In the first six weeks of this year, there was a whooping cough outbreak in Spain. More than 2,500 cases of whooping cough were reported in that time, compared to 2,211 in 2023. In 2022, there were only 241 infections. The infection is caused by the bacterium Bordetella pertussis.
This is according to provisional figures from the bulletins of the Instituto de Salud Carlos III. The main outbreak was in Guadalajara, where some 500 cases have already been reported. In addition, there have been significant outbreaks in the provinces of Barcelona, Madrid, Seville and Albacete.
Whooping cough outbreak comes in waves
Whooping cough has epidemic waves that occur every three to five years. The disease is characterised by a prolonged, dry cough that usually ends in whooping cough. That’s why it’s known as the “100-day cough,” although it only takes 14 days to establish a suspected case. “It’s not a problematic disease from an epidemic point of view, but it’s annoying,” says Javier Álvarez Aldeán, a member of the Vaccine Advisory Committee of the Spanish Society of Pediatrics. “We don’t have problems with whooping cough in hospitals like we had with RSV until the advent of the vaccination,” he continues. Especially not after the start of vaccination in pregnant women in 2016. The first dose in children is given between 2 and 4 months, so vaccinating pregnant women protects during the first three months of the child’s life.
Whooping cough can be dangerous for babies
However, the disease is not completely harmless. In 2016, there were 952 hospital admissions due to Bordetella pertussis, in 2017 there were 628. The trend continued to decline until 2021, with 62 admissions, but in 2022 – the last year with data – it rose again.
A report on the impact of whooping cough in Spain between 2005 and 2020, estimates that 91.7% of hospitalisations occur in children under 1 year of age. The number of hospitalisations in this age group is 100 times higher than in children aged 1 to 4 years. And 1000 times higher than in children aged 5 to 14 years. Fifty deaths were counted during this period, all in infants under 3 months of age.
Extra boost needed
The report also concludes that pertussis “remains a common disease. Who needs better vaccines that can reduce the circulation of Bordetella pertussis”.
Fernando Moraga-Llop, pediatrician and spokesman for the Spanish Society of Vaccinology, explains that vaccination against whooping cough began in 1965, Since the beginning of the 21st century, an “acellular vaccine, which contains only three components of the bacterium, has been given. It is therefore less reactogenic, but also less immunogenic. This means that the protection offered by the vaccine lasts for a shorter period of time.
Therefore, the Spanish Society of Pediatrics recommends including an additional booster at age 14 in the current schedule. That now consists of a first dose at 2-4 months, a second at 11 months and a third at 6 years of age. At the moment, only Asturias offers a new booster at the age of 13.
Intranasal pertussis vaccines are currently being tested, which would provide better protection in the event of a whooping cough outbreak. But, “it must be said that pertussis in a vaccinated person is usually weaker than in a person who has not been previously vaccinated”.
Epidemic this year or not?
Moraga-Llop suspects that “whooping cough will become an epidemic this year. And that thousands of cases will be reported. Of the classic diseases, which can be prevented by vaccination, whooping cough is one of the worst controlled. Together with mumps.”
Álvarez Aldeán believes that the peak is almost reached. And that the number of infections will begin to decline in the not-too-distant future. He explains that the control measures against Covid-19 had an effect on other respiratory infections. “The number of susceptible people is decreasing, and so the disease is kept under control on its own.”
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