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Whooping Cough Still More Common Than Previously Thought

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Although vaccination programmes against pertussis are very effective in Europe, new Finnish study shows that the disease is still very common among middle-aged adults in various European countries. At the same time, the results show that the disease is underdiagnosed as the annually reported figures are considerably lower than those discovered in the study.

The primary cause of pertussis, also known as whooping cough, is the Bordetella pertussis agent which spreads through the respiratory mucosa and produces toxins that damage the mucous membrane. These toxins incapacitate the body’s defence mechanisms and the infection is marked by severe, spasmodic coughing episodes. Pertussis is often categorised as a childhood disease, but adults can also contract it.

Before the vaccination programmes, whooping cough was one of the deadliest childhood diseases. In Finland, the vaccinations started in 1952, and the pertussis vaccination is included in the national DTP vaccination programme. Even though the vaccination programmes are effective in Europe, the number of pertussis cases has increased in several countries. 200–500 whooping cough cases are reported in Finland each year, while globally there were over 150,000 reported cases in 2018.

The University of Turku in Finland leads an extensive European follow-up study on pertussis, diphtheria and tetanus. The study is part of the EUPert-LabNet laboratory network funded by the European Centre for Disease Prevention and Control (ECDC). The EUPert-LabNet network is led by the Head of Finnish National Reference Laboratory for Pertussis and Diphtheria, Professor Qiushui He from the University of Turku. 18 European countries have participated in the study.

– To our best knowledge, this is the largest follow-up study in Europe since the DTP vaccines were introduced. On the basis of the results, whooping cough seems to be more common in Europe than previously thought. The disease was most common in Norway, France and Denmark, and most uncommon in Finland and Hungary, says Professor He and continues:

– A very alarming finding in our research was the low levels of antibodies against diphtheria in many European countries. This clearly indicates that the herd immunity in middle-aged adults is decreasing. Attention should be paid to this matter in the entire Europe.

– On the other hand, antibodies against tetanus are on a sufficient level in different European countries, says He.

Berbers G, van Gageldonk P, Kassteele J van de, et al. Circulation of pertussis and poor protection against diphtheria among middle-aged adults in 18 European countries. Nature Communications. 2021;12(1):2871. doi:10.1038/s41467-021-23114-y

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