Research article Open Access
Like 0


We aimed to investigate transmission rates of pertussis in household contacts of cases and factors associated with transmission. A prospective epidemiological study was conducted in 2012 and 2013 to determine the incidence of pertussis among household contacts of reported cases in Catalonia and Navarre, Spain. An epidemiological survey was completed for each case and contact, who were followed for 28 days to determine the source of infection (primary case) and detect the occurrence of secondary cases. Odds ratios (ORs) were used to estimate the effectiveness of vaccination and chemoprophylaxis in preventing new cases, using the formula (1 − OR) × 100. For the 688 primary cases, a total of 2,852 contacts were recorded. The household transmission rate was 16.1% (459/2,852) and rose according to the age (> 18 years) and lack of immunisation of the primary cases, and also the age (0–18 years), family relationship (siblings and children), lack of vaccination and chemoprophylaxis of contacts. Pertussis vaccine effectiveness in preventing new cases was 65.0% (95% confidence interval (CI): 11.6 to 86.2) for full vaccination (≥ 4 doses) and 59.7% (95% CI: −6.8 to 84.8) for incomplete vaccination (< 4 doses). The effectiveness of chemoprophylaxis was 62.1% (95% CI: 40.3 to 75.9). To reduce household transmission, contacts should be investigated to detect further cases and to administer chemoprophylaxis. The current vaccination status of cases and contacts can reduce household transmission.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO). WHO SAGE pertussis working group. Background paper. SAGE April 2014. Geneva: WHO; 2014. Available from: http://www.who.int/immunization/sage/meetings/2014/april/1_Pertussis_background_FINAL4_web.pdf?ua=
  2. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151-61.  https://doi.org/10.1016/S0140-6736(12)60560-1  PMID: 22579125 
  3. Cherry JD. Epidemic pertussis in 2012--the resurgence of a vaccine-preventable disease. N Engl J Med. 2012;367(9):785-7.  https://doi.org/10.1056/NEJMp1209051  PMID: 22894554 
  4. Crespo I, Cardeñosa N, Godoy P, Carmona G, Sala MR, Barrabeig I, et al. Epidemiology of pertussis in a country with high vaccination coverage. Vaccine. 2011;29(25):4244-8.  https://doi.org/10.1016/j.vaccine.2011.03.065  PMID: 21496465 
  5. Jenkinson D. Duration of effectiveness of pertussis vaccine: evidence from a 10 year community study. Br Med J (Clin Res Ed). 1988;296(6622):612-4.  https://doi.org/10.1136/bmj.296.6622.612  PMID: 3126927 
  6. Witt MA, Katz PH, Witt DJ. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak. Clin Infect Dis. 2012;54(12):1730-5.  https://doi.org/10.1093/cid/cis287  PMID: 22423127 
  7. Cortese MM, Baughman AL, Zhang R, Srivastava PU, Wallace GS. Pertussis hospitalizations among infants in the United States, 1993 to 2004. Pediatrics. 2008;121(3):484-92.  https://doi.org/10.1542/peds.2007-1393  PMID: 18310196 
  8. Lambert HJ. Epidemiology of a small pertussis outbreak in Kent County, Michigan. Public Health Rep. 1965;80(4):365-9.  https://doi.org/10.2307/4592424  PMID: 14279983 
  9. Pertussis vaccines: WHO position paper - September 2015. Wkly Epidemiol Rec. 2015;90(35):433-58. PMID: 26320265 
  10. Gustafsson L, Hessel L, Storsaeter J, Olin P. Long-term follow-up of Swedish children vaccinated with acellular pertussis vaccines at 3, 5, and 12 months of age indicates the need for a booster dose at 5 to 7 years of age. Pediatrics. 2006;118(3):978-84.  https://doi.org/10.1542/peds.2005-2746  PMID: 16950988 
  11. Klein NP, Bartlett J, Fireman B, Rowhani-Rahbar A, Baxter R. Comparative effectiveness of acellular versus whole-cell pertussis vaccines in teenagers. Pediatrics. 2013;131(6):e1716-22.  https://doi.org/10.1542/peds.2012-3836  PMID: 23690518 
  12. Klein NP, Bartlett J, Rowhani-Rahbar A, Fireman B, Baxter R. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med. 2012;367(11):1012-9.  https://doi.org/10.1056/NEJMoa1200850  PMID: 22970945 
  13. Sizaire V, Garrido-Estepa M, Masa-Calles J, Martinez de Aragon MV. Increase of pertussis incidence in 2010 to 2012 after 12 years of low circulation in Spain. Euro Surveill. 2014;19(32):20875.  https://doi.org/10.2807/1560-7917.ES2014.19.32.20875  PMID: 25139074 
  14. Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE, et al. Infant pertussis: who was the source? Pediatr Infect Dis J. 2004;23(11):985-9.  https://doi.org/10.1097/01.inf.0000145263.37198.2b  PMID: 15545851 
  15. Wendelboe AM, Njamkepo E, Bourillon A, Floret DD, Gaudelus J, Gerber M, et al. Infant Pertussis Study Group. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J. 2007;26(4):293-9.  https://doi.org/10.1097/01.inf.0000258699.64164.6d  PMID: 17414390 
  16. Kowalzik F, Barbosa AP, Fernandes VR, Carvalho PR, Avila-Aguero ML, Goh DYT, et al. Prospective multinational study of pertussis infection in hospitalized infants and their household contacts. Pediatr Infect Dis J. 2007;26(3):238-42.  https://doi.org/10.1097/01.inf.0000256750.07118.ee  PMID: 17484221 
  17. Deen JL, Mink CA, Cherry JD, Christenson PD, Pineda EF, Lewis K, et al. Household contact study of Bordetella pertussis infections. Clin Infect Dis. 1995;21(5):1211-9.  https://doi.org/10.1093/clinids/21.5.1211  PMID: 8589145 
  18. Wirsing von König CH, Postels-Multani S, Bock HL, Schmitt HJ. Pertussis in adults: frequency of transmission after household exposure. Lancet. 1995;346(8986):1326-9.  https://doi.org/10.1016/S0140-6736(95)92343-8  PMID: 7475771 
  19. Tiwari T, Murphy TV, Moran JNational Immunization Program, CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR Recomm Rep. 2005;54(RR-14):1-16. PMID: 16340941 
  20. Instituto Nacional de Estadística (INE). Cifras de población y censos demográficos. [National Statistics Institute. Population figures and Demographic Censuses and Population figures]. 2016 data. Madrid: INE. [Accessed 31 Oct 2016]. Spanish. Available from: http://www.ine.es/inebaseDYN/cp30321/cp_inicio.htm
  21. Baptista PN, Magalhães VS, Rodrigues LC. Children with pertussis inform the investigation of other pertussis cases among contacts. BMC Pediatr. 2007;7(1):21.  https://doi.org/10.1186/1471-2431-7-21  PMID: 17518997 
  22. European Centre for Disease Prevention and Control (ECDC). Systematic review on the incubation and infectiousness/shedding period of communicable diseases in children. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/publications/publications/systematic-review-incubation-period-shedding-children.pdf
  23. Roorda L, Buitenwerf J, Ossewaarde JM, van der Zee A. A real-time PCR assay with improved specificity for detection and discrimination of all clinically relevant Bordetella species by the presence and distribution of three Insertion Sequence elements. BMC Res Notes. 2011;4(1):11.  https://doi.org/10.1186/1756-0500-4-11  PMID: 21255383 
  24. Resumen anual 2011. [Annual summary 2011]. Boletin Epidemiológico Semanal. 2011;19(1):255. Spanish. Available from: http://revista.isciii.es/index.php/bes/article/view/689/721
  25. Las formas de la convivencia. [Ways of cohabitation. National Statistics Institute.]. Boletin informative del Instituto Nacional de Estadistica. July 2014. [Accessed 31 Oct 2016]. Available from: http://www.ine.es/ss/Satellite?L=es_ES&c=INECifrasINE_C&cid=1259944407896&p=1254735116567&pagename=ProductosYServicios%2FINECifrasINE_C%2FPYSDetalleCifrasINE
  26. Wirsing von König CH, Postels-Multani S, Bogaerts H, Bock HL, Laukamp S, Kiederle S, et al. Factors influencing the spread of pertussis in households. Eur J Pediatr. 1998;157(5):391-4.  https://doi.org/10.1007/s004310050836  PMID: 9625336 
  27. de Greeff SC, de Melker HE, Westerhof A, Schellekens JF, Mooi FR van BM, van Boven M. Estimation of household transmission rates of pertussis and the effect of cocooning vaccination strategies on infant pertussis. Epidemiology. 2012;23(6):852-60.  https://doi.org/10.1097/EDE.0b013e31826c2b9e  PMID: 23018969 
  28. Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, et al. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. 2005;353(15):1555-63.  https://doi.org/10.1056/NEJMoa050824  PMID: 16221778 
  29. Baptista PN, Magalhães V, Rodrigues LC, Rocha MW, Pimentel AM. Pertussis vaccine effectiveness in reducing clinical disease, transmissibility and proportion of cases with a positive culture after household exposure in Brazil. Pediatr Infect Dis J. 2006;25(9):844-6.  https://doi.org/10.1097/01.inf.0000232642.25495.95  PMID: 16940847 
  30. Baptista PN, Magalhães VS, Rodrigues LC. The role of adults in household outbreaks of pertussis. Int J Infect Dis. 2010;14(2):e111-4.  https://doi.org/10.1016/j.ijid.2009.03.026  PMID: 19559636 
  31. Deen JL, Mink CA, Cherry JD, Christenson PD, Pineda EF, Lewis K, et al. Household contact study of Bordetella pertussis infections. Clin Infect Dis. 1995;21(5):1211-9.  https://doi.org/10.1093/clinids/21.5.1211  PMID: 8589145 
  32. Sala-Farré MR, Arias-Varela C, Recasens-Recasens A, Simó-Sanahuja M, Muñoz-Almagro C, Pérez-Jové J. Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine. Enferm Infecc Microbiol Clin. 2015;33(1):27-31.  https://doi.org/10.1016/j.eimc.2013.09.013  PMID: 24216286 
  33. Moraga F, Roca J, Méndez C, Rodrigo C, Pineda V, Martinez A, et al. TOSCA Study Group. Epidemiology and surveillance of pertussis among infants in Catalonia, Spain, during 1997-2001. Pediatr Infect Dis J. 2005;24(6):510-3.  https://doi.org/10.1097/01.inf.0000164701.50766.62  PMID: 15933560 
  34. Althouse BM, Scarpino SV. Asymptomatic transmission and the resurgence of Bordetella pertussis. BMC Med. 2015;13(1):146.  https://doi.org/10.1186/s12916-015-0382-8  PMID: 26103968 
  35. Marchant CD, Loughlin AM, Lett SM, Todd CW, Wetterlow LH, Bicchieri R, et al. Pertussis in Massachusetts, 1981-1991: incidence, serologic diagnosis, and vaccine effectiveness. J Infect Dis. 1994;169(6):1297-305.  https://doi.org/10.1093/infdis/169.6.1297  PMID: 8195607 
  36. Plans P, Álvarez E, de Ory F, Campins M, Payà T, Balfagón P, et al. Prevalence of antibody to Bordetella pertussis in neonates and prevalence of recent pertussis infection in pregnant women in Catalonia (Spain) in 2003 and 2013. Pediatr Infect Dis J. 2014;33(11):1114-8.  https://doi.org/10.1097/INF.0000000000000413  PMID: 24871642 
  37. McGuiness CB, Hill J, Fonseca E, Hess G, Hitchcock W, Krishnarajah G. The disease burden of pertussis in adults 50 years old and older in the United States: a retrospective study. BMC Infect Dis. 2013;13(1):32.  https://doi.org/10.1186/1471-2334-13-32  PMID: 23343438 
  38. Iroh Tam PY, Menk JS, Hughes J, Kulasingam SL. An ecological analysis of pertussis disease in Minnesota, 2009-2013. Epidemiol Infect. 2016;144(4):847-55.  https://doi.org/10.1017/S0950268815002046  PMID: 26330135 
  39. Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci USA. 2014;111(2):787-92.  https://doi.org/10.1073/pnas.1314688110  PMID: 24277828 
  40. van den Biggelaar AH, Poolman JT. Predicting future trends in the burden of pertussis in the 21st century: implications for infant pertussis and the success of maternal immunization. Expert Rev Vaccines. 2016;15(1):69-80.  https://doi.org/10.1586/14760584.2016.1105136  PMID: 26559122 
  41. Bertilone C, Wallace T, Selvey LA. Finding the ‘who’ in whooping cough: vaccinated siblings are important pertussis sources in infants 6 months of age and under. Commun Dis Intell Q Rep. 2014;38(3):E195-200. PMID: 25391405 
  42. Baxter R, Bartlett J, Rowhani-Rahbar A, Fireman B, Klein NP. Effectiveness of pertussis vaccines for adolescents and adults: case-control study. BMJ. 2013;347(jul17 1):f4249.  https://doi.org/10.1136/bmj.f4249  PMID: 23873919 
  43. Sheridan SL, Ware RS, Grimwood K, Lambert SB. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak. Clin Infect Dis. 2012;55(10):1434-5, author reply 1435-6.  https://doi.org/10.1093/cid/cis672  PMID: 22871826 
  44. Zhang L, Prietsch SO, Axelsson I, Halperin SA, et al. Acellular vaccines for preventing whooping cough in children. Cochrane Database Syst Rev. 2014; (9):CD001478. PMID: 25228233 
  45. Dodhia H, Crowcroft NS, Bramley JC, Miller E. UK guidelines for use of erythromycin chemoprophylaxis in persons exposed to pertussis. J Public Health Med. 2002;24(3):200-6.  https://doi.org/10.1093/pubmed/24.3.200  PMID: 12831090 
  46. Friedman DS, Curtis CR, Schauer SL, Salvi S, Klapholz H, Treadwell T, et al. Surveillance for transmission and antibiotic adverse events among neonates and adults exposed to a healthcare worker with pertussis. Infect Control Hosp Epidemiol. 2004;25(11):967-73.  https://doi.org/10.1086/502328  PMID: 15566032 
  47. Thampi N, Gurol-Urganci I, Crowcroft NS, Sander B. Pertussis post-exposure prophylaxis among household contacts: a cost-utility analysis. PLoS One. 2015;10(3):e0119271.  https://doi.org/10.1371/journal.pone.0119271  PMID: 25747269 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error