Laboratory confirmed cases of pertussis in England: July to September 2022
Updated 6 July 2023
Applies to England
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In England, there were 19 laboratory confirmed cases of pertussis – culture, PCR, serology or oral fluid (OF) – reported to the UK Health Security Agency (UKHSA) pertussis enhanced surveillance programme in the third quarter of 2022, from July to September (Table 1).
Total case numbers were double those reported in same quarter of 2021 (9 cases). However, the number of laboratory confirmed cases in this quarter was 46% lower than in the third quarter of 2020 (35 cases) and markedly lower than the 1,174 cases reported in the same, pre-pandemic, period in 2019 (see Figure 1 and Table 2). Between July and September 2022, a total of 1,833 samples were submitted to UKHSA for testing with a positivity rate of 1.1% (20 of 1,828 samples).
The COVID-19 pandemic and the implementation of social distancing measures and lockdown across the UK from 23 March 2020 had a significant impact on the spread and detection of other infections, including pertussis (1). From July 2021, COVID-19 containment measures were withdrawn in England. Vaccination continues to be important as levels of disease are likely to increase following the easing of control measures.
To date, laboratory-confirmed pertussis cases remain low following cessation of control measures. The number of confirmed cases in infants under 3 months, who are targeted by the maternal immunisation programme, continues to remain extremely low with 0 confirmed case in this quarter compared to 0, 1 and 29 cases in the same quarters in 2021, 2020 and 2019, respectively. There were 2 confirmed cases in infants aged between 3 and 11 months compared to 0, 1 and 18 cases in the same quarters in 2021, 2020 and 2019 respectively, consistent with protection from primary vaccination offered at 2, 3 and 4 months of age
There was 1 confirmed case in in a child aged between 1 and 4 years compared to 1, 1 and 72 cases in 2021, 2020 and 2021, respectively (Table 2).
Between July and September 2022, 13 of the 19 cases of laboratory confirmed pertussis in England occurred in individuals aged 15 years or older. This compares to 7 and 29 cases in the same period in 2021 and 2020, with 856 cases reported in the same, pre-pandemic, period in 2019.
Guidelines for the public health management of pertussis provide details on the appropriate laboratory investigation of suspected cases of pertussis which is informed by the age of the suspected case and time since onset of their symptoms. Investigation of those with clinical presentation consistent with pertussis should be undertaken, in line with this guidance.
Deaths
There were no reported deaths in infants with pertussis confirmed between July and September 2022. The last pertussis-related death of an infant was reported in the second quarter (April to June) of 2019. Calculated maternal vaccine effectiveness against death of infants from pertussis is very high at around 97% (2).
Childhood vaccination programme
The national vaccination schedule recommends pertussis vaccination at 8, 12 and 16 weeks of age and a pre-school booster at 3 years and 4 months.
Vaccine coverage estimates (evaluated between July and September 2022) for DTaP/IPV/Hib/HepB immunisation across England was 92.1% for 3 doses at 12 months of age and 83.4% for the DTaP/IPV booster dose by 5 years of age (3). Coverage estimates at 12 months of age were higher than the coverage estimates for July to September 2021 when the proportion of children vaccinated at 12 months was 91.3% and coverage estimates for the booster dose were lower than the 84.0% reported for the same period in 2021 (4).
The introduction of social distancing in response to the COVID-19 pandemic from late March 2020, when some of this cohort would have been scheduled for vaccination, may have contributed to the modest decrease seen in the booster dose coverage.
Maternal vaccination programme
The maternal pertussis immunisation programme introduced in response to the 2012 outbreak (5, 6) became permanent from June 2019 (7) based on evidence of disease impact, high effectiveness and safety (2, 8, 9, 10). The recommended gestational age for vaccination is between 20 and 32 weeks, ideally after the 20-week scan, but the vaccine can be given as early as 16 weeks for pragmatic reasons to ensure vaccination (7).
Monthly pertussis vaccine coverage was 60.2% in July, 59.8% in August and 60.8% in September 2022. The mean coverage for the quarter was 60.2%, which was 4.7 and 6.4 percentage points lower than mean coverage for the same quarters in 2021 and 2020, respectively (11). This observed decline in coverage has largely been driven by a decrease in London NHS Commissioning Region which had coverage that was 9.0 percentage points lower in September 2022 as compared to September 2020 (11).
The impact of the pandemic on healthcare services has possibly resulted in vaccine coverage this quarter being lower than any previous quarter since 2016 (11). This could be due to a potential increase in the delivery of the vaccines through maternity units during the pandemic, which may not have been captured completely in the survey and therefore resulted in an underestimation of coverage.
Surveillance data in young infants following the introduction of the pertussis immunisation in pregnancy programme demonstrated that a low incidence had been maintained in this age group, with expected seasonal increases (2). COVID-19 control measures appear to have had an additional impact on these observed effects. It is therefore important that women continue to be supported to access immunisation against pertussis during pregnancy (ideally between 20 and 32 weeks) to optimise protection for their babies from birth.
Table 1. Laboratory-confirmed cases of pertussis, by age and testing method, in England: July to September 2022
| Age group | Culture | PCR | Serology | Oral fluid only | Total |
|---|---|---|---|---|---|
| Less than 3 months | 0 | 0 | 0 | 0 | 0 |
| 3 to 5 months | 0 | 2 | 0 | 0 | 2 |
| 6 to 11 months | 0 | 0 | 0 | 0 | 0 |
| 1 to 4 years | 0 | 1 | 0 | 0 | 1 |
| 5 to 9 years | 0 | 0 | 1 | 1 | 2 |
| 10 to 14 years | 0 | 0 | 0 | 1 | 1 |
| 15 years and over | 0 | 0 | 13 | 0 | 13 |
| Total | 0 | 3 | 14 | 2 | 19 |
*Culture-confirmed cases may additionally have tested positive by any other method; PCR-confirmed cases may have additionally tested positive by serology or OF; and serology-confirmed cases may also have been confirmed by OF. Cases are only represented once in the table.
Figure 1. Total number of laboratory-confirmed pertussis cases per quarter in England, 2011 to quarter 3 of 2022
Table 2. Laboratory-confirmed cases of pertussis, by age and year, in England: July to September, 2012 to 2022
| Age group | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Less than 3 months | 147 | 21 | 47 | 51 | 49 | 40 | 15 | 29 | 1 | 0 | 0 |
| 3 to 5 months | 37 | 4 | 4 | 18 | 12 | 12 | 11 | 12 | 1 | 0 | 2 |
| 6 to 11 months | 15 | 3 | 5 | 5 | 18 | 7 | 7 | 6 | 0 | 0 | 0 |
| 1 to 4 years | 42 | 13 | 13 | 22 | 42 | 28 | 40 | 72 | 1 | 1 | 1 |
| 5 to 9 years | 67 | 27 | 33 | 75 | 96 | 52 | 41 | 72 | 0 | 1 | 2 |
| 10 to 14 years | 252 | 88 | 99 | 129 | 126 | 99 | 73 | 125 | 3 | 0 | 1 |
| 15 years and over | 2,959 | 973 | 892 | 1,027 | 1,532 | 1,086 | 720 | 856 | 29 | 7 | 13 |
| Not known | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 |
| Total | 3,519 | 1,129 | 1,093 | 1,327 | 1,875 | 1,324 | 907 | 1,174 | 35 | 9 | 19 |
References
1. Tessier E and others (2022). ‘Impact of the COVID-19 pandemic on Bordetella pertussis infections in England’. BMC Public Health: volume 22, number 405
2. Amirthalingam G and others (2023) ‘Optimization of timing of maternal pertussis immunization from 6 years of post-implementation surveillance data in England’, Clinical Infectious Diseases: volume 76, issue 3
3. Quarterly vaccination coverage statistics for children aged up to 5 years in the UK (COVER programme): July to September 2022. Health Protection Report: volume 16, number 13 (20 December 2022)
4. Quarterly vaccination coverage statistics for children aged up to 5 years in the UK (COVER programme): July to September 2021. Health Protection Report: volume 15, number 20 (21 December 2021)
5. Confirmed pertussis in England and Wales continues to increase (2012). Health Protection Report: volume 6 number 15
6. Department of Health (2012) ‘Pregnant women to be offered whooping cough vaccine’ (website news story, 28 September)
7. Joint Committee on Vaccination and Immunisation minutes (meeting of 5 June 2019)
8. Amirthalingam G and others (2014) ‘Effectiveness of maternal pertussis vaccination in England: an observational study’, The Lancet: volume 384 issue 9953, pages 1521 to 1528
9. Dabrera G and others (2015) ‘A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting new-born infants in England and Wales, 2012–2013’, Clinical Infectious Diseases: volume 60(3), pages 333 to 337
10. Donegan K and others (2014) ‘Safety of pertussis vaccination in pregnant women in UK: observational study’, British Medical Journal
11. Pertussis vaccination programme for pregnant women update: vaccine coverage in England, July to September 2022. Health Protection Report: volume 17, number 2 (27 February 2022)