The incidence of the highly infectious respiratory disease named pertussis or whooping cough has been increasing for the past two decades in different countries, as in much of the highly vaccinated world. A decrease in vaccine effectiveness over time, especially when acellular vaccines were used for primary doses and boosters, and pathogen adaptation to the immunity conferred by vaccines have been proposed as possible causes of the resurgence. The contributions of these factors are not expected to be the same in different communities, and this could lead to different epidemiological trends. In fact, differences in the magnitude and dynamics of pertussis outbreaks as well as in the distribution of notified cases by age have been reported in various regions. Using an age-structured mathematical model designed by us, we evaluated how the changes in some of the parameters that could be related to the above proposed causes of disease resurgence - vaccine effectiveness and effective transmission rates - may impact on pertussis transmission. When a linear decrease in vaccine effectiveness (VE) was assayed, a sustained increase in pertussis incidence was detected mainly in infants and children. On the other hand, when changes in effective transmission rates (βij) were made, a dynamic effect evidenced by the presence of large peaks followed by deep valleys was detected. In this case, greater incidence in adolescents than in children was observed. These different trends in the disease dynamics due to modifications in VE or βij were verified in 18 possible scenarios that represent different epidemiological situations. Interestingly we found that both incidence trends produced by the model and their age distribution resemble the profiles obtained from data reported in several regions. The implications of these correlations are discussed.

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Pertussis or whooping cough is a vaccine-preventable respiratory disease that has reemerged in the past decades. A higher morbidity and mortality has been recorded in infants, although cases have also been reported in adolescents and adults. The epidemiological scenario for this condition has urged to review and implement new strategies aimed at improving its control. However, many of these strategies have not been investigated in depth so as to be established as universal. In this context, mathematical models of disease transmission are useful decision-making tools. Using a mathematical model of pertussis, this study assessed the possible impact of the different control measures on the most vulnerable population (0-1 year old infants). In particular, the analysis focused on the impact of including a booster vaccination at 11 years old, the effect of improving the coverage provided by primary doses, and the reduction of any delay in their administration. The assessment also estimated the effect of immunizing pregnant women. Results show that including a booster dose at 11 years reduces the incidence of pertussis by 3% in infants younger than 1 year old. In addition, administering primary doses in compliance with the schedule (with no delays) reduces pertussis incidence by 16%. Increasing coverage from 80% to 95% results in a signifcantly decreased incidence in the vulnerable population (38%). If the percentage of immunized pregnant women reaches 50%, the reduction of the most severe infant cases could be more than 43% (0-2 month-old infants).