China’s experts outline a medical-preventive blueprint to tackle the resurgence of pertussis

The global resurgence of pertussis, or whooping cough, presents a critical public health challenge, with China reporting nearly 477,000 cases in 2024—its highest level in nearly four decades. In response, Chinese experts have published a new consensus in Infectious Diseases & Immunity, offering a comprehensive framework to enhance prevention, diagnosis, and management through medical-preventive integration.

The consensus highlights that despite high vaccination coverage, the waning durability of immunity and the spread of macrolide-resistant Bordetella pertussis strains are driving the resurgence. To address this, the expert panel recommends a multi-faceted approach. First, healthcare professionals must strengthen early identification and standardized nucleic acid testing, particularly for older children and adults who often present with mild, atypical symptoms but act as primary transmission sources.

Crucially, the guidelines update antimicrobial treatment strategies. Given widespread macrolide resistance, azithromycin is recommended only for confirmed susceptible cases. For empirical treatment in children aged 2 months and older, sulfamethoxazole-trimethoprim is recommended as the first-line therapy, with levofloxacin suggested as an alternative under specific risk-benefit assessments and informed consent.

Furthermore, the consensus provides clear guidance on post-exposure prophylaxis for high-risk close contacts and advocates for a life-course immunization strategy, including advancing the first vaccine dose to 2 months of age and adding a booster at 6 years.

By bridging the gap between clinical practice and disease control agencies, this consensus aims to empower healthcare professionals to dynamically optimize pertussis control strategies and protect vulnerable populations.