The burden of pertussis in older adults: what is the role of vaccination? A systematic literature review

<b>Introduction</b>: Pertussis (whooping cough) is a vaccine-preventable disease; however, neither natural- nor vaccine-induced protection is life-long. Although generally not severe in adults, pertussis can be associated with complications in patients with chronic conditions such as asthma or chronic obstructive pulmonary disease, and can be readily transmitted to more vulnerable populations, including neonates before they complete their primary vaccination. Furthermore, as the global population ages, the health and economic burden of the disease is expected to rise. <b>Areas covered</b>: A systematic literature review was conducted to ascertain the current epidemiological and financial burden of pertussis in older adults and to discuss the potential value of a booster vaccination in this population. <b>Expert commentary</b>: Our review indicates a considerable underestimation of the pertussis burden amongst older adults. Seroprevalence studies consistently demonstrate that the reported incidence may be much lower than the actual incidence. Tetanus toxoid-reduced diphtheria toxoid and acellular pertussis vaccines are immunogenic in older adults, induce high booster responses and are well-tolerated. There is therefore a good rationale for the advocacy of booster pertussis vaccination throughout life to prevent pertussis infection and its transmission, especially in adults aged ≥50 years.

<b>引言</b>：百日咳（whooping cough）是一种可通过疫苗预防的疾病，但无论是自然感染诱导的免疫保护，还是疫苗接种带来的免疫保护，均无法终身维持。尽管成人感染百日咳后通常症状并不严重，但对于哮喘、慢性阻塞性肺疾病等慢性病患者而言，百日咳可能引发并发症，且该病菌极易传播给更易感人群，包括尚未完成基础免疫的新生儿。此外，随着全球人口老龄化加剧，该疾病带来的健康与经济负担预计将进一步攀升。
<b>研究范围</b>：本研究通过系统文献综述，明确了当前老年人群百日咳的流行病学与经济负担，并探讨了该人群接种百日咳加强疫苗的潜在价值。
<b>专家评述</b>：本次综述显示，当前对老年人群百日咳负担的评估存在显著低估。血清流行病学研究一致表明，官方报告的发病率可能远低于实际发病水平。含减量白喉类毒素的破伤风类毒素-无细胞百日咳联合疫苗（Tdap）在老年人群中具有免疫原性，可诱导高效的加强免疫应答，且耐受性良好。因此，倡导终身接种百日咳加强针以预防百日咳感染及其传播具有充分的理论依据，尤其针对50岁及以上的成人群体。