Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024
Objectives: Despite high vaccination coverage, pertussis resurgence in megacities challenges conventional control strategies. We investigated epidemiological patterns and policy impacts in a densely populated urban setting in Chongqing, China. Methods: Using population-based surveillance data (2005-...
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Elsevier
2025-07-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S120197122500133X |
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| author | Rui Shen Jiawei Xu Yugang Li Jianxing Yu Na Sun Zilu Xu Xueying Xu Xiao Liu Yang Liu Bosong Li Li Qi Luzhao Feng |
| author_facet | Rui Shen Jiawei Xu Yugang Li Jianxing Yu Na Sun Zilu Xu Xueying Xu Xiao Liu Yang Liu Bosong Li Li Qi Luzhao Feng |
| author_sort | Rui Shen |
| collection | DOAJ |
| description | Objectives: Despite high vaccination coverage, pertussis resurgence in megacities challenges conventional control strategies. We investigated epidemiological patterns and policy impacts in a densely populated urban setting in Chongqing, China. Methods: Using population-based surveillance data (2005-2024) from Chongqing (population 32.1 million; DTP3 coverage >97%), we conducted hierarchical Bayesian spatial modeling and age-structured Susceptible-Infected-Recovered-Vaccinated transmission analysis. We assessed four sequential policy transitions and simulated four vaccination strategies over three years (2025-2027) to evaluate their potential impact. Results: Annual pertussis incidence increased from 0.25 to 70.82/100,000. Infants showed highest absolute risk, while children aged 6-7 years demonstrated elevated risk (RR: 0.55 and 0.54, respectively). Urban areas showed marginally elevated risk (RR: 1.04, 95% CI: 1.00-1.07). Molecular diagnostics implementation revealed substantial hidden transmission (RR: 82.65, 95% CI: 73.47-92.99). Modeling projected extended school-age boosters (ages 5-7 years) would reduce incidence by 47.93%, targeted vaccination of ages 6-7 years achieved 36.64% reduction, and the national benchmark with 6-year booster reduced incidence by 19.09%. All strategies provided substantial indirect protection to infants without direct intervention. Conclusion: Enhanced molecular surveillance uncovered substantial hidden transmission in urban settings. Strategic school-age targeted vaccination could effectively disrupt urban transmission chains while protecting vulnerable infants. |
| format | Article |
| id | doaj-art-04d154b9af9e4b64a23e53c2457c7dc0 |
| institution | DOAJ |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-04d154b9af9e4b64a23e53c2457c7dc02025-08-20T03:11:26ZengElsevierInternational Journal of Infectious Diseases1201-97122025-07-0115610791010.1016/j.ijid.2025.107910Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024Rui Shen0Jiawei Xu1Yugang Li2Jianxing Yu3Na Sun4Zilu Xu5Xueying Xu6Xiao Liu7Yang Liu8Bosong Li9Li Qi10Luzhao Feng11Public Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, ChinaChongqing Center for Disease Control and Prevention (Chongqing Academy of Preventive Medicine), Chongqing, ChinaPublic Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, ChinaPublic Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, ChinaPublic Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, ChinaPublic Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, ChinaSchool of Public Health, China Medical University, Shenyang, ChinaPublic Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, ChinaChongqing Center for Disease Control and Prevention (Chongqing Academy of Preventive Medicine), Chongqing, ChinaChongqing Center for Disease Control and Prevention (Chongqing Academy of Preventive Medicine), Chongqing, ChinaChongqing Center for Disease Control and Prevention (Chongqing Academy of Preventive Medicine), Chongqing, ChinaPublic Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China; Corresponding author: Luzhao Feng, Public Health Emergency Management Innovation Center, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College; Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education; State Key Laboratory of Respiratory Health and Multimorbidity, no. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China.Objectives: Despite high vaccination coverage, pertussis resurgence in megacities challenges conventional control strategies. We investigated epidemiological patterns and policy impacts in a densely populated urban setting in Chongqing, China. Methods: Using population-based surveillance data (2005-2024) from Chongqing (population 32.1 million; DTP3 coverage >97%), we conducted hierarchical Bayesian spatial modeling and age-structured Susceptible-Infected-Recovered-Vaccinated transmission analysis. We assessed four sequential policy transitions and simulated four vaccination strategies over three years (2025-2027) to evaluate their potential impact. Results: Annual pertussis incidence increased from 0.25 to 70.82/100,000. Infants showed highest absolute risk, while children aged 6-7 years demonstrated elevated risk (RR: 0.55 and 0.54, respectively). Urban areas showed marginally elevated risk (RR: 1.04, 95% CI: 1.00-1.07). Molecular diagnostics implementation revealed substantial hidden transmission (RR: 82.65, 95% CI: 73.47-92.99). Modeling projected extended school-age boosters (ages 5-7 years) would reduce incidence by 47.93%, targeted vaccination of ages 6-7 years achieved 36.64% reduction, and the national benchmark with 6-year booster reduced incidence by 19.09%. All strategies provided substantial indirect protection to infants without direct intervention. Conclusion: Enhanced molecular surveillance uncovered substantial hidden transmission in urban settings. Strategic school-age targeted vaccination could effectively disrupt urban transmission chains while protecting vulnerable infants.http://www.sciencedirect.com/science/article/pii/S120197122500133XMolecular diagnosticsPertussisSchool-age transmissionUrban epidemiologyVaccination policy |
| spellingShingle | Rui Shen Jiawei Xu Yugang Li Jianxing Yu Na Sun Zilu Xu Xueying Xu Xiao Liu Yang Liu Bosong Li Li Qi Luzhao Feng Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024 International Journal of Infectious Diseases Molecular diagnostics Pertussis School-age transmission Urban epidemiology Vaccination policy |
| title | Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024 |
| title_full | Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024 |
| title_fullStr | Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024 |
| title_full_unstemmed | Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024 |
| title_short | Urban pertussis epidemiological patterns in a highly vaccinated megacity: Policy impacts and control strategies in Chongqing, China, 2005-2024 |
| title_sort | urban pertussis epidemiological patterns in a highly vaccinated megacity policy impacts and control strategies in chongqing china 2005 2024 |
| topic | Molecular diagnostics Pertussis School-age transmission Urban epidemiology Vaccination policy |
| url | http://www.sciencedirect.com/science/article/pii/S120197122500133X |
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