The importance of pertussis in older adults: A growing case for reviewing vaccination strategy in the elderly

Pertussis

“…From an epidemiological point of view, a major role is played by adolescents and adults, who are a significant source of infection for unvaccinated or incompletely immunized newborns/infants in whom the severity of the disease can be serious. [33][34][35][36] Notification-based surveillance of pertussis is affected by a number of limitations that are inherent in passive surveillance systems, including under or delayed reporting and under-diagnosis. Cases involving adolescents and adults are certainly underestimated as are mild/asymptomatic cases in immunized subjects.…”

Elderly vaccination—The glass is half full

“…Diseases such as influenza, pneumococcal disease and herpes zoster have long been recognized as causing a high burden in the elderly, but evidence is also emerging for other infections such as pertussis being a major cause of the morbidity in this age group [6]. In most countries, acute hospital care consumes >90% of the health budget.…”

“…The exponential rise of herpes zoster incidence after the age of 50, as first described by Hope-Simpson, is thought to reflect the corresponding decline in cell-mediated immunity, with the elderly being at risk for herpes zoster despite commonly having high antibody levels to varicella-zoster virus [27,28]. Immunosenescence combined with the tendency for waning vaccine-induced immunity for many vaccines of importance to the elderly, such as influenza, pneumococcus and herpes zoster [6,25,29], places the elderly at greater risk and poses a challenge that require innovative solutions.…”

Public health measures for pertussis prevention and control

“…The seemingly much lower incidence in adults may be explained by ascertainment bias, since the affected adults are less likely to seek medical attention due to milder disease manifestations. 20 Moreover, limited physician awareness of pertussis in adults may result in the underestimation of the true incidence of pertussis in the non-paediatric population.…”

“…Ridda et al 20 demonstrated that pertussis in the elderly represents a significant public health issue due to its inherent morbidity and mortality, as well as the transmission risk to vulnerable infants.…”