Critical Pertussis: “Prevention is better than cure”

Abstract The global incidence of pertussis has increased in the last two decades. Critical pertussis (cases necessitating intensive care unit admission or resulting in death) is a major health concern, especially among infants. Inadequately transferred maternal immunity, high susceptibility to disease before completion of the primary immunization schedule, and differential expression of pertussis toxins are some of the proposed reasons for higher disease burden in infancy. Adolescent children with waning immunity and susceptible adults contribute to the transmission of the disease. Siblings and parents are a major source of infection in infants. Multisystem involvement includes respiratory failure, central nervous system manifestations, shock, and pulmonary artery hypertension. Hyperleukocytosis, a characteristic feature of critical pertussis, is a proven risk factor for increased mortality. Other predictors of mortality include pulmonary artery hypertension, requirement of mechanical ventilation, and vasoactive requirements. Early macrolide antibiotics and organ support measures are the major domains of management. Intensive care needs include mechanical ventilation, inotropic support, and leukodepletion measures. Studies regarding optimal management strategies are scarce, and strategies like leukapheresis or ECMO have shown variable mortality benefit in literature. Routine immunization along with adolescent booster dose and immunization of pregnant mothers have shown promising impacts on reducing pertussis-related morbidity and mortality. We describe the updates regarding the risk factors for resurgence, disease morbidity, and management strategies in children with critical pertussis.