Since the second half of last year, an accelerated increase in the incidence of whooping cough has been observed in Spain, which is why the Spanish Association of Pediatrics (AEP) has proposed applying a booster vaccine before adolescence. Reinforcement that is currently only injected in Asturias.
According to reports from the National Center for Epidemiology, this year, as of March 10, 8,260 whooping cough infections had been recorded, a figure that practically quadruples the cases of the entire year 2023 (2,211).
More than half of these infections have occurred in Catalonia. The most affected are children between 10 and 14 years old, who represent 60% of the incidence. “It is important that the booster dose of the vaccine that we have been recommending be introduced into the calendar of all of Spain,” said the president of the AEP, Carlos Blesa, in the presentation of the Immunization Days that this scientific society is holding in Girona.
Whooping cough is an illness caused by bacteria that begins as a cold with no or little fever and some occasional, non-productive cough over a period of about two weeks. In the second phase, which lasts between three and six weeks, the cough increases in frequency and severity and appears in the form of strong attacks, followed by a characteristic sound when inhaling.
After the cough, which increases at night, nausea, choking or exhaustion, or profuse sweating occur. Children, especially under six months, can suffer from apnea. The convalescent phase, when the cough subsides, lasts from one to twelve weeks.
Anna Gatell, president of the Catalan Pediatric Society, has mentioned a possible greater detection capacity as one of the causes of the outbreak registered in Catalonia. In the first three months of the year, 7,230 cases have been detected in this community, when in all of 2023 there were 566. However, only 60% of the diagnoses have been microbiologically confirmed.
The rate of hospital admissions for whooping cough in Catalonia is low, at 0.3%, and one of those affected had to be admitted to the ICU, explained Gatell.
The main tool for preventing whooping cough is vaccination and pediatricians insist on the need to reinforce it. On the one hand, they consider it essential to maintain and increase the vaccination rate of pregnant women (between weeks 27 and 32), which exceeds 85%.
On the other hand, they propose applying an additional booster dose at 14 years of age. It would be the fifth, since the vaccination schedule in force for about eight years includes vaccinating against cough at 2, 4 and 11 months (hexavalent vaccine), with a booster at 6 years.
The better diagnostic capacity favors the detection of a greater number of cases, but the adaptation of the microorganism – the Bordetella pertussis bacteria – also influences, which would have mechanisms to evade the defense response induced by vaccination. That is why booster doses are necessary.
Francisco Álvarez, coordinator of the AEP vaccine advisory committee, explains that periodically, every three or five years, outbreaks of whooping cough occur because the bacteria that produces it – located in the throat – accumulate in carriers.
The abnormal increase in cases, for the first time after the pandemic, has not only been observed in Spain but also in the United Kingdom, Belgium, Croatia, the Czech Republic and the Nordic countries.
And the numbers may be substantially higher than the records say. “Underdiagnosis of whooping cough is common, and not all places carry out the same diagnostic protocols, so the real incidence of this disease will most likely be even higher than that indicated by official figures,” says Anna Gatell. .
Pediatricians have expressed satisfaction with the existing vaccine coverage rates in Spain, illustrated by the respiratory syncytial virus (RSV) vaccine, which began to be administered in the fall to children with high demand.
“Awareness has worked with RSV because people are afraid of this disease,” argued Dr. Álvarez. However, expectations regarding the flu vaccine have been punctured: “Because people think that the flu is a cold with fever and that it does not get complicated, but every season, children under 2 years of age are admitted as much as people. over 65”.
