Infection that has already claimed lives in Hungary keeps on spreading

New data arrive

The NNGYK has published its weekly report on the epidemiological situation, which includes detailed data on certain infections for the 28th week of 2024 (8-14 July). These show that 21 suspected cases of pertussis have been identified, a new weekly record, with week 20 being the sad record holder with 20 suspected cases.

With this new weekly data, the total number of suspected cases for the year to mid-July has risen to 153.

Before many people shrug off the above figures (21 and 153) and say that these are not high, we would like to point out that the base of comparison is paramount.

In previous years, there was almost no incidence of the disease (between 0 and 23 cases per year), as the extremely high level of domestic vaccination prevented the spread of the infection in the domestic population.

In light of this, the actual number of cases may be many times higher, as neither patients nor professionals are often aware that they are dealing with this infection. And the NNGYK does not seem to focus on case detection.

Reports of suspected whooping cough were received from the capital and seven counties (Bács-Kiskun, Békés, Fejér, Hajdú-Bihar, Pest, Vas and Zala), the NNGYK said.

Despite the worsening pertussis situation, the epidemiological authority rarely addresses the issue or answers our questions. At the end of June, the NNGYK issued a statement saying that "although the number of reported cases has increased in our country in recent weeks, there are still some counties where no cases have been reported, so we cannot speak of a national epidemic".

It is unclear why the NNGYK said last month that the criterion for officially declaring an epidemic is whether the infection is present in all counties. Indeed, the likely scenario is that the epidemiological service has just not found a case in a given county yet.

Our data collection reveals that

by now, pertussis has been reported in 18 out of the 19 counties, i.e. we are on the brink of an epidemic even according to the nngyk's own criterion.

However, if we look at the graphs and case trends above, we have been talking about an epidemic situation for some time. From our database we can see that only Szabolcs-Szatmár-Bereg county is the only area where this infection has not yet been identified. We believe that the emphasis is on yet. In light of the NNGYK's epidemiological track record, it may well be that the authorities cannot detect this old-new infection, as it does not have the same health capacity and infrastructure in this county as in the rest of the country.

It is no coincidence that the epidemiological authority has already dropped the "all counties" criterion for a national outbreak in its latest statement issued on Monday evening, and now NNGYK is saying that

thanks to the Hungarian vaccination system, there is no outbreak of whooping cough and the disease is sporadic.

Research shows that people in different parts of the country do not have equal chances in the fight for their health. The national epidemiological surveillance system is unlikely to be able to identify cases with the same level of effectiveness across the country.

In an interview with Portfolio, epidemiologist Beatrix Oroszi pointed out a few weeks ago that we have to learn that not looking for a disease or an infection, not researching it, does not mean that it is not present and cannot spread.

Failing to detect infections is just flying blind: we don't know exactly how, where it spreads and whether it is changing, making it easier and easier for people to get infected. This gives it a head start on us, she added.

NNGYK makes a move, but there are a lot of open questions

The deterioration of the situation, our series of articles on the subject and several of our enquiries - which went unanswered - led, among other things, to the National Centre for Public Health and Pharmacy finally reacting to the situation, in several forms, at a more serious level than before.

Chief Medical Officer Cecília Müller told commercial broadcaster TV2 last week that pertussis is typically mild in adults and vaccinated people. As this infection is caused by bacteria, it is well treated with antibiotics. However, she pointed out that in high-risk groups, such as newborns and infants, the course of the infection can be very severe and sometimes fatal due to respiratory failure. 

In order to protect them in the current epidemiological situation, the NNGYK recommends that women should ask for the pertussis vaccine in the last trimester of pregnancy to protect themselves and their future newborn. Booster shots are also recommended for family members and relatives visiting the infant, Müller said. However, there is no information on how this type of vaccination uptake is encouraged by the NNGYK or by the GP system.

Subsequently, the epidemiological authority issued a fresh statement on the evening of 22 July, making several important claims about the outbreak, and

in fact taking epidemiological action by issuing new official - non-binding, but highly important and useful - recommendations.

While the NNGYK previously said there is no pertussis epidemic because the infection is not present in every county, it now uses a different argument, namely that the disease is sporadic. It reiterates that whooping cough is usually mild in adults and vaccinated people, but could be fatal for newborns.

It has also acknowledged - for the first time, after Portfolio sough confirmation of pertussis-related baby deaths a month ago - that two newborn babies have died of complications arising from a pertussis infection in Hungary. It warns that unvaccinated family members (and relatives, visitors) that carry the disease are the greatest threat to newborns.

In its statement issued on 22 July, the NNGYK has announced several, non-binding epidemiological recommendations:

1. No visitation or very restricted visitation of newborns for six to eight weeks after birth. Avoid crowded places during this period, as the infant's immune system is still partially unprotected against environmental influences and infections.
2. The booster vaccine is recommended for pregnant women because it also protects the newborn.
3. The NNGYK reminds the public that vaccination is also recommended for family members living in the same household as the infant and for those involved in the care of the infant. At present, the vaccine for pertussis revaccination is available to pharmacies nationwide and the availability of the vaccine is continuously monitored by the authority.

Questions waiting to be answered

Meanwhile, many questions remain unanswered, and in such an epidemic situation and with such a rapid spread of the infection, there is a great need for credible information, including for the general public. These questions were sent last Tuesday to the NNGYK, and even after the communication of 22 July, many of them reman unanswered.

Can you confirm that there has been a death linked to the infection? How many deaths can you officially report, how many cases have been confirmed by tests? What was the age of the deceased and in which counties did they live?

How come there no epidemic according to your assessment? In your assessment, what is the objective condition for declaring an epidemic? Is this influenced by the evolution of the case numbers? If so, where would be the objective level, the yardstick?

Why is it a condition for the epidemic to have pertussis cases detected in all counties? Isn't it enough that now only three counties have not officially detected the outbreak (this has since changed to only 1 county - ed.)

Could it not be the case that the more disadvantaged districts and regions lack the infrastructure, expertise and capacity to detect this infection?

What is the current procedure for a formal investigation of a suspected infection? What is the role of the general practitioner? If the case is confirmed by laboratory tests, are there any epidemiological measures in place for the patient's environment (community, family, etc.)?

Is there a protocol in place for where samples can be sent, how many labs will receive them and how has the infrastructure been set up? How many days after sampling are the results evaluated and communicated to patients and GPs?

In order to better detect and identify suspected cases of whooping cough, what measures has the NNGYK, as an epidemiological authority, taken recently? Has the current practice changed in this respect compared to the practice of the past years? Communication to general practitioners, facilitating laboratory tests in more locations, etc.?

Has the practice of investigating suspected cases as an epidemiological authority changed? If so, how is this activity carried out?

What about the availability of vaccines? The standard adult vaccine is still in short supply nationwide, but substitutes are available, according to the official medicines database. Is it really available in pharmacies? What is your experience and what is the demand for it? Can the quantities available meet current demand?

Cover photo (for illustration purposes only): Portfolio