Pertussis in infants and the resurgence of a vaccine preventable disease: what to do? Commentary.

Pertussis or whooping cough remains one of the most poorly controlled vaccine-preventable diseases across the world. Universal vaccination has dramatically reduced its incidence but has failed to bring it completely under control. In the last decades, changes in pertussis epidemiology have been noted, likely related to the introduction of acellular pertussis vaccines. Increasing incidence is recorded among adolescents and adults who have become a reservoir for transmission to unimmunized infants, who are at risk of severe disease and death. In Italy, experimental evidences suggest a sustained circulation of Bordetella pertussis in the adult population and a significant health burden of pertussis among infants less than six months of age. Public health systems are currently exploring new vaccination strategies, including a cocooning strategy to prevent the transmission of the disease from family members to the newborn and vaccination of pregnant mothers to transmit protective antibodies to the offspring, and neonatal vaccination. An integrated approach for pertussis control and prevention is needed to enhance the current surveillance system and provide an accurate estimate of the real burden of pertussis in our Country, particularly among infants.