Seroepidemiology of pertussis immunity in five provinces of China: A population-based, cross-sectional study

This study aimed to evaluate the seroprevalence of <i>Bordetella pertussis</i> and persistence of antibodies following vaccination. We recruited 6060 healthy subjects from five provinces of China during 2017-2018. Serum IgG antibodies against pertussis toxin (anti-PT IgG) and filamentous hemagglutinin (anti-FHA IgG), and serum IgA antibodies against pertussis toxin (anti-PT IgA) were measured by ELISA. Geometric mean concentration (GMC), seropositivity rate, and recent infection rate were calculated. Among 0-6 years-olds, the anti-PT IgG, anti-PT IgA, and anti-FHA IgG GMCs were 6.4 IU/ml (95% CI 6.1-6.8), 2.8 IU/ml (95% CI 2.7-2.8), and 13.3 IU/ml (95% CI 12.4-14.2), respectively. The anti-PT IgG GMC increased in accordance with the primary vaccination series (4-6 months) and the toddler booster (18-24 months), but declined thereafter through to age 5 years [4.7 IU/ml (95% CI 4.2-5.4)]. The seropositivity rate of pertussis in >6 year-olds was 9.0% (95% CI 8.1-9.9) and the recent infection rate was 3.3% (95% CI, 2.7-3.8). Recent infection rate began to increase from 6 years of age, with peaks at 9, 20, 40, and ≥60 years of age. The anti-PT IgG GMCs of children aged 0-6 years who were vaccinated with DTaP, DTaP-IPV//PRP～T, and DTaP-Hib were 5.9 IU/ml (95% CI 5.6-6.3), 20.7 IU/ml (95% CI 15.6-27.8), and 11.7 IU/ml (95% CI 7.5-18.1) (<i>p</i> < .001), respectively (<i>p</i> < .001). Pertussis vaccination improves anti-PT IgG levels, however these wane soon after vaccination. Sero-estimated recent infection rates appear to increase from school age into adolescence and adulthood. Pertussis vaccine boosters should be considered in these age groups.