Linli Wang,1,* Meiying Gao,2,* Ying Chen,1 Qing Gu,1 Lejing Guan,2 Lidan Sun,2 Antonita Shereen George,3 Abdul Rafay,4 Yang Yang,5 Guannan Bai2 

1Department of Preventive Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Children’s Regional Medical Center, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Child Health Care, Children’s Hospital, Zhejiang University School of Medicine, National Children’s Regional Medical Center, National Children’s Regional Medical Center, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People’s Republic of China; 3School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 4School of Medicine, Imperial College London, London, UK; 5School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yang Yang, Email yangyang@kmmu.edu.cn Guannan Bai, Email guannanbai@zju.edu.cn

Background: Pertussis is a highly contagious respiratory disease caused by Bordetella pertussis, posing a significant health threat to children. Despite vaccination efforts, a resurgence of pertussis has been observed globally, especially during and after the COVID-19 pandemic. This study aims to investigate the epidemiological trends and characteristics of pertussis among pediatric patients during and after the COVID-19 pandemic in East China.
Methods: We included 92,300 patients aged 0– 18 years with suspected symptoms of pertussis infection from January 1, 2022, to November 30, 2024, in a tertiary children’s hospital in China. Clinical information (eg, detection date, date of birth, gender, type of patients) and pertussis test results were extracted from the laboratory information system. We used two independent sample t-tests and Chi-square tests to compare differences in the above-mentioned variables between the two pandemic phases. Positive detection rates were calculated across age groups, gender, patient types, seasons, and pandemic phases, while nonlinear associations between age and detection rates were assessed using restricted cubic spline regression models.
Results: Twenty-two thousand six hundred and forty-two (24.5%) cases were detected as positive cases. Cases surged from November 2023, peaking in April 2024 (n=5363). The highest positive detection rate of pertussis infection was observed in children aged over 6 years (36.2%), particularly among outpatients (37.6%), while the lowest rate was in those aged 18 months to 3 years (12.8%); significant differences were also noted by gender, patient type, season, and COVID-19 pandemic phases (p < 0.05). Nonlinear regression analysis shows a higher risk and wider susceptible age range after the COVID-19 pandemic than those during the pandemic (pnon-linear < 0.001).
Conclusion: This study highlights the resurgence of pertussis among children in Eastern China during and after the COVID-19 pandemic, emphasizing significant epidemiological shifts and expanded age susceptibility, underscoring the urgent need for enhanced vaccination strategies and public health interventions.

Keywords: pertussis, resurgence, epidemiology, children, COVID-19 pandemic