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Pertussis in Africa: Findings and recommendations of the Global Pertussis Initiative (GPI).

Wednesday, 9th of May 2018 Print


Vaccine. 2018 Apr 25;36(18):2385-2393. doi: 10.1016/j.vaccine.2018.03.025. Epub 2018 Mar 27.

Pertussis in Africa: Findings and recommendations of the Global Pertussis Initiative (GPI).

Muloiwa R1Wolter N2Mupere E3Tan T4Chitkara AJ5Forsyth KD6von König CW7Hussey G8.

Author information

1 Department of Paediatrics and Child Health, University of Cape Town, 7701 Cape Town, South Africa.

2 National Institute for Communicable Diseases and University of the Witwatersrand, 2131 Johannesburg, South Africa.

3 Department of Paediatrics & Child Health, Makerere University College of Health Sciences, 7072 Kampala, Uganda.

4 Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.

5 Max Super Speciality Hospital, Shalimar Bagh, New Delhi 110 088, India.

6 Flinders University and Flinders Medical Centre, Bedford Park, 5042 Adelaide, Australia.

7 Labor:Medizin Krefeld MVZ GmbH, 47805 Krefeld, Germany.


Department of Pathology and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, 7701 Cape Town, South Africa. Electronic address: gregory.hussey@uct.ac.za.


Pertussis remains a major cause of morbidity and mortality, particularly in infants and young children, and despite the availability of vaccines and pertinent national and international guidelines. The disease burden is more severe in low- and middle-income countries (LMICs), especially in the African continent. Pertussis is more prevalent among young infants in Africa. Poor or no pertussis surveillance, lack of disease awareness, diagnostic limitations, and competing health priorities are considered key contributory factors for this high pertussis burden in Africa. Most African countries use whole-cell pertussis (wP) vaccines, but coverage with three primary doses of diphtheria-tetanus-pertussis vaccines falls short of the World Health Organizations recommended goal of >90%. The Global Pertussis Initiative (GPI) works toward developing recommendations through systematic evaluation and prioritization of strategies to prevent pertussis-related infant and child deaths, as well as reducing global disease burden to acceptable national, regional, and local levels. For countries using wP vaccines, the GPI recommends continuing to use wP to improve primary and toddler booster vaccination coverage. Vaccination during pregnancy is the next priority when acellular pertussis (aP) vaccines and other resources are available that directly protect newborns too young to be vaccinated, followed by, in order of priority, booster doses in older children, adolescents, healthcare workers and finally, all adults. Improved surveillance should be a high priority for African LMICs assessing true disease burden and vaccine effectiveness to inform policy. More research is warranted to evaluate the safety and efficacy of wP and aP vaccines and strategies, and to determine their optimal use.