Should Pertussis Vaccine be Administered During Pregnancy?

Pertussis, caused by Bordetella pertussis, is an acute respiratory infection.While this infection can affect individuals of all ages, severe infections and mortality predominantly occur in the neonatal period.Despite the inclusion of pertussis vaccination in routine childhood immunization programs globally, pertussis remains a significant cause of death among infants under one year of age.The infection is primarily transmitted through respiratory droplets produced by coughing or sneezing.Initial symptoms typically appear after an incubation period of 7 to 10 days post-exposure, manifesting as mild fever and rhinorrhea.As the infection progresses, paroxysmal coughing episodes begin, intensifying as the body attempts to expel mucus from the lungs.Following expulsion of mucus, rapid inhalation of air produces the characteristic "whooping" sound.Post-tussive vomiting may also occur.In infants, paroxysmal cough may be absent, with respiratory distress being more prominent.In severe cases, apnea and cyanosis may develop.The period of highest pertussis-related mortality and morbidity in infants occurs within the first two months of life (1)(2)(3) .This period also precedes the administration of the first dose of the pertussis vaccine, typically given at two months of age as part of the national immunization schedule.Between October 2023 and July 2024, respiratory polymerase chain reaction (PCR) tests were requested from 634 patients hospitalized at our institution due to upper respiratory tract infections.It was observed that 295 of these patients were under 1 year of age, and 280 patients were between 1 and 18 years old.B. pertussis was detected in 12 (1.89%) of the throat swab/sputum samples sent for PCR testing.Most of these 12 patients (n.10; 83.3%) were infants younger than 2 months (33-59 days) at the time the test.One infant was 71 days old at the time of the test, and considering the incubation period of pertussis, it was thought that the infection developed before the vaccine could elicit an effective immune response.Six of these infants were treated and monitored in the pediatric ward, and five infants were managed in the intensive care unit due to clinical indications before being discharged.The remaining 15-year-old patient was treated in the pediatric ward and subsequently discharged.A study conducted in the United States similarly demonstrated that over 80% of pertussis cases requiring hospitalization involved infants younger than 2 months of age (4) .In a multicenter study conducted in Turkey in 2023, involving 6601 children monitored in 11 different pediatric intensive care units, B. pertussis infection was detected in 50 cases (0.76%) through PCR testing.The median age of the patients diagnosed with pertussis was 9.14 weeks (range, 7.29-15.3weeks) (5) .