.