Sharp Increase in Pertussis Cases Reported in Saxony-Anhalt, Germany

Saxony-Anhalt, a state in eastern Germany, experienced a significant surge in pertussis, commonly known as whooping cough, cases throughout the past year. Data released by the state’s Ministry of Health, in response to an inquiry from the Left Party (Die Linke), reveals a stark increase in reported infections. In 2023, the region documented 1,110 cases of pertussis, a substantial leap compared to the 178 cases registered in the preceding year. Even compared to pre-pandemic levels, the rise is noteworthy. In 2019, before the onset of the COVID-19 pandemic and the widespread implementation of associated protective measures, Saxony-Anhalt recorded 499 cases of pertussis.

Pertussis is a highly contagious respiratory illness primarily known as a childhood disease, though individuals of all ages can contract it. Vaccination offers effective protection against the disease, but waning immunity necessitates booster doses to maintain long-term protection. The illness is characterized by severe coughing fits, often followed by a high-pitched "whoop" sound during inhalation, hence the name whooping cough. The most common complication of pertussis is pneumonia, a serious lung infection that can require hospitalization. Furthermore, the persistent cough associated with pertussis can last for months, significantly impacting the quality of life for those infected.

Data from the Saxony-Anhalt Ministry of Health indicated that children and adolescents between the ages of 7 and 17 were disproportionately affected by the pertussis outbreak in 2023, accounting for over half of the documented cases. This age group may be particularly vulnerable due to factors such as declining immunity from earlier vaccinations and increased social interaction within school settings.

The Robert Koch Institute (RKI), Germany’s national public health institute, had already issued warnings regarding the escalating pertussis situation nationwide towards the end of the previous year. The RKI reported that the country was experiencing the highest case numbers since the introduction of mandatory reporting in 2013. This elevated incidence of pertussis across Germany underscores the severity of the outbreak and the need for comprehensive public health interventions.

The RKI suggested that the unusually low pertussis case numbers observed during the COVID-19 pandemic years were likely a direct result of the widespread infection control measures implemented to mitigate the spread of SARS-CoV-2, the virus that causes COVID-19. These measures, including mask-wearing, social distancing, enhanced hand hygiene, and school closures, effectively reduced the transmission of various respiratory pathogens, including Bordetella pertussis, the bacterium responsible for whooping cough.

However, with the relaxation of these measures and the return to pre-pandemic social behaviors, a resurgence of pertussis and other respiratory illnesses was anticipated. The RKI identified several potential factors contributing to the sharp increase in pertussis cases in 2023. These include a "catch-up effect" following the pandemic years, where cases that might have occurred were suppressed due to infection control measures and consequently, the susceptibles individuals remained susceptible; waning immunity from prior infections and vaccinations, highlighting the need for booster doses; and suboptimal vaccination rates, particularly for booster vaccinations and vaccinations during pregnancy.

The issue of vaccination rates is of particular concern. While childhood vaccination programs have been successful in reducing the overall incidence of pertussis, maintaining high coverage rates, including timely booster doses, is crucial for long-term control of the disease. Furthermore, vaccination during pregnancy is recommended to protect newborns, who are at the highest risk of severe complications from pertussis. Maternal antibodies are transferred to the infant, providing passive immunity during the first few months of life, before the infant can be fully vaccinated.

The rise in pertussis cases in Saxony-Anhalt and across Germany highlights the importance of maintaining strong vaccination programs and promoting awareness of the need for booster doses. Public health authorities must focus on improving vaccination rates, particularly among vulnerable populations such as children, adolescents, and pregnant women. Effective communication strategies are needed to address vaccine hesitancy and provide accurate information about the benefits and safety of pertussis vaccination.

Moreover, healthcare providers should be vigilant in recognizing and diagnosing pertussis, particularly in adults, where the symptoms may be atypical. Early diagnosis and treatment with antibiotics can help to reduce the severity and duration of the illness and prevent further transmission.

The resurgence of pertussis underscores the ongoing challenges of controlling infectious diseases, even those for which effective vaccines are available. Continuous monitoring, proactive vaccination strategies, and effective communication are essential for protecting public health and preventing future outbreaks. Further investigation may be needed to analyze the specific strain of pertussis circulating and the effectiveness of the current vaccine against it. Also, it is imperative to analyze factors that could be affecting vaccination rate. The Saxony-Anhalt’s pertussis situation is a clear indication that public health efforts must be intensified to avert further potential outbreaks.