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OPS alerta sobre resistencia de la tosferina a antibióticos en las Américas y pide reforzar vacunación y vigilancia
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La Organización Panamericana de la Salud (OPS) advirtió sobre la propagación de cepas resistentes de Bordetella pertussis, bacteria causante de la tosferina, en varios países de la región. La institución llamó a reforzar la vacunación, la detección temprana y la vigilancia epidemiológica, en un contexto de resurgimiento de casos y descenso en coberturas de inmunización.
Durante una reunión con la Red Latinoamericana y del Caribe de Vigilancia de la Resistencia a los Antimicrobianos (ReLAVRA+), la OPS reiteró la urgencia de implementar medidas coordinadas. “La vacunación, la vigilancia y el uso responsable de los antibióticos son fundamentales para evitar que la tosferina vuelva a convertirse en una amenaza grave de salud pública”, afirmó Pilar Ramón-Pardo, jefa del Programa Especial de Resistencia Antimicrobiana de la OPS.
La principal preocupación se centra en el uso de antibióticos del grupo de los macrólidos azitromicina, claritromicina y eritromicina que han perdido eficacia debido a mutaciones en el gen 23S rRNA de la bacteria. Estos cambios genéticos dificultan el tratamiento y elevan el riesgo de propagación, especialmente en poblaciones con baja cobertura vacunal.
El uso extensivo e inadecuado de antibióticos durante la pandemia de COVID-19, particularmente la azitromicina, habría contribuido al surgimiento de cepas resistentes. Desde 2024 se han reportado casos en Brasil, Estados Unidos, México y Perú, lo que demuestra la capacidad de diseminación de la resistencia.
Panorama epidemiológico en las Américas
La tosferina, también conocida como coqueluche, ha resurgido con fuerza en la región. Mientras en 2023 se notificaron 4.139 casos, en 2024 la cifra se disparó a 43.751. Solo entre enero y julio de 2025, nueve países reportaron 18.595 casos y 128 defunciones.
Este repunte está directamente asociado a la caída en la cobertura de vacunación durante la pandemia. En 2021, la aplicación de la primera dosis de DTP (DTP1) se redujo al 87%, y la tercera dosis (DTP3) cayó al 81%, muy por debajo del 95% recomendado por la OPS. Aunque en 2023 se evidenció una recuperación parcial (90% y 88%, respectivamente), aún persisten brechas y desigualdades entre los países.
La reducción en la cobertura deja expuestos a los lactantes, quienes corren el mayor riesgo de complicaciones graves o fallecimiento. La OPS insiste en la necesidad de incluir a las embarazadas y al personal de salud dentro de los grupos prioritarios de vacunación.
Factores de riesgo y complicaciones
La resistencia antimicrobiana (RAM) en la tosferina incrementa la complejidad del manejo clínico. Si los antibióticos pierden efectividad, el control de brotes se vuelve más difícil y aumenta el riesgo de complicaciones respiratorias graves. Esto es especialmente crítico en zonas donde las coberturas de inmunización se encuentran rezagadas o en descenso.
La OPS advierte que la RAM puede “limitar las opciones de tratamiento, dificultar el control de brotes y aumentar el riesgo de complicaciones graves”, en particular para lactantes y poblaciones vulnerables.
Vigilancia epidemiológica y cooperación internacional
El fortalecimiento de laboratorios de referencia nacionales es clave para enfrentar este desafío. La OPS, a través de ReLAVRA+ y la Red de Vigilancia Genómica Regional (PAHOgen), ha impulsado la estandarización de metodologías diagnósticas y el intercambio de información entre países.
El 19 de agosto, la OPS organizó un seminario virtual con laboratorios de referencia de Colombia, México, Brasil y Perú. En este encuentro, expertos compartieron hallazgos recientes, metodologías de detección y estrategias de respuesta coordinada.
Estas redes regionales permiten detectar de manera temprana la circulación de cepas resistentes, orientar las decisiones de salud pública y coordinar acciones transfronterizas que reduzcan el riesgo de expansión.
El rol de la vacunación en la prevención
La vacuna DPT, que protege contra la difteria, la tosferina y el tétanos, es la herramienta más efectiva para contener la enfermedad. Tres dosis en menores de un año y refuerzos posteriores son fundamentales para asegurar protección.
La OPS insiste en que el Día Internacional contra la Tosferina, debe servir como recordatorio de que la prevención comienza en casa y en la comunidad. Eliminar criaderos de vectores no es suficiente: es indispensable mantener altas coberturas de vacunación y garantizar esquemas completos en todas las etapas de vida.
Llamado a la acción regional
La OPS insta a los ministerios de salud de la región a:
- Reforzar coberturas de vacunación, priorizando poblaciones vulnerables y territorios con brechas significativas.
- Ampliar la capacidad de vigilancia epidemiológica mediante laboratorios de referencia y diagnóstico molecular.
- Promover el uso racional de antibióticos, evitando prescripciones innecesarias y fortaleciendo la regulación en farmacias y servicios de salud.
- Invertir en formación del talento humano con competencias en microbiología, vigilancia y control de brotes.
“Estamos aún a tiempo de contener este problema, pero necesitamos actuar con rapidez y decisión”, advirtió Ramón-Pardo, subrayando que la resistencia antimicrobiana en tosferina puede convertirse en una amenaza grave para la salud pública si no se adoptan medidas inmediatas.
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