Improving vaccination rates in older adults and at-risk groups: focus on pertussis

Abstract

Despite the implementation of effective paediatric vaccination programmes, pertussis remains a global health problem. Disease epidemiology has changed over time, shifting towards the adolescent and adult populations. In adults, the true burden of pertussis is greatly underestimated and pertussis vaccine coverage rates are suboptimal, including individuals with chronic conditions. Here, we report the outcomes of a virtual international scientific workshop to assess the evidence on the burden of pertussis in older adults and identify potential solutions to improve uptake of pertussis vaccines. In adults, pertussis is underdiagnosed in part due to atypical or milder clinical presentation and the lack of testing and case confirmation. However, contemporary epidemiological data denoted an increase in the burden of pertussis among adolescents and adults. This might be related to a variety of reasons including the waning of immunity over time, the lack of booster vaccination, and the improved diagnostic methods that led to increased recognition of the disease in adults. Pertussis sequelae can be severe in older adults, particularly those with existing chronic medical conditions, and the vulnerability of these groups is further enhanced by low pertussis vaccine coverage. Possible measures to increase vaccine uptake include strengthening and harmonisation of immunisation guidelines, healthcare professionals taking a more active role in recommending pertussis vaccination, involvement of vaccination centres and pharmacies in the vaccination process, and improving knowledge of pertussis burden and vaccine efficacy among the general population.

Multidimensional Frailty and Vaccinations in Older People: A Cross-Sectional Study

“…Finally, the lowest vaccination coverage among the four vaccinations was observed for diphtheria-tetanus-pertussis. Even if the vaccination coverage in children against diphtheria-tetanus-pertussis is overall good [35], only one adult in three is protected against these infections [36], and this figure is probably lower in older adults [37]. Our study reported a significantly lower vaccination coverage of vaccination against diphtheriatetanus-pertussis when compared to US data [37].…”

Coping Strategies for Pertussis Resurgence

“…These variants were more toxic and infectious, with greater epidemic selection advantages [ 37 , 38 ]. With the decline in immunity over time and lack of booster vaccination, older people became more susceptible to B. pertussis [ 39 , 40 ]. In particular, the presentation of pertussis was generally less severe in adolescents and adults, which often caused medical professionals to miss out on their diagnosis, making them a potential source of transmission [ 41 ].…”

Understanding the impact of adult pertussis and current approaches to vaccination: A narrative review and expert panel recommendations

“…1 , 8 The molecular pathogenesis of pertussis has been investigated in infants, for whom disease is severe. 22 Adolescents and adults less often present with the classic symptoms of pertussis, because they are usually milder than in children, 17 yet there are limited data available on the pathology of mild or typical pertussis in adults. 23 …”

“…A previous publication examined methods to improve pertussis vaccination in at-risk groups including older adults. 17 The current publication, developed by an international panel of pertussis experts, builds on that article to provide up-to-date perspectives on the burden of pertussis in adults, identify current gaps in the evidence around adult Tdap vaccination, and lay out recommendations for future research directions.…”