Surveillance Open Access
Like 0



Interventions to mitigate the COVID-19 pandemic may impact other respiratory diseases.


We aimed to study the course of pertussis in France over an 8-year period including the beginning of the COVID-19 pandemic and its association with COVID-19 mitigation strategies, using multiple nationwide data sources and regression models.


We analysed the number of French pertussis cases between 2013 and 2020, using PCR test results from nationwide outpatient laboratories (Source 1) and a network of the paediatric wards from 41 hospitals (Source 2). We also used reports of a national primary care paediatric network (Source 3). We conducted a quasi-experimental interrupted time series analysis, relying on negative binomial regression models. The models accounted for seasonality, long-term cycles and secular trend, and included a binary variable for the first national lockdown (start 16 March 2020).


We identified 19,039 pertussis cases from these data sources. Pertussis cases decreased significantly following the implementation of mitigation measures, with adjusted incidence rate ratios of 0.10 (95% CI: 0.04–0.26) and 0.22 (95% CI: 0.07–0.66) for Source 1 and Source 2, respectively. The association was confirmed in Source 3 with a median of, respectively, one (IQR: 0–2) and 0 cases (IQR: 0–0) per month before and after lockdown (p = 0.0048).


The strong reduction in outpatient and hospitalised pertussis cases suggests an impact of COVID-19 mitigation measures on pertussis epidemiology. Pertussis vaccination recommendations should be followed carefully, and disease monitoring should be continued to detect any resurgence after relaxation of mitigation measures.


Article metrics loading...

Loading full text...

Full text loading...



  1. Domenech de Cellès M, Magpantay FM, King AA, Rohani P. The pertussis enigma: reconciling epidemiology, immunology and evolution. Proc Biol Sci. 2016;283(1822):283.  https://doi.org/10.1098/rspb.2015.2309  PMID: 26763701 
  2. Yeung KHT, Duclos P, Nelson EAS, Hutubessy RCW. An update of the global burden of pertussis in children younger than 5 years: a modelling study. Lancet Infect Dis. 2017;17(9):974-80.  https://doi.org/10.1016/S1473-3099(17)30390-0  PMID: 28623146 
  3. European Centre for Disease Prevention and Control (ECDC). Pertussis - Annual epidemiological report for 2018. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/pertussis-annual-epidemiological-report-2018
  4. World Health Organization (WHO). WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. Geneva: WHO; 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
  5. République Française. Décret n° 2020-260 du 16 mars 2020 portant réglementation des déplacements dans le cadre de la lutte contre la propagation du virus covid-19. [Decree No. 2020-260 of 16 March 2020 regulating travel in the context of the fight against the spread of the covid-19 virus]. Journal Officiel de la République Française. Text 2. 2020. French. Available from: https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000041728476
  6. EPI-PHARE. Covid-19: usage des médicaments de ville en France. [Covid-19: use of community drugs in France]. Saint-Denis: EPI-PHARE; 2020. French. Available from: https://www.epi-phare.fr/rapports-detudes-et-publications/covid-19-usage-des-medicaments-de-ville-en-france-rapport4
  7. Angoulvant F, Ouldali N, Yang DD, Filser M, Gajdos V, Rybak A, et al. Coronavirus disease 2019 pandemic: impact caused by school closure and national lockdown on pediatric visits and admissions for viral and nonviral infections-a time series analysis. Clin Infect Dis. 2021;72(2):319-22.  https://doi.org/10.1093/cid/ciaa710  PMID: 33501967 
  8. Paireau J, Guillot S, Aït El Belghiti F, Matczak S, Trombert-Paolantoni S, Jacomo V, et al. Effect of change in vaccine schedule on pertussis epidemiology in France: a modelling and serological study. Lancet Infect Dis. 2022;22(2):265-73.  https://doi.org/10.1016/S1473-3099(21)00267-X  PMID: 34672963 
  9. Tubiana S, Belchior E, Guillot S, Guiso N, Lévy-Bruhl D, Renacoq Participants. Monitoring the impact of vaccination on pertussis in infants using an active hospital-based pediatric surveillance network: results from 17 years’ experience, 1996-2012, France. Pediatr Infect Dis J. 2015;34(8):814-20.  https://doi.org/10.1097/INF.0000000000000739  PMID: 25955837 
  10. Guillot S, Guiso N. Follow-up of external quality controls for PCR-based diagnosis of whooping cough in a hospital laboratory network (Renacoq) and in other hospital and private laboratories in France. J Clin Microbiol. 2016;54(8):2169-71.  https://doi.org/10.1128/JCM.00882-16  PMID: 27194689 
  11. Guiso N, Levy C, Romain O, Guillot S, Werner A, Rondeau MC, et al. Whooping cough surveillance in France in pediatric private practice in 2006-2015. Vaccine. 2017;35(45):6083-8.  https://doi.org/10.1016/j.vaccine.2017.09.072  PMID: 28974408 
  12. Kontopantelis E, Doran T, Springate DA, Buchan I, Reeves D. Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. BMJ. 2015;350(jun09 5):h2750.  https://doi.org/10.1136/bmj.h2750  PMID: 26058820 
  13. 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 
  14. Santé Publique France. Rougeole: données annuelles 2020. Saint-Maurice: Santé Publique France; 2021. Available from: https://www.santepubliquefrance.fr/les-actualites/2021/rougeole-donnees-annuelles-2020
  15. Fourgeaud J, Toubiana J, Chappuy H, Delacourt C, Moulin F, Parize P, et al. Impact of public health measures on the post-COVID-19 respiratory syncytial virus epidemics in France. Eur J Clin Microbiol Infect Dis. 2021;40(11):2389-95.  https://doi.org/10.1007/s10096-021-04323-1  PMID: 34347190 
  16. Foley DA, Yeoh DK, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, et al. The interseasonal resurgence of respiratory syncytial virus in Australian children following the reduction of coronavirus disease 2019-related public health measures. Clin Infect Dis. 2021;73(9):e2829-30.  https://doi.org/10.1093/cid/ciaa1906  PMID: 33594407 
  17. Delestrain C, Danis K, Hau I, Behillil S, Billard MN, Krajten L, et al. Impact of COVID-19 social distancing on viral infection in France: A delayed outbreak of RSV. Pediatr Pulmonol. 2021;56(12):3669-73.  https://doi.org/10.1002/ppul.25644  PMID: 34473914 
  18. Sullivan SG, Carlson S, Cheng AC, Chilver MB, Dwyer DE, Irwin M, et al. Where has all the influenza gone? The impact of COVID-19 on the circulation of influenza and other respiratory viruses, Australia, March to September 2020. Euro Surveill. 2020;25(47):25.  https://doi.org/10.2807/1560-7917.ES.2020.25.47.2001847  PMID: 33243355 
  19. Uyeki TM, Wentworth DE, Jernigan DB. Influenza activity in the US during the 2020-2021 season. JAMA. 2021;325(22):2247-8.  https://doi.org/10.1001/jama.2021.6125  PMID: 34028492 
  20. Rybak A, Levy C, Jung C, Béchet S, Batard C, Hassid F, et al. Delayed bronchiolitis epidemic in French primary care setting driven by respiratory syncytial virus: preliminary data from the Oursyn study, March 2021. Pediatr Infect Dis J. 2021;40(12):e511-4.  https://doi.org/10.1097/INF.0000000000003270  PMID: 34260480 
  21. Adegbija O, Walker J, Smoll N, Khan A, Graham J, Khandaker G. Notifiable diseases after implementation of COVID-19 public health prevention measures in central Queensland, Australia. Commun Dis Intell. 2018;2021:45.
  22. Belingheri M, Paladino ME, Piacenti S, Riva MA. Effects of COVID-19 lockdown on epidemic diseases of childhood. J Med Virol. 2021;93(1):153-4.  https://doi.org/10.1002/jmv.26253  PMID: 32617991 
  23. Huh K, Jung J, Hong J, Kim M, Ahn JG, Kim JH, et al. Impact of nonpharmaceutical interventions on the incidence of respiratory infections during the coronavirus disease 2019 (COVID-19) outbreak in Korea: a nationwide surveillance study. Clin Infect Dis. 2021;72(7):e184-91.  https://doi.org/10.1093/cid/ciaa1682  PMID: 33150393 
  24. Yun HE, Ryu BY, Choe YJ. Impact of social distancing on incidence of vaccine-preventable diseases, South Korea. J Med Virol. 2021;93(3):1814-6.  https://doi.org/10.1002/jmv.26614  PMID: 33079384 
  25. Kim DH, Nguyen TM, Kim JH. Infectious respiratory diseases decreased during the COVID-19 pandemic in South Korea. Int J Environ Res Public Health. 2021;18(11):18.  https://doi.org/10.3390/ijerph18116008  PMID: 34205018 
  26. Falkenstein-Hagander K, Appelqvist E, Cavefors AF, Källberg H, Nilsson LJ, Silfverdal SA, et al. Waning infant pertussis during COVID-19 pandemic. Arch Dis Child. 2022;107(3):e19.  https://doi.org/10.1136/archdischild-2021-323055  PMID: 34857511 
  27. Marchal C, Belhassen M, Guiso N, Jacoud F, Van Ganse E, Le Pannerer M, et al. Vaccination coverage rates for diphtheria, tetanus, poliomyelitis and pertussis booster vaccination in France between 2013 and 2017: learnings from an analysis of national health system real-world data. Vaccine. 2021;39(3):505-11.  https://doi.org/10.1016/j.vaccine.2020.12.021  PMID: 33357956 
  28. von König CHW. Acellular pertussis vaccines: where to go to? Lancet Infect Dis. 2018;18(1):5-6.  https://doi.org/10.1016/S1473-3099(17)30613-8  PMID: 29066129 
  29. Cohen R, Ashman M, Taha MK, Varon E, Angoulvant F, Levy C, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Infect Dis Now. 2021;51(5):418-23.  https://doi.org/10.1016/j.idnow.2021.05.004  PMID: 33991720 
  30. InfoVac-France. Point sur les consultations à maintenir durant la Pandémie COVID-19. [Update on the consultations to be maintained during the COVID-19 Pandemic]. InfoVac-France; 2020. French. Available from: https://www.infovac.fr/actualites/point-sur-les-consultations-a-maintenir-durant-la-pandemie-covid-19
  31. Taine M, Offredo L, Drouin J, Toubiana J, Weill A, Zureik M, et al. Mandatory infant vaccinations in france during the COVID-19 pandemic in 2020. Front Pediatr. 2021;9:666848.  https://doi.org/10.3389/fped.2021.666848  PMID: 34123969 

Data & Media loading...

Supplementary data

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