Pertussis in Low and Medium Income Countries: A Pragmatic Approach.

Pertussis is a vaccine preventable disease since late 1940s. However, it is still endemic in all countries and occurs in epidemic cycles. The number of cases/deaths has decreased during the last decade but a high number of deaths persists in Low and Medium Income Countries (LMIC). The epidemiological situation in LMIC is not precisely known due to lack of surveillance and specific diagnostic tools. A pragmatic approach in these countries should be to establish; (i) a hospital-based surveillance in the largest cities of the country with clinicians and nurses trained to detect clinical symptoms, to obtain biological samples for specific analysis and diagnosis; (ii) a reference laboratory as part of an international network of reference laboratories, under quality assurance, and able to perform at least PCR diagnosis and if possible detection of antibiotic resistance. This surveillance network would allow specific diagnosis of pertussis and facilitate the reporting of cases at national level, thereby improving awareness of the disease at clinician, population and decision maker levels. This network could allow a better evaluation of vaccine coverage, timely vaccination and impacts of modification of national vaccine strategy or type of pertussis vaccine used. Collaboration between this network and basic scientists should be strengthened through translational research projects in order to improve fundamental knowledge on pertussis in LMIC and help clinicians' access to specific diagnostic tools.