Pertussis in the Post-COVID-19 Era: Resurgence, Diagnosis, and Management

Abstract

Pertussis is endemic worldwide, with epidemics occurring every 2 to 5 years despite a high vaccination coverage. After limited circulation during the coronavirus disease 2019 (COVID-19) pandemic, pertussis cases have increased rapidly worldwide since mid-late 2023, returning to pre-pandemic patterns. In Korea, 90 cases of pertussis were reported from April 2020 to May 2023, with elderly individuals aged ≥65 years accounting for 48.9%. Pertussis cases have increased sharply since June 2024, showing a nationwide epidemic, with a large increase among adolescents aged 13-15 years. As of August 2024, the national incidence rate of pertussis was estimated to be 37.75 per 100,000 population, with the highest incidence of 526.2 per 100,000 population in 13-year-olds. In Europe, during 2023-2024, an increase in pertussis incidence among infants was observed, along with large increases in 10-19-year-olds. In China, the number of reported cases of pertussis has increased rapidly since late 2023, with an age shift to older children, increase of vaccine escape, and a marked increase in the prevalence of macrolide-resistant Bordetella pertussis. The recent global resurgence of pertussis is due to decreased opportunities for boosting immunity by natural infection during the COVID-19 pandemic in combination with waning of immunity-induced pertussis vaccines.

Keywords: Bordetella pertussis; Epidemiology; Whooping cough.

Figure 1. Annual number of notified pertussis cases (both laboratory-confirmed and clinically suspected cases) from 2001 to August 2024. Data were obtained from the infectious disease portal of the Korea Disease Control and Prevention Agency.

^aProvisional data. Available at: https://dportal.kdca.go.kr/pot/is/summaryEDW.do . (Accessed 2 September 2024).

Figure 2. Annual number of notified pertussis cases from 2011 to 2023 (A) and incidence rate of pertussis (per 100,000 population) by regions (B-E).

Figure 3. Age distribution of notified pertussis cases in Korea from 2001 to August 2024.

Figure 4. Incidence rate of pertussis by age group in Korean pediatric population. (A) From 2011 to 2023. (B) As of August 2024.

Figure 5. Occurrence of pertussis in Korea from January to August 2024. (A) Number of cases by week. (B) Number of cases by region. (C) Incidence rate of pertussis by region.

Map source: Statistics Korea. Statistical Geographic Information Service. Available at: https://sgis.kostat.go.kr/statexp/view/index.