The Global Pertussis Initiative: meeting report from the fourth regional roundtable meeting, France, April 14-15, 2010.

Despite the widespread availability of 2 classes of effective vaccines, whole cell and acellular, Bordetella pertussis infection remains a global epidemic. Pertussis is primarily a disease of childhood; however, in countries with high vaccine coverage in children, the distribution of cases appears to have shifted to adolescents and adults. The waning of vaccine-induced and naturally acquired immunity underlie these observations. The Global Pertussis Initiative (GPI) is an expert forum that aims to raise awareness about pertussis and to recommend effective vaccination strategies for disease control. This paper reports the proceedings of the Fourth GPI Regional Roundtable Meeting held in France in April 2010, which involved representatives from 21 countries in Central and Eastern Europe, the Middle East and Africa. A 3-dose primary immunization series with a booster dose in the second year is recommended in nearly every country from these regions. Preschool booster doses are also widely recommended in Central and Eastern Europe and the Middle East. Adolescent vaccination has been implemented in the Czech Republic and Hungary. Epidemiological data indicate that adolescent vaccination would be beneficial in several other Central and Eastern European countries but premature in other regions. The cocoon strategy (selective immunization of mothers, family and close contacts of neonates) has not yet been introduced in any country, although the Czech Republic is considering introducing it. There is widespread support for the vaccination of healthcare workers involved with children, although implementation is likely to require educational initiatives and support from employers. In all regions, surveillance systems for pertussis are generally passive and the disease is probably underreported. Adequate diagnostic facilities are lacking in several countries. Improved surveillance and detection will permit a more accurate assessment of the epidemiology of pertussis and the need for vaccination after childhood.