Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity

Abstract

After the pertussis vaccine had been introduced in the 1940s and was shown to be very successful in reducing the morbidity and mortality associated with the disease, the possibility of improving both vaccine composition and vaccination schedules has become the subject of continuous interest. As a result, we are witnessing a considerable heterogeneity in pertussis vaccination policies, which remains beyond universal consensus. Many pertussis-related deaths still occur in low- and middle-income countries; however, these deaths are attributable to gaps in vaccination coverage and limited access to healthcare in these countries, rather than to the poor efficacy of the first generation of pertussis vaccine consisting in inactivated and detoxified whole cell pathogen (wP). In many, particularly high-income countries, a switch was made in the 1990s to the use of acellular pertussis (aP) vaccine, to reduce the rate of post-vaccination adverse events and thereby achieve a higher percentage of children vaccinated. However the epidemiological data collected over the past few decades, even in those high-income countries, show an increase in pertussis prevalence and morbidity rates, triggering a wide-ranging debate on the causes of pertussis resurgence and the effectiveness of current pertussis prevention strategies, as well as on the efficacy of available pertussis vaccines and immunization schedules. The current article presents a systematic review of scientific reports on the evaluation of the use of whole-cell and acellular pertussis vaccines, in the context of long-term immunity and vaccines efficacy.

Impact of maternal whole-cell or acellular pertussis primary immunization on neonatal immune response

“…On one hand, we detected a longer duration of transferable immunity to the pups from mothers in which the primary scheme was carried out with wP. This data is consistent with evidence showing that wP induces a longer-lasting immune response than aP ( 55 ). Therefore, we observed that in mothers vaccinated with the wP-wP-aPpreg scheme, PTx specific IgG levels only declined to less than 17% after week 22 of receiving the aPpreg dose, compared to the decline of more than 30% detected in mothers vaccinated with aP-aP-aPpreg after week 22 of receiving the aPpreg dose ( Figure 1C ).…”

The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus

“…The first generation of pertussis vaccine consisted of an inactivated and detoxified whole-cell pathogen. To reduce the rate of post-vaccination adverse events, a switch was made by the 1990s to the use of an acellular pertussis vaccine [ 132 ]. However, epidemiological data collected over the past few decades show an increase in pertussis and it has become a typical infection in adults [ 133 ].…”