Circulation of pertussis and poor protection against diphtheria among middle-aged adults in 18 European countries

the Serosurveillance Study Team

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Reported incidence of pertussis in the European Union (EU) and the European Economic Area (EEA) varies and may not reflect the real situation, while vaccine-induced protection against diphtheria and tetanus seems sufficient. We aimed to determine the seroprevalence of DTP antibodies in EU/EEA countries within the age groups of 40–49 and 50–59 years. Eighteen countries collected around 500 samples between 2015 and 2018 (N = 10,302) which were analysed for IgG-DTP specific antibodies. The proportion of sera with pertussis toxin antibody levels ≥100 IU/mL, indicative of recent exposure to pertussis was comparable for 13/18 countries, ranging between 2.7–5.8%. For diphtheria the proportion of sera lacking the protective level (<0.1 IU/mL) varied between 22.8–82.0%. For tetanus the protection was sufficient. Here, we report that the seroprevalence of pertussis in these age groups indicates circulation of B. pertussis across EU/EEA while the lack of vaccine-induced seroprotection against diphtheria is of concern and deserves further attention.

Original languageEnglish
Article number2871
JournalNature Communications
Publication statusPublished - 17 May 2021

Bibliographical note

Funding Information: The funder of the study had a role in the study design, data interpretation and writing of the manuscript, but no role in data collection or data analysis. The corresponding authors had full access to all data from the study, and final responsibility for the decision to submit for publication was by consensus of all co-authors. The study was undertaken as part of the framework contract “Coordination of activities for laboratory surveillance of whooping cough in Member States/EEA countries” (EUPert-LabNet) [ECDC/2015/009] coordinated by the National Institute for Public Health and the Environment (RIVM, the Netherlands) and the University of Turku (Finland) and funded by ECDC. Part of this research has been conducted using the Danish National Biobank resource, supported by the Novo Nordisk Foundation, grant number 2010-11-12 and 2009-07-28. The Dutch sample collection was commissioned and funded by the Ministry of Health, Welfare and Sport (VWS) of the Netherlands. We would like to thank from all participating countries the laboratories and personnel who contributed to the collection of the serum samples for this study, in particular Karin Baier (Austria), Amber Litzroth (Belgium), Sophie Guillot, Sabine Trombert-Paolantani, Véronique Jacomo (France), Paraskevi C. Fragkou, Theano Georgakopoulou (Greece), Erzsébet Rusvai (Hungary), Suzanne Cotter (Ireland), Jurijs Perevoscikovs (Latvia), Gaby Smits, Mark Jonker (the Netherlands), Cristina Oprea (Romania), Teodora Aktas, Teghesti Tecleab, Tiia Lepp (Sweden) and Ezra Linley (United Kingdom).

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit

Publisher Copyright: © 2021, The Author(s).

Citation: Berbers, G., van Gageldonk, P., Kassteele, J.v.d. et al. Circulation of pertussis and poor protection against diphtheria among middle-aged adults in 18 European countries. Nat Commun 12, 2871 (2021).



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