Abstract
Pertussis, or whooping cough, remains a significant public health issue in Iran, despite high vaccination coverage. The incidence of pertussis has increased over the past two decades, attributed primarily to the waning of vaccine-induced immunity, particularly in adolescents and adults, who may act as reservoirs and transmit the infection to infants. Additional contributing factors include increased population density in closed communities,, incomplete primary immunization in infants, the presence of unvaccinated or partially vaccinated Afghan immigrants, and suboptimal booster coverage in older populations, particularly due to the absence of a national booster vaccination program for children beyond 72 months of age. In the present study, we reviewed and analyzed epidemiological studies on pertussis seroprevalence and diagnostic confirmation rates in Iran. Screening published reports from PubMed, Scopus, Web of Science, and Google Scholar revealed that the pooled seroprevalence of pertussis-specific IgG was 47.79% among vaccinated healthy Iranians, reflecting the overall level of antibody presence in this population. Comparing diagnostic methods, PCR-based diagnosis had a significantly higher confirmation rate (15.94%) compared to culture (3.02%) for detection of pertussis among suspected Iranian cases, emphasizing the need for improved diagnostic protocols. Although vaccination coverage has exceeded 95% since 1988, the persistence of pertussis suggests that current immunization strategies may be inadequate. Studies show that circulating Bordetella pertussis strains exhibit genetic variations that could contribute to vaccine escape. However, the body of evidence suggests that loss of acquired immunity over time palys the main role in pertussis resurgence. Whole-cell pertussis vaccines remain the primary immunization strategy in Iran. Considering the lower rate of adverse effects, acellular vaccines have been suggested to be used as booster doses, especially for adolescents and pregnant women. As a result, in order to prevent pertussis in newborn/young infants, many health authorities now recommend booster doses for adolescents, young adults, and pregnant women. In conclusion, pertussis continues to pose a public health challenge in Iran. Addressing this issue requires improved diagnostic techniques, enhanced surveillance, and consideration of updated vaccination strategies. Future research should focus on genomic surveillance, antibiotic resistance, and the long-term efficacy of booster immunizations to reduce pertussis transmission and protect vulnerable populations.