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Despite substantial evidence supporting the benefits of vaccination across all age groups, achieving high vaccine coverage in adults remains a global challenge. Limited disease knowledge and vaccine hesitancy contribute to this issue. To increase vaccination rates, we need to understand the gaps in knowledge, attitudes, and practices (KAP) among adults and healthcare professionals (HCPs). Our primary objectives were to describe the KAP regarding vaccine-preventable diseases and vaccination among adults and HCPs in Mexico, and to identify differences by sociodemographic factors. We conducted an observational cross-sectional survey study in three states in Mexico from July to October 2024. Two surveys were administered to adults aged ≥20 years and HCPs to capture outcomes of general vaccine and disease KAP, particularly for vaccine-preventable diseases such as herpes zoster (HZ), influenza, whooping cough, and respiratory syncytial virus (RSV). A total of 1,169 adults from the general population and 228 HCPs were included. Among the population group, 95.6% acknowledged the importance of vaccines, and 87.6% knew adults could receive routine vaccines. Knowledge of vaccine-preventable diseases ranged from high for influenza (97.3%) to limited for RSV (16.1%) and HZ (39.4%). Fewer knew about RSV (10.1%) and HZ (18.6%) vaccines. Only 23.5% of HCPs had recommended the HZ vaccine to older adults, while more did so for whooping cough (52.2%), influenza (96%). The main factors for HCPs to accept and recommend vaccinations were knowledge of the disease, complications, and vaccine efficacy and effectiveness. Also, 69.8% indicated that information about the disease was the most critical factor in vaccination recommendations. The findings underscore the need to strengthen health communication and education, and address barriers that impede access to vaccination, particularly for less well-known vaccines. Bridging the gaps between KAP is essential to improving adult vaccination coverage, thereby reducing vaccine-preventable diseases and enhancing public health.

The Third National Pediatrics Congress was held in Zaragoza in 1925. There were 208 registered delegates. Among those registered were fourteen French pediatricians and three Italian pediatricians. The president of the meeting was Dr Patricio Borobio Díaz. This paper presents an overview of the content of the conference presentations, which were divided into four sections: Pedagogy, Pediatric and Orthopedic Surgery, Hygiene, Nutrition and Child Protection, and Pediatric Medicine. In the latter section, the most common topics were infectious diseases (whooping cough, diphtheria, meningitis/encephalitis). Several papers attested to the effectiveness of ultraviolet light as a treatment for rickets and spasmophilia. Gregorio Vidal Jordana deduced that the increase in phosphatemia levels served as an exact test to verify the effectiveness of ultraviolet treatment and was superior to X-rays. Several pediatric surgeons debated the treatment of pyloric stenosis in infants. There is no record of any female pediatricians attending the Congress. Four women who were not doctors presented papers on legal and family changes in favor of children, abandoned and delinquent children, and education issues. Within the Child Protection Section, there were debates on the subject of illegitimate children and wet nursing. The conference was a harmonious international gathering where current pediatric issues were discussed alongside other topics related to child protection. Participation was diverse, with contributions from doctors, lawyers, teachers and people in other professions.

Vaccination is one of the most important public health interventions, preventing an estimated five million deaths worldwide each year. This retrospective observational study analyzed hospitalizations and deaths among children aged 0 to 10 years admitted to a university hospital in the state of Rio de Janeiro, Brazil, over a sixty-year period (1965-2024). During the study period, 3968 children were hospitalized, and 779 deaths were recorded, with a predominance of males (55.6%). The overall mortality rate was 19.6%, being highest among children aged 0 to 1 year (28.9%), and lower among those aged 2 to 5 years (13.4%) and 6 to 10 years (11.9%). Hospitalizations and deaths were concentrated in the first two decades of observation, accounting for 64.2% and 86.6% of events, respectively. The highest mortality rate was observed in the first decade (29.2%), decreasing more than threefold from the third decade onward (9.4%) and approaching zero in the final years of analysis. Tetanus and meningoencephalitis accounted for more than half of all deaths, predominantly among children under one year of age (65.8%). Diphtheria and measles were the next most frequent causes of death, while whooping cough, although less common, was an important cause of mortality in early infancy. These findings highlight the substantial and sustained association between the expansion of immunization programs and the reduction of childhood hospitalizations and mortality from vaccine-preventable diseases. Maintaining high vaccination coverage remains essential to preserve these public health gains.

Existing clinical case definitions of pertussis are decades old and mainly rely on clinical signs and symptoms in infants and children. In the recent past, an age shift of pertussis towards adolescents and adults has been noted and disease presentation often is different from that in children. Therefore, in 2011 the Global Pertussis Initiative (GPI) proposed an age-stratified case definition, but its uptake has been slow. This prompted members of the GPI steering committee to critically review the case definition. In preparation for this, we performed a review to learn which case definitions have been used worldwide. We performed a narrative literature review to collect publications from January 1, 1975, to September 1, 2025, which include pertussis case definitions. This was complimented by a survey amongst GPI members to gather case definitions currently in use for pertussis surveillance in their countries. The literature review identified 117 relevant publications. The two most often used case definitions were those proposed by CDC and WHO, followed by individual case definitions developed by the respective investigators for the purpose of their studies. Additionally, GPI members provided 16 country-specific surveillance case definitions. Cough and typical pertussis signs paroxysms, whooping and post-tussive vomiting are most commonly used clinical criteria. With regards to laboratory confirmation of B. pertussis infection, all case definitions require at least one criterion, most often a positive culture and/or PCR, followed by specific serology. Most case definitions do not use age-specific criteria. Many different case definitions are in use all over the world. Most of them are focusing on the typical presentation of pertussis, i.e. disregarding less typical disease presentations and do not use age-specific criteria. This hampers a reliable and comparable disease surveillance. Therefore, a harmonized case definition that could be used globally would be highly welcome. Not applicable.

The life-threatening disease pertussis, also known as whooping cough, is caused by a complex interplay of several virulence factors produced by the bacterium Bordetella (B.) pertussis. These include the AB-type protein toxin pertussis toxin (PT), the main causative agent of pertussis. After infection with B. pertussis, PT is released and binds to its human target cells, which internalize PT. The enzyme subunit of PT is then taken up into the cytosol, where it catalyzes the ADP-ribosylation of the α-subunit of inhibitory GTP-binding proteins from the Gαi type. This ultimately leads to the development of the characteristic clinical symptoms associated with pertussis. Pertussis is a vaccine-preventable but highly infectious respiratory disease, and especially younger children are prone to develop severe pertussis. Despite the vaccination, over the past few years, increasing case numbers have been reported globally. Moreover, treatment options are strongly limited to antibiotics and symptomatic treatment. Therefore, novel therapies against toxin-mediated diseases are urgently required, while AB-type toxins such as PT are promising pharmacological targets to combat these associated diseases. To identify novel pharmacological inhibitors for AB-type toxins, huge potential lies within the human proteome/peptidome. Endogenous protein or peptide inhibitors for bacterial toxins might have evolved as part of the innate immunity and are awaited to be discovered. The scientific community is committed to identify potential candidates through targeted screening or explorative hypothesis-driven approaches. This review summarizes the recent efforts in the identification and characterization of the human body's own proteins and peptides that inhibit PT. PT-inhibiting peptides were found by unbiased screening of peptide libraries from human hemofiltrate or hypothesis-driven evaluation, and PT-neutralizing mechanisms were discovered in cell-based approaches. The identification of endogenous peptides and proteins, e.g., defensins and α1-antitrypsin, as potent inhibitors of PT paves the way towards the development of novel therapeutic options against pertussis.

Whooping cough has resurged globally despite high vaccination coverage. In China, a macrolide-resistant (MR) Bordetella pertussis lineage carrying the high-virulence ptxP3 allele, termed ptxP3 MR-MT28 (MT28), has been increasingly reported as a predominant circulating lineage, although the factors underlying its expansion remain unclear. By integrating epidemiological surveillance with genomic, phenotypic, and in vitro and in vivo infection analyses of representative clinical isolates, we demonstrate that MT28 strains exhibit enhanced colonization capacity and heightened inflammatory potential. Transcriptomic analysis revealed upregulation of key virulence-associated genes (ptxA, fhaB, tcfA and bvgA), providing a molecular basis for these phenotypes. Furthermore, lipid-targeted metabolomics and LC-MS identified B. pertussis-derived palmitic acid (PA) as a pro-inflammatory mediator that amplifies MT28-associated inflammation responses via TLR4/NF-κB signaling. These findings provide mechanistic insights into the pathogenic features of the MT28 lineage and reveal a previously unrecognized lipid-driven inflammatory pathway in B. pertussis infection.

Vaccination against tetanus, diphtheria, and pertussis (Tdap) is essential to protecting mothers and infants against these severe diseases. In the Kingdom of Saudi Arabia, vaccination coverage among pregnant women remains suboptimal, with only 25-30% of pregnant females. The analysis of their knowledge, attitudes, and behaviors concerning the vaccine will, in turn, help formulate strategies to increase the vaccination rate. A cross-sectional study was carried out on 398 pregnant Saudi women aged 18-40 y using a validated questionnaire examining their knowledge of the vaccine. The study demonstrated that there were significant gaps in knowledge in that 36% of the participants correctly identified pertussis as a highly contagious disease yet preventable by vaccination, while 22% identified its severity in newborns. Better knowledge was associated with higher education attainment, and prior knowledge of vaccination against pertussis in adults was associated with more positive attitudes. A more significant majority of participants reported positive attitudes about vaccination overall, but 71% of them expressed concerns about side effects and safety. The findings indicate a need for targeted educational interventions as far as safety and knowledge gaps are concerned. Improving communication by health providers can increase vaccination uptake among pregnant women to ensure an increase in the protection of mothers and infants against whooping cough.

Pertussis (whooping cough), a vaccine-preventable disease that affects people of any age, has resurged globally after the COVID-19 pandemic. Key reasons for recent pertussis outbreaks include suboptimal pertussis vaccination coverage (particularly for vaccination during pregnancy) and growing vaccination hesitancy. During the 2023-2024 pertussis outbreaks in Europe, adolescents aged 10-14 years and 15-19 years had the first and third highest incidence rates, respectively. To reduce pertussis burden, it is essential to strengthen vaccination programs in the indicated target groups. This requires increased awareness among healthcare professionals about the local epidemiology of pertussis and its clinical presentation, alongside reinforcement of the benefits of vaccination for disease prevention. In parallel, robust surveillance systems and strong public health capacity for early disease detection and response are crucial to effectively manage outbreaks and build resilience against future outbreaks. Infants remain at high risk for pertussis, with complications, hospitalisation, and death being more common than in other age groups. Immunisation programmes combining vaccination during pregnancy, to protect newborn infants until their primary immunisation series has induced immunity, and infant immunisation are key to reducing morbidity and mortality. Strategies to improve pertussis vaccination uptake among adolescents and adults, especially those with high-risk medical conditions, are also essential. Strengthening global collaborations to invest in and build surveillance systems capable of identifying and responding to future outbreaks, to align national policies, to scale up immunisation during pregnancy, and to adopt a life-long immunisation approach are needed to better control endemic pertussis and manage future outbreaks.

Pertussis remains a serious health problem despite high global vaccination coverage. The identification of the optimal combination of blood immune markers to determine the persistence of specific memory responses to pertussis vaccines is needed to determine the optimal schedule of booster dose administrations. We evaluated different parameters of specific cellular immune responses in addition to antibody levels in three different cohorts of children considered to be still protected against whooping cough at the time of analysis. Group I (n = 13) received a whole-cell vaccine in infancy and two acellular vaccine (aPV) boosters. Group II (n = 31) had an aPV (Tetravac) in infancy and two aPV boosters. Group III (n = 42) received aPV (Infanrix-hexa) in infancy and one aPV booster. IgG against pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN), tetanus and diphtheria toxins were measured by a fluorescent bead-based multiplex immunoassay, and the numbers of PT-, FHA-, PRN-specific memory IgG+ B cells (Bm) were enumerated by Elispot. PT-, FHA- and PRN-specific IFN-γ- and/or TNF-α-containing CD4+ T lymphocytes were enumerated by flow cytometry, as were the numbers of PT-, FHA-, and PRN-induced proliferating cells. Most children had detectable specific memory responses, but the patterns were very heterogenous. Th1-type CD4+ T cells and anti-FHA IgG and/or Bm responses characterized group I, whereas FHA- and PT-specific IgG and/or Bm responses were a hallmark of group II. Finally, Th1-type CD4+ T cells and FHA- and PRN-specific humoral and/or Bm responses were detected in group III. A combination of humoral and cellular markers of immunity to B. pertussis thus offers a more comprehensive assessment of immunity compared to serology alone and reveals that almost all recipients of a recent aP booster have several markers of immune memory.

Vaccinations against bacterial pathogens play a crucial role in infection prevention, especially given the growing prevalence of antibiotic resistance. Historically, vaccines against cholera, diphtheria, and pertussis (whooping cough) marked the first significant advances in the fight against bacterial diseases. Later, vaccines against meningococcus and tetanus, among others, were added. These active immunizations expose the immune system to components of the pathogen, stimulating the production of antibodies, T helper cells, B cells, and memory cells, thereby providing long-term protection. The targeted development of new vaccines, even against difficult-to-treat bacterial pathogens, is enabled by a wide range of vaccine types, including inactivated, toxoid-based, and recombinant vaccines, as well as modern approaches such as reverse vaccinology and messenger Ribonucleic Acid (mRNA) technologies combined with enhancing adjuvants. In addition to active immunization, passive immunization, in which pathogen-specific antibodies are administered directly, also plays an important role.At the population level, clear epidemiological effects of vaccination programs are evident, as vaccinations protect not only individuals but also communities, thus contributing to public health. Despite the clear medical and economic advantages of vaccination programs, their acceptance among the population must be significantly increased through objective information policies. Currently, numerous vaccines are under development, which, through innovative technologies, are opening up new avenues for effectively preventing and controlling bacterial infections-a crucial step in an era of increasing antibiotic resistance. Impfungen gegen bakterielle Erreger spielen eine wichtige Rolle in der Prävention von Infektionen, insbesondere angesichts der wachsenden Antibiotikaresistenz. Historisch markierten Impfstoffe gegen Cholera, Diphtherie und Pertussis (Keuchhusten) erste bedeutende Fortschritte im Kampf gegen bakterielle Krankheiten. Später kamen Impfstoffe unter anderem gegen Meningokokken und Tetanus dazu. Bei diesen aktiven Immunisierungen wird das Immunsystem mit Teilen des Erregers konfrontiert, was die Bildung von Antikörpern, T‑Helferzellen, B‑Zellen und Gedächtniszellen anregt und dadurch einen langfristigen Schutz entstehen lässt. Die gezielte Entwicklung neuer Impfstoffe, auch gegen schwer behandelbare bakterielle Erreger, wird durch eine große Bandbreite von verschiedenen Impfstoffarten ermöglicht, darunter inaktivierte, toxoidbasierte und rekombinante Impfstoffe, sowie moderne Ansätze, wie die reverse Vakzinologie und messenger Ribonucleic Acid (mRNA)-Technologien verbunden mit verstärkenden Adjuvanzien. Neben der aktiven Immunisierung spielt die passive Immunisierung eine wichtige Rolle, bei der erregerspezifische Antikörper direkt verabreicht werden.Auf Bevölkerungsebene zeigen sich durch Impfprogramme deutliche epidemiologische Effekte, da Impfungen nicht nur Einzelpersonen, sondern auch Gemeinschaften schützen und damit zur Volksgesundheit beitragen. Trotz klarer medizinischer und ökonomischer Vorteile von Impfprogrammen muss deren Akzeptanz in der Bevölkerung durch objektive Informationspolitik noch deutlich erhöht werden. Derzeit befinden sich zahlreiche Impfstoffe in der Entwicklung, die durch innovative Technologien neue Wege eröffnen, bakterielle Infektionen wirksam zu verhindern und zu kontrollieren – ein entscheidender Schritt in einer Ära zunehmender Antibiotikaresistenz.

Pertussis (whooping cough) is a highly contagious respiratory infection that continues to cause substantial morbidity and mortality, particularly among infants, and has re-emerged globally among adolescents and adults. Large language models (LLMs) are increasingly used for health communication and science popularization; however, evidence regarding their readability, quality, and educational suitability for disease-specific patient education remains limited. To date, no systematic evaluation has focused on LLM-generated pertussis health education materials. This study aimed to systematically evaluate and compare the performance of five mainstream LLMs in generating pertussis-related science popularization content, with particular attention to readability, informational quality, and educational suitability. A cross-sectional simulation study was conducted using 20 frequently asked pertussis-related questions covering five domains: basic knowledge, symptom presentation, diagnostic methods, treatment and management, and prevention and prognosis. On October 28, 2025, all questions were identically input into five publicly accessible LLMs. Text readability was assessed using seven classical indices. Two independent pharmacists performed blinded evaluations using the Chinese version of the Patient Education Materials Assessment Tool for print materials (C-PEMAT-P) and the Global Quality Score (GQS). Additionally, two independent clinical experts assessed the factual accuracy and guideline concordance of each LLM-generated response against the Chinese Pertussis Diagnosis and Treatment Guidelines (2024) using a 4-point scale. Inter-rater agreement was evaluated using Cohen's kappa coefficient. ChatGPT, DeepSeek, and Doubao achieved significantly higher C-PEMAT and GQS scores than Wenxin Yiyan and Gemini (p&#x202f;<&#x202f;0.001), indicating superior understandability, actionability, and overall quality. Median C-PEMAT scores across all models suggested generally acceptable accessibility for patient education. Regarding factual accuracy and guideline concordance, ChatGPT achieved the highest mean score. No harmful advice or direct guideline contradictions were identified in any model output. Correlation analyses showed weak associations between traditional readability metrics and GQS, whereas C-PEMAT demonstrated a moderate positive correlation with GQS (r&#x202f;=&#x202f;0.34). Mainstream LLMs show preliminary capability in generating pertussis-related health education materials, although substantial inter-model variability persists. Domain-specific patient education assessment tools better capture perceived informational quality than generic readability metrics. These findings support the cautious, assistive use of LLMs in health communication within a human-AI collaborative framework.

Pertussis, also known as whooping cough,is a significant contributor to pneumonia cases in children. The existing literature regarding pertussis in China is sparse, highlighting the need for further research in this area. This research aimed to find out the factors related to pneumonia in B. Pertussis co-infected children. From January to April 2024,children identified with B. Pertussis infection were enrolled in the study. Subsequently, they were divided into two groups:one consisting of those without pneumonia and another comprising those with pneumonia. This study was a retrospective observational study. In this study, variables assessed included demographics, clinical symptoms and laboratory findings. The study examined the various risk factors associated with pneumonia resulting from infection with B. Pertussis in both groups. Seventy-five patients participated in the study, Among the participants, individuals (77.30&#x202f;%) had completed the full course of the pertussis vaccine, while 17 individuals (22.70&#x202f;%) had not,with 29 belonging to the pneumonia group and 46 to the non-pneumonia group. There was borderline significance between the completion of vaccination and the occurrence of pneumonia (p=0.05). Those in the pneumonia group exhibited the highest recorded body temperature due to fever and increased expectoration (p<0.05). Analysis using a univariate approach indicated significant correlations between the highest body temperature during fever,the cycle threshold at the initial detection,and expectoration with pneumonia (p<0.05). Univariate logistic regression showed that the initial cycle threshold was significantly associated with pertussis-associated pneumonia (OR=1.483, p<0.001); multivariate logistic regression further confirmed it as an independent risk factor (OR=0.675, 95&#x202f;% CI: 0.542-0.839, p<0.001). The group affected by pneumonia administered higher usage of erythromycin/cephalosporins (p<0.05). Both univariate and multivariate logistic regression analyses revealed a substantial relationship between the&#xa0;initial detection cycle threshold and pneumonia (p<0.05). 54.6&#x202f;% patients had co-infections. In our pediatric population, the&#xa0;most commonly identified pathogens were human rhinovirus, mycoplasma pneumoniae and respiratory syncytial&#xa0;virus. The cycle threshold values were a risk factor for pneumonia in children with B. Pertussis infection,a lower initial Ct value (indicating higher bacterial load) is a significant risk factor for developing pneumonia in children with pertussis. There was higher usage of erythromycin/cephalosporins in the pneumonia group. While B.&#xa0;Pertussis has a high coinfection rate in childhood infections, mainly with HRV,MP and RSV, which also highlighed the importance of comprehensive pathogen detection. Clinical doctors should fully consider the above situation in children with B. Pertussis infection to diagnose and treat correctly.

In the living world, copper is both toxic in excess and necessary for the activity of specific oxidoreductases and electron transfer chains and as such is involved in the host-pathogen interface. Mammalian hosts deploy anti-microbial strategies of copper intoxication or starvation of invading microorganisms, collectively called nutritional immunity, and bacteria have developed both protection and acquisition systems in response. We recently described a TonB-dependent copper importer, CrtABp in the whooping cough agent Bordetella pertussis. Here we characterized another protein encoded in the same operon and similarly upregulated by copper starvation, CrpH. By combining in vitro and in vivo experiments with transcriptomics, we showed that CrpH contributes to bacterial fitness and enhances respiration by the heme-copper oxidoreductases (HCO) of B. pertussis. CrpH belongs to the PepSY_TM superfamily of membrane-associated bacterial enzymes, whose known members catalyze heme-mediated ferrisiderophore reduction in the periplasm. The corresponding heme-binding motifs of CrpH are similarly required for function. Furthermore, we uncovered a synthetic growth phenotype of a double crpH-ccoG mutant, the latter gene encoding a putative copper reductase involved in HCO assembly. In silico analyses identified thousands of CrpH orthologs, leading us to define a new subfamily of PepSY_TM proteins found in diverse bacterial species all harboring HCO genes. Collectively, our results indicate that CrpH of B. pertussis is a prototype of a family of proteins supporting HCO function.

Bordetella pertussis , the causative agent of whooping cough, produces a &#x223c;370 kDa filamentous hemagglutinin FhaB that serves as a major bacterial adhesin in airway infection. FhaB is secreted via a two-partner secretion pathway and under in vitro culture conditions it is proteolytically processed to the shed &#x223c;230 kDa FHA antigen used currently in acellular pertussis vaccines. We show that FhaB remains largely unprocessed during B. pertussis adhesion to ciliated airway epithelial cells and that its C-terminal domain (CT) is essential for the adhesin function of FhaB. CT deletion did not affect FhaB folding, secretion, or surface exposure, but abolished B. pertussis adhesion to primary human nasal ciliated epithelial cells, thus preventing bacterial colonization of the nasal mucosa and shedding and transmission of the pathogen in a murine nasal infection model. In situ cryo-electron tomography revealed a structural reorganization of the FhaB filaments upon contact with the cilia, presumably due to export of the CT from bacterial periplasm and its subsequent delivery across the ciliary membrane. These findings establish the CT of FhaB as a critical determinant of upper airway colonization by B. pertussis and identify the unprocessed FhaB as the biologically relevant adhesin form involved in airway infection. The revised model of FhaB biogenesis underpins its unique mode of action in pertussis pathogenesis and makes the CT domain to a candidate antigen for future pertussis vaccines.

Whooping cough is endemic in many regions in T&#xfc;rkiye and the world, and is an important cause of morbidity and mortality, especially in children and adolescents. The aim of this study was to evaluate the epidemiological findings of pertussis cases in a region. The cross-sectional study was conducted in 2024-2025. The study evaluated the relationship between the frequency of pertussis cases reported in 2020 to 2024 and the demographic characteristics of the patients (age, gender, nationality, district of residence, etc.), the season of notification, and vaccination status. The definitive diagnosis of the cases was made by isolating Bordotella pertussis from nasopharyngeal sample cultures or by detecting the Bordotella pertussis gene in nasopharyngeal samples by PCR. When the distribution of cases in Mersin province by years was examined, 2 cases were detected in 2020, 1 in 2021, 0 in 2022, 3 in 2023, and 92 cases in 2024. It was determined that there was a significant increase in the number of cases in 2024 compared to previous years. Of the 92 cases reported in 2024, 46 were laboratory confirmed and the case rate in 2024 was determined as 2.35 per hundred thousand. 57 cases (62.0%) had never been vaccinated with pertussis vaccine. Of the 46 cases with positive results, 30 (65.2%) were unvaccinated and 42 (91.3%) were younger than 6 months. The frequency of case positivity was significantly higher in infants younger than 6 months (p=.028). The increase in cases in 2024 is thought to be linked to migration movements.Protective measures, especially vaccination studies, should be increased in infants younger than 6 months and pregnants where the frequency of cases is high. Not applicable.

Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis. Hyperleukocytosis in pertussis contributes to a drastically worsened prognosis by promoting pulmonary hypertension and multiorgan failure, leading to accelerated disease progression and elevated mortality. Exchange transfusion can improve the prognosis of in children with pertussis and increase the success rate of treatment. We retrospectively analyzed 2 infants with severe pertussis treated with modified exchange transfusion. Reconstituted whole blood was prepared using O-type leukoreduced concentrated red blood cells and AB-type leukocyte-reduced, virus-inactivated fresh frozen plasma, with a red blood cell to plasma ratio of 1:1 to 2:1 and a hematocrit of 40% to 50%. The total exchange volume was 150 to 180&#x2009;mL/kg (approximately twice the blood volume). After exchange transfusion, both infants showed marked reduction in white blood cell count and clinically significant improvement in dyspnea. No severe adverse reactions occurred, and both children were discharged. Modified double-volume exchange transfusion is a safe and effective treatment for infants with severe pertussis and hyperleukocytosis.

Glucagon-like peptide-1 (GLP-1) receptor agonists have transformed obesity treatment by inducing clinically significant weight loss. However, long-term use can lead to a plateau that may trigger discontinuation and weight regain. Use mathematical modeling to test the hypothesis that the weight-loss plateau observed during long-term GLP-1 receptor agonist use reflects predictable changes in energy dynamics. Secondary mathematical modeling applying Hall's human metabolism model to estimate changes in energy intake and expenditure over 176 weeks of treatment and 17 weeks after discontinuation. Modeling was anchored to a single representative phenotype using average baseline demographics and weight dispersions from a clinical trial. Percent change in body weight, body mass index (BMI), energy intake, energy expenditure. Monte Carlo methods captured variability. Modeled trajectories of energy intake and expenditure illustrated energy balance dynamics. Modeled weight loss peaked at 24.0% (95% confidence interval [CI], 22.6-25.4) by week 96, reducing weight from 108 kg (BMI, 40.0) to 82.9 kg (BMI, 33.0). A plateau persisted for &#x223c;78 weeks despite continued treatment. Energy intake decreased 32.1% during the first 4 weeks, then rose to match energy expenditure by week 98 (2500 kcal, vs 2508 kcal, respectively). After discontinuation (week 176), energy intake exceeded baseline, contributing to a 5.3% weight loss reversal. Energy expenditure declined 9.2% from baseline by week 98 and stabilized. Although GLP-1 receptor agonists achieve unprecedented weight loss, many individuals plateau but remain with overweight/obesity. This plateau reflects the narrowing of the energy intake and expenditure gap during long-term treatment. To attenuate this, systematic integration of nutrition and behavioral therapy could be tested as adjuncts, particularly approaches that support nutrient adequacy and prevent excess energy intake. Whether such strategies can sustain or extend GLP-1 receptor agonist-induced weight loss warrants future study.