Robert Wellington
Pertussis is still a serious public-health concern. The pathogen's transmission has been slowed by high coverage rates, but the loss of immunity suggests that adolescents and adults play an important role in infective dynamics, since they may be a large source of infection for unvaccinated or partially immunise neonates. Many constraints impact the passive surveillance system. The lack of lab confirmation and unique clinical characteristics of patients contribute to underestimate of pertussis in adolescents, young adults, and adults. Because the true epidemiological impact of pertussis is not always apparent, the lack of comprehensive data should not hinder the use of active preventive treatments aimed at preventing the pertussis impact of declining immunity. In adolescents and adults, a booster dose of low-antigen content combination vaccine should be used to minimise a rise in the mean age of infection acquisition. The cocoon technique can reduce the chance of infection in neonates, while there is still controversy on this point, and more surveillance and research are needed to fine-tune the pertussis preventive strategy.