What is Pertussis?

Pertussis (Whooping Cough)

  • A highly contagious acute respiratory infection caused by the bacterium Bordetella pertussis
  • Symptoms in children include severe cough of at least 14 days, plus paroxysmal cough, inspiratory whoop or post tussive vomiting
  • Symptoms in adults can be mild and unspecific
  • Adults appear to serve as the reservoir of the organism

The global incidence of pertussis is estimated at 48.5 million cases a year with 295,000 deaths [Mattoo 2005]. In the US, pertussis has the greatest incidence and mortality of all vaccine-preventable diseases [Roush 2007].

Pertussis continues to be a public health concern, even in countries with high vaccination coverage [ECDC 2013].

  • Adults may be unaware of having the disease and may infect vulnerable infants who are not yet vaccinated [ECDC 2013]
  • Infants can be severely affected by the disease [ECDC 2013]

Epidemiology [ECDC 2013]
The incidence of pertussis varies widely in Europe due to differences in vaccination policies, levels of awareness, and surveillance procedures.

  • In 2010, confirmed cases were low overall (3.87 per 100,000 population), with the highest rates reported in Estonia and Norway (95.44 and 73.28 per 100,000, respectively)
  • Austria, Estonia, Slovakia and Spain reported an increase in confirmed cases in 2010
  • Children aged 5–14 years are the most affected (Figure 4)
  • There is a considerable gap between number of confirmed cases reported in the EU in 2010 (14,000) when compared to epidemiological evidence from the US showing infection rates of 1–6% (800,000 to 1 million cases) during non-epidemic periods [Cherry 2012]

There has been an increase in pertussis cases in some countries in the EU (Belgium, France, Germany, the Netherlands and Spain), particularly among older children, adolescents and adults [ECDC 2013]. This may be due to:

  • Public concern over vaccines
  • Vaccination programme failure
  • Changes in the infectious organism

Recent Pertussis outbreaks

Pertussis outbreaks (Figure 5) occur even in the presence of excellent paediatric vaccination programmes, and peaks are typically seen every 3–4 years. Recently there was an outbreak in England and Wales in 2011 that continued into 2012 [Health Protection Agency UK]:

Reported cases more than doubled from 2010 to 2011 (421 to 1,040 cases, respectively)

Total cases in 2011 were higher than a typical peak year

There were 665 confirmed cases between January and March 2012

Most of the increase was due to infection in teenagers and adults aged 15-40 years, but also included very young children with highest risk of complications

Hospitalisation and Mortality [WHO European Hospital Morbidity Database, WHO Detailed European Mortality Database]

Hospitalisation and mortality for pertussis are rare in Europe.

  • Hospitalisation rates vary from 0 to 0.035 per 1000
  • Age standardised mortality rates range from 0.0005 per 100,000 in Germany in 2009 to 0.125 per 100,000 in Cyprus, in 2006

Vaccination and Control Strategies
In view of concerns about transmission of pertussis from adults and adolescents to young children, several countries have recommended booster doses
for adolescents (e.g. Austria, France and Germany) and adults (e.g. Austria). In addition, the Global Pertussis Initiative has recommended universal adult
immunisation [Tan 2005]. Success of these strategies depends on:

  • Increasing awareness among the public and health professionals
  • Optimising diagnostic methods
  • Improving surveillance systems [ECDC 2013]


Pertussis (Whooping Cough): Summary of key points 

  • Pertussis is relatively common and underdiagnosed in EU countries
  • It remains a public health concern, even in countries with high vaccination coverage
  • Many EU countries report an increase in cases, particularly among adolescents and adults
  • Infected adults are a source of infection for unvaccinated infants, who may be severely affected
  • Vaccination strategies call for vaccination of adults and teenagers, and increased awareness among the public and health care professionals