Only 4.1 percent of mothers had been vaccinated during pregnancy
In six Gulf region countries, a two-year study of 204 infants admitted to intensive care with severe pertussis has laid bare one of medicine's most painful paradoxes: the children most vulnerable to a preventable disease are those who arrive in the world before their own defenses can be built. Thirty-one of these infants — most younger than two months — did not survive. The data points not toward the limits of intensive care, but toward the absence of a far simpler intervention: a vaccine given to a mother before her child is born.
- Whooping cough has surged globally since 2023, and its most devastating toll falls on infants under six months whose lungs, blood, and organs are not yet equipped to withstand the assault.
- Nearly half the infants in the study developed dangerously elevated white blood cell counts, forcing doctors into difficult and inconsistent decisions about blood-reduction procedures that varied widely across countries.
- Mechanical ventilators, high-flow oxygen, and in three cases an artificial heart-lung machine became the last line of defense for children whose bodies could no longer breathe on their own.
- A mortality rate of 15.2 percent — roughly one in seven — underscores how little the ICU can compensate for the protection that was never given in the first place.
- With only 4.1 percent of mothers having been vaccinated during pregnancy, the study exposes a near-total collapse of the prenatal immunization shield that could have kept these infants out of intensive care entirely.
Between 2022 and 2024, researchers across six Gulf countries followed 204 infants admitted to intensive care with severe pertussis. The median age was 53 days. Nearly all had been healthy before hospitalization. Thirty-one died.
Pertussis — whooping cough — has been rising globally since 2023, and its cruelest impact falls on the youngest infants. In these patients, the disease can trigger respiratory failure, dangerous spikes in pulmonary blood pressure, and white blood cell counts so elevated they become life-threatening. Close to half the infants in the study developed this condition, known as hyperleukocytosis, prompting doctors to attempt blood-reduction interventions including exchange transfusions and, less commonly, a filtration technique called leukapheresis. Approaches varied considerably from country to country.
Respiratory support was nearly universal. More than half received high-flow nasal oxygen; one in three required mechanical ventilation, with half of those remaining intubated for a week or more. Three infants needed ECMO — an artificial heart-lung machine deployed when the body's own organs can no longer sustain life. Almost every child received macrolide antibiotics, the standard treatment, often alongside additional drug classes. The median ICU stay was five days. The leading causes of death were septic shock and respiratory failure.
What the data makes impossible to ignore is the absence of maternal protection. Only 4.1 percent of the infants had mothers vaccinated against pertussis during pregnancy — a straightforward intervention that transfers protective antibodies to the fetus before birth, bridging the gap before infants can complete their own vaccination series. Fewer than one in five infants had received any pertussis vaccine at all.
The researchers concluded that this burden is substantial and largely preventable. As pertussis cases continue to climb and prenatal vaccination rates remain critically low, the study's quiet argument is that the most important place to fight this disease is not the intensive care unit — it is the obstetric clinic, months before the crisis begins.
Across six countries in the Gulf region, researchers tracked 204 infants admitted to intensive care units with severe pertussis between 2022 and 2024. The median age was 53 days. Nearly all had been healthy before arriving at the hospital. Thirty-one of them died—a mortality rate of 15.2 percent.
Pertussis, the bacterial infection commonly called whooping cough, has surged globally since 2023, hitting infants under six months hardest. These youngest patients face the steepest risk: their lungs can fail, their blood pressure in the pulmonary vessels can spike dangerously, their white blood cell counts can soar to life-threatening levels, and their organs can begin to shut down. The disease can demand weeks on a ventilator and round-the-clock intensive care. The study, published in Pediatric Critical Care Medicine, aimed to map how these infants were treated and what happened to them.
Nearly half the infants—49.5 percent—developed hyperleukocytosis, a condition where white blood cell counts exceed 30 billion per liter. This dangerous elevation was so common that doctors across the region tried different strategies to bring it down. Some performed exchange transfusions, a procedure in which large volumes of the patient's blood are removed and replaced with donor blood. Forty-seven infants underwent this intervention, most receiving a single session. A smaller number had leukapheresis, a gentler filtration technique, but it was used in only nine cases.
Respiratory support was nearly universal. More than half the infants received high-flow nasal oxygen. One in three needed mechanical ventilation—a breathing tube and a machine to do the work their lungs could not. Of those intubated, half remained on the ventilator for a week or longer. Three infants required ECMO, an artificial heart-lung machine that takes over when the body's own organs are failing. Almost every child received macrolide antibiotics, the standard treatment. Most also received additional antibiotics from other drug classes, with third-generation cephalosporins prescribed most often.
What stands out starkly in the data is the absence of maternal protection. Only 4.1 percent of the infants had mothers who had been vaccinated against pertussis during pregnancy. Just 17.3 percent of the infants themselves had received any pertussis vaccine. Maternal vaccination during pregnancy transfers antibodies to the fetus, offering a shield during the first months of life when infants are most vulnerable and before they can complete their own vaccination series. That protection was almost entirely absent in this population.
The study also revealed how differently doctors approached these critically ill infants depending on where they worked. Practices around blood cell reduction, fluid management, and other intensive care strategies varied substantially from country to country. The median stay in the ICU was five days; in the hospital overall, nine days. The primary causes of death were septic shock and respiratory failure—the very complications the intensive care was meant to prevent.
The researchers concluded that severe pertussis in infants represents a substantial and preventable burden. The low rates of maternal vaccination they documented suggest that prenatal immunization programs in the region are not reaching the mothers who need them most. As pertussis cases continue to climb and vaccination coverage continues to fall in many countries, the question becomes urgent: how do we protect infants too young to be fully vaccinated? The answer, the data suggests, lies not in the ICU but in the obstetric clinic.
Notable Quotes
The analysis revealed that severe pertussis predominantly affects very young infants, with substantial illness and death rates. Management practices, including blood cell reduction techniques, varied widely across the region, highlighting gaps in prevention and treatment strategies.— Study researchers, Gulf Cooperation Council
The Hearth Conversation Another angle on the story
Why does pertussis hit infants so much harder than older children?
Their immune systems are still forming. They haven't had time to build defenses. And their airways are smaller, so any swelling or mucus buildup becomes a crisis faster. A cough that an older child might weather can stop an infant from breathing.
The study mentions hyperleukocitosis in nearly half these cases. What does that actually do to a baby?
The white blood cells spike so high they can clog the tiny blood vessels in the lungs and brain. It's like a traffic jam in the bloodstream. Some doctors try to drain blood and replace it to bring those counts down, but there's no consensus on whether it helps or how to do it best.
Only 4 percent of mothers were vaccinated during pregnancy. Is that unusual?
It's alarmingly low. In countries with strong prenatal vaccination programs, you see rates above 80 percent. These infants were almost entirely unprotected from birth. That's the preventable part.
If the mortality rate is 15 percent, what kills the ones who survive? What's the long-term picture?
The study doesn't follow them after discharge. We know some infants who survive severe pertussis can have lasting lung damage or developmental delays from prolonged oxygen deprivation. But this research stops at the hospital door.
Why did treatment vary so much between countries?
There's no international guideline for managing severe pertussis in infants. Each country developed its own approach based on what resources it had and what its doctors believed worked. That fragmentation is part of what the researchers flagged—a need for consensus.
What would change if maternal vaccination rates went up?
Most of these infants wouldn't be in the ICU at all. Maternal antibodies would carry them through the first months until they could start their own vaccine series. It's the simplest intervention possible, and it's almost entirely absent from this population.