We undertook an epidemiological survey of the annual incidence of pertussis reported from 2000 to 2013 in ten Central and Eastern European countries to ascertain whether increased pertussis reports in some countries share common underlying drivers or whether there are specific features in each country. The annual incidence of pertussis in the participating countries was obtained from relevant government institutions and/or national surveillance systems. We reviewed the changes in the pertussis incidence rates in each country to explore differences and/or similarities between countries in relation to pertussis surveillance; case definitions for detection and confirmation of pertussis; incidence and number of cases of pertussis by year, overall and by age group; population by year, overall and by age group; pertussis immunization schedule and coverage, and switch from whole-cell pertussis vaccines (wP) to acellular pertussis vaccines (aP). There was heterogeneity in the reported annual incidence rates and trends observed across countries. Reported pertussis incidence rates varied considerably, ranging from 0.01 to 96 per 100,000 population, with the highest rates generally reported in Estonia and the lowest in Hungary and Serbia. The greatest burden appears for the most part in infants (<1 year) in Bulgaria, Hungary, Latvia, Romania, and Serbia, but not in the other participating countries where the burden may have shifted to older children, though surveillance of adults may be inappropriate. There was no consistent pattern associated with the switch from wP to aP vaccines on reported pertussis incidence rates. The heterogeneity in reported data may be related to a number of factors including surveillance system characteristics or capabilities, different case definitions, type of pertussis confirmation tests used, public awareness of the disease, as well as real differences in the magnitude of the disease, or a combination of these factors. Our study highlights the need to standardize pertussis detection and confirmation in surveillance programs across Europe, complemented with carefully-designed seroprevalence studies using the same protocols and methodologies.

Clinic of Children's Diseases Faculty of Medicine Vilnius University Vilnius Lithuania

Department of Epidemiology University of Defence Hradec Kralove Czech Republic

Department of Family Medicine Medical University of Warsaw Warsaw Poland

Department of Paediatrics Riga Stradins University Riga Latvia

Estonian Health Board Tallinn Estonia

Faculty of Public Health Slovak Medical University Bratislava Slovakia

Hospital for Infectious Diseases Sofia Bulgaria

Institute for Public Health of Vojvodina Faculty of Medicine University of Novi Sad Novi Sad Serbia

National Institute of Health Promotion Paediatric Directorate Budapest Hungary

Service d'Hygiène Epidémiologie et Prévention Hôpital Edouard Herriot Hospices Civils de Lyon Lyon France

University Hospital Hradec Kralove Czech Republic

University of Basel Children's Hospital Basel Switzerland

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Effectiveness of one and two doses of acellular pertussis vaccines against laboratory-confirmed pertussis requiring hospitalisation in infants: Results of the PERTINENT sentinel surveillance system in six EU/EEA countries, December 2015 - December 2019

Evaluation of the Completeness and Timeliness of the Infant Pertussis Surveillance System in the Czech Republic in 2015, 2017 and 2019

Effectiveness of pertussis vaccination in pregnancy to prevent hospitalisation in infants aged <2 months and effectiveness of both primary vaccination and mother's vaccination in pregnancy in infants aged 2-11 months

Incidence and severity of pertussis hospitalisations in infants aged less than 1 year in 37 hospitals of six EU/EEA countries, results of PERTINENT sentinel pilot surveillance system, December 2015 to December 2018