Reemergence of Pertussis in the Highly Vaccinated Population of The Netherlands: Observations on Surveillance Data

Hester E. de Melker, J.F.P. Schellekens, S.E. Neppelenbroek, F.R. Mooi, H.C. Rümke, M.A.E. Conyn-van Spaendonck, National Institute of Public Health and the Environment, Bilthoven, the Netherlands

Disclosures

Emerging Infectious Diseases. 2000;6(4) 

In This Article

Conclusions

The surveillance data support, even if they do not definitively explain, the hypothetical role of antigenic changes in B. pertussis during the 1996 pertussis outbreak in the Netherlands. The indisputable role of whole-cell vaccine in protecting against severe pertussis is clearly shown by the sharp decrease in hospitalizations among children >12 months of age; this protection is also shown by a much smaller pertussis incidence (in the past and at present) in the Netherlands than in countries with large unvaccinated populations[29]. In such countries, 60% of unvaccinated persons have clinical pertussis before the age of 10. This incidence is at least 30 times higher than that in the Netherlands, even if we assume a case-reporting rate of 25% and an incidence similar to that observed during the Dutch epidemic in 1996.

Booster vaccination will be helpful in reducing the incidence of pertussis. However, some acellular vaccines do not contain the antigenic variants of pertactin and pertussis toxin that dominate in Europe[9,23,24]. Furthermore, if pertussis infections are to be postponed until adulthood as a result of boosting, the probability of transmission from adults to young, unvaccinated infants might be greater. The effects of booster vaccination on the epidemiology of pertussis must be monitored carefully, and various surveillance sources must be used to distinguish surveillance artifacts and real epidemiologic effects.

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