Global Pertussis Revival: The Rise of Drug-Resistant Strains and the Frontline of "Cough Etiquette" — Protecting Infants and Preventing Widespread Transmission in Society —

Global Pertussis Revival: The Rise of Drug-Resistant Strains and the Frontline of "Cough Etiquette" — Protecting Infants and Preventing Widespread Transmission in Society —

2025年07月14日 19:55

Table of Contents

  1. What is Whooping Cough? — History and Basic Knowledge

  2. What's Happening Globally? The 2024-25 Epidemic Situation

  3. Mechanism of Emergence of Macrolide-Resistant Strains (MRBP)

  4. Infant Risks and Severe Patterns

  5. "Hidden Infections" in Older Children and Adults — For Those Who Can't Stop Coughing

  6. Challenges of Vaccines: Waning Immunity and Strain Variation

  7. Cutting-edge Treatments: Alternative Drugs like ST Combination and Broad-Spectrum β-Lactams

  8. Public Health Measures: From School Closures to Pregnant Women Vaccination

  9. Cough Etiquette Practice Guide (Checklist for Adults)

  10. International Cooperation and Future Research Challenges

  11. Conclusion — Roadmap to Zero Whooping Cough

  12. 📚List of Reference Articles (External Links, Chronological Order)



1. What is Whooping Cough? — History and Basic Knowledge

Whooping cough is an acute respiratory infection primarily caused by B. pertussis, characterized by paroxysmal coughing with a typical "whoop" sound during inhalation, though in infants, it may present only with apnea, leading to delayed diagnosis†Infectious Disease Information Site. The epidemic dramatically decreased with the introduction of modern vaccines, but recently, a combination of waning vaccine immunity, genetic changes in the pathogen, and delayed vaccinations post-COVID-19 has led to a resurgence.



2. What's Happening Globally? The 2024-25 Epidemic Situation

  • United States: 10,062 cases and 5 deaths from EW1-18 in 2025, maintaining a high level for two consecutive years†paho.org.

  • Japan: 22,351 cases by week 21 of 2025 — over 2,000 cases per week, the highest ever†Infectious Disease Information Site.

  • China and Europe: An 11-fold increase in China, with 14 MRBP cases reported in France†The LancetmedRxiv.
    PAHO/WHO issued an alert to all member countries on May 31, 2025, prioritizing the prevention of deaths in infants under one year old†Infectious Disease Information Sitepaho.org.



3. Mechanism of Emergence of Macrolide-Resistant Strains (MRBP)

First detected in China in the 2000s, strains with the A2047G mutation in 23S rRNA have spread. By 2020, 57.5-91.9% of Chinese patients harbored resistance†Japan Pediatric Society. In Japan, cases have been detected in patients without travel history since 2023. Drug selection pressure, antigenic divergence from vaccine strains, and the resumption of international travel are considered background factors.



4. Infant Risks and Severe Patterns

Infants aged 0-6 months have incomplete immunity and a shorter paroxysmal cough phase, making them prone to pneumonia, encephalopathy, and pulmonary hypertension. In April 2025, a one-month-old girl in Tokyo died of respiratory failure due to MRBP†Infectious Disease Information Site. WHO recommends the pregnant women vaccine (28-36 weeks) and the "cocooning" strategy (additional vaccination for all family members).



5. "Hidden Infections" in Older Children and Adults — For Those Who Can't Stop Coughing

In Japan's 2025 epidemic, 58.7% of cases were in the 10-19 age group, where chronic cough often leads to delayed diagnosis†Infectious Disease Information Site. Adult cases may be mild to moderate but can transmit to infants, becoming a source of severe infection. "Cough lasting more than two weeks," "worsening at night," and "inspiratory whooping sound" are warning signs.



6. Challenges of Vaccines: Waning Immunity and Strain Variation

The adjuvant-improved non-toxic component vaccine (aP) is highly effective against the conventional type (ptxP1) but shows early decline in protective effect against the currently prevalent ptxP3 strain†The Lancet. Expanding booster vaccinations in preschool and adolescence is becoming an international trend.



7. Cutting-edge Treatments: Alternative Drugs like ST Combination and Broad-Spectrum β-Lactams

The Japan Pediatric Society proposes the use of trimethoprim/sulfamethoxazole (for children over 2 months) in suspected resistant cases†Japan Pediatric Society. In the UK and Australia, clinical guidelines are being revised to make this drug the first choice, and there are reports of piperacillin/tazobactam intravenous cases in severe infants†Lippincott.



8. Public Health Measures: From School Closures to Pregnant Women Vaccination

  • Schools and Childcare Facilities: Attendance is allowed after the disappearance of cough or five days of appropriate antibiotic treatment. However, in MRBP epidemic areas, testing confirmation is desirable†Japan Pediatric Society.

  • Pregnant Women Vaccination: Late pregnancy aP vaccine reduces infant severity by 50-90%.

  • Information Sharing: Linking electronic health records with vaccination history and using social media for youth awareness are key.



9. Cough Etiquette Practice Guide (Checklist for Adults)

  1. Cover coughs and sneezes with a tissue/elbow

  2. Ensure the mask fits from nose to chin snugly

  3. Dispose of used tissues in a sealed container

  4. Frequent handwashing and hand sanitization

  5. Cough lasting more than two weeks should be checked at a medical facility



10. International Cooperation and Future Research Challenges

  • Expansion of MRBP Genome Surveillance Network (Sharing Next-Generation Sequencers)

  • Clinical Trials for New Antibacterial Drugs and Vaccine Candidates (Multivalent Toxins, Neutralizing Antibodies)

  • Animal Reservoir Surveys from a "One Health" Perspective



11. Conclusion — Roadmap to Zero Whooping Cough

Whooping cough is not a "disease of the past." With the expansion of drug resistance and the highlighted immunity gap, a "Triple Shield" strategy integrating vaccine policy, clinical guidelines, and citizen behavior change centered on infant protection is essential. By ensuring cough etiquette in every home, school, and company, and advancing diagnosis and treatment updates in medical settings, let's break the chain of "coughs that claim lives."




📚List of Reference Articles (External Links, Chronological Order)

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