PAHO calls for strengthened vaccination and surveillance amid the spread of antibiotic-resistant pertussis in the Americas – PAHO/WHO

Washington, DC, August 26, 2025 (PAHO)-to the light of the resurgence of the Raine cough in several countries of the region and the appearance and propagation of antibiotic resistant strains, the Pan American Health Organization (PAHO) reiterated the importance of strengthening vaccination and surveillance systems. The concern was shared during a recent meeting with the Latin America and Caribbean network for the surveillance of antimicrobial resistance (relax+), where the latest findings and response strategies to this highly contagious disease were discussed.

«Vaccination, surveillance and the responsible use of antibiotics are critical to prevent the people from becoming a serious threat to public health,» said Pilar Ramón-Pardo, head of the Special Program of Paho on resistance to antimicrobials. «We still have time to contain this problem, but we must act now: increase vaccination coverage, strengthen early detection and improve our ability to outbreak,» he added.

One of the main challenges is that standard treatment is based on macroll antibiotics, such as azithromycin, clarithromycin and erythromycin. However, genetic mutations at Bordetella Pertussis, particularly in the 23S RRNA gene, are reducing the effectiveness of these medications, which complicates treatment for patients and prevention among nearby contacts.

During the COVID-19 pandemic, the generalized and inappropriate use of antibiotics such as azithromycin may have contributed to the appearance of resistant strains. Since 2024, cases have been reported in Brazil, Mexico, Peru and the United States, detected thanks to strengthened diagnostic and surveillance systems, including molecular tests and standardized methods in reference laboratories. These advances, backed by international associations, have been key to identifying and containing these cases.

Given the generalized use of these antibiotics and high international mobility, there is a risk of broader propagation if health responses are not reinforced.

Antimicrobial resistance (AMR) occurs when bacteria develop mechanisms to evade the effects of drugs, which makes them ineffective. In the case of the Raine cough, this can limit treatment options, hinder outbreak control and increase the risk of serious complications, particularly in areas with low vaccination coverage.

Decline vaccination coverage

The Raine cough, also known as the Raine cough, can be prevented with three doses of the DPT vaccine in children under one year old, with reinforcements during childhood and adolescence. However, in infected individuals, especially babies, it can cause serious diseases, with risks of complications or even death.

The disease has resurfaced in the Americas. Although 4,139 cases were reported in 2023, the number shot at 43,751 in 2024. In the first seven months of 2025, nine countries reported more than 18,595 cases and 128 deaths. Resurgence is related to the decrease in vaccination rates and underlines the need for standardized and strengthened surveillance.

During the pandemic, the regional coverage for the first doses (DTP1) and third (DTP3) of the vaccine fell to historical minimums of 87% and 81% in 2021, respectively. By 2023, a partial recovery (90% and 88%) was observed, but these rates remain below the 95% recommended by the PAHO, with significant disparities within the countries. In addition to children’s vaccination, PAHO recommends vaccinating pregnant women, especially during shoots, and health workers in contact with newborns.

Laboratories strengthen surveillance

Strengthening national reference laboratories with reliable standardized diagnostic methods is essential for timely detection of resistance and guiding the responses of health authorities. Collaboration initiatives such as PAHO Relavra+ Network and Regional Genomic Surveillance Networks of Paho (PAHOGO), together with other strategic associations, have allowed standardized methodologies and an expanded surveillance capacity in several countries in the region.

As part of his technical cooperation, Paho organized a Virtual Relavra+ Red Seminar on August 19, gathering national reference laboratories and microbiology experts in the region. During the event, specialists from Brazil, Colombia, Mexico and Peru shared recent findings, methodologies to detect resistant strains and surveillance and response strategies.

Given this scenario, the PAHO urges countries to reinforce their diagnostic capacity, improve technical training for health personnel, maintain or increase vaccination coverage, and establish active and standardized surveillance systems to allow a rapid and effective response to resistance to antimicrobials.