Pauline Labe, Alexandre Meunier. Pauline Leroux, Mirko Sadi, Carla Rodrigues, Valerie Bouchez, Marion Grimaud, Sylvain Brisse, Jérémie F. Cohen, Julie Toubiana
Université Paris Cité, Institut Pasteur and Hôpital Necker-Enfants Malades.
France
Journal of the American Medical Association Network Open
JAMA Netw Open 2026; 9:
DOI: 10.1001/jamanetworkopen.2026.22211
Abstract
Importance: Pertussis, or whooping cough, can be life threatening in infants, yet the concept of severe pertussis remains poorly defined in the literature. Lack of standardization may impair research and public health interventions.
Objective: To assess the variability in terminology and criteria used to define severe pertussis in the published literature.
Evidence review: A systematic review of the literature drawn from PubMed and Web of Science databases was performed. Studies involving infants with pertussis that provided a definition for severe pertussis and published from database inception to April 2025 were included without language restrictions. Study characteristics and detailed definitions of severe pertussis were extracted. Variations in terminology and criteria used across definitions were described.
Findings: Of the 914 unique studies identified, 133 underwent full-text review, and 78 were included in the study, encompassing 49 observational studies, 22 case reports, 3 case-control studies, and 4 reviews; no randomized clinical trials were included. Five different terms used to define severe pertussis were identified: severe (44 of 78 studies [56%]), malignant (12 of 78 studies [15%]), critical (9 of 78 studies [12%]), fatal (9 of 78 studies [12%]), and fulminant (4 of 78 studies [5%]). Across studies, 22 different criteria were used to define clinical severity, which were classified into 3 categories (ie, clinical, biological, and outcome). The most commonly reported criteria included respiratory failure (40 of 78 studies [51%]), pulmonary hypertension (30 of 78 studies [38%]), leukocytosis (28 of 78 studies [36%]), death (29 of 78 studies [37%]), and intensive care unit admission (29 of 78 studies [37%]).
Conclusions and relevance: This systematic review revealed substantial heterogeneity in the definition of severe pertussis in the literature. A consensus-based definition of severe pertussis is urgently needed to improve the understanding of its pathophysiology and to enhance clinical management, clinical research, and public health decision-making.
Category
Class I. Pulmonary Hypertension Associated with Infection
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes