Nikhil Prasad Fact checked by:Thailand Medical News Team Jan 14, 2026 7 hours, 2 minutes ago
Medical News: Surge Returns After Pandemic Lull
Whooping cough (pertussis) is making an unwelcome comeback across Japan and a worrying amount of it is now resistant to the most commonly prescribed antibiotic macrolides. Researchers from Kawasaki Medical School analyzed samples from children treated at six clinics spread across the Chubu Kinki and Chugoku regions to uncover what is happening on the ground.
Researchers warn that macrolide resistant whooping cough now dominates child infections in Japan.
Six Clinics Provide Real World Clues
The team studied nasal swabs taken from 54 children aged up to 15 years old who appeared to have pertussis more commonly known as whooping cough. Swabs were first tested locally with rapid gene detection tools including BioFire, SpotFire and the LAMP Pertussis Detection kit. Samples testing positive for Bordetella pertussis were couriered to Kawasaki Medical School for deeper laboratory work.
In all six clinics, children were mostly school aged with a median age of 12 but infants under one year old were also affected. Doctors noted a strong resemblance to regional patterns seen during the 2025 pertussis wave when schools reported clusters of prolonged cough.
Resistance Levels Shockingly High
Once samples reached the central laboratory, they were sequenced to look for a key genetic change linked to macrolide resistance. That mutation known as A2047G in the 23S rRNA gene has been spreading in Asia and makes macrolide drugs much less effective.
The findings were stark. Of 52 successfully sequenced strains 43 carried the resistant mutation meaning 82.7 percent of infections across the clinics were resistant to first line macrolide treatment. Individual clinics reported between 40 percent and an astonishing 96 percent resistant strains showing that resistant bacteria have spread broadly and unevenly in communities.
Why This Matters Now
Pertussis declined sharply during the COVID years when masks and lockdowns stopped the germs circulating. As public health measures relaxed, Japan experienced a sharp rebound and doctors were surprised by the number of treatment failures. Because macrolides are routinely prescribed and rapid bedside resistance testing does not yet exist, children may briefly improve while still carrying the bacteria and spreading it to others. That hidden transmission could fuel the rapid expansion documented in this Medical News report.
Another problem is that B pertussis is difficult to grow in culture, so most clinics rely on molecular diagnosis rather than full drug sensitivity testing. The Kawasaki Medical School team bypassed culture by sequencing DNA directly from swab samples a method that may become more common.
A Call for Action
The researchers conclude that Japan urgently needs stronger surveillance and drug sensitivity testing along with exploration of alternative treatments beyond macrolides. They add that follow up studies should monitor children’s clinical outcomes investigate co infections and test other antibiotic classes. Their view is that routine use of rapid testing should be paired with public education, vaccine boosters for older children and more research investment.
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Conclusion
The discovery that more than four in five whooping cough infections sampled from Japanese children carry macrolide resistance is a striking warning sign. It suggests that long standing antibiotic routines may no longer reliably clear the infection and that community spread can continue even when symptoms appear to improve. Strengthened monitoring wider use of sequencing and reconsideration of vaccine schedules will likely be needed if Japan aims to reverse the trend. Close attention now could prevent resistant pertussis from becoming entrenched across the country and help protect infants and schoolchildren from prolonged illness for years to come.
Institutions involved: Kawasaki Medical School Kurashiki Japan across its Department of Clinical Infectious Diseases and Department of Pediatrics working with six outpatient clinics in the Chubu Kinki and Chugoku regions.
The study findings were published in the peer reviewed journal: Biomedicines.
https://www.mdpi.com/2227-9059/14/1/167
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https://www.thailandmedical.news/articles/infectious-diseases
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