Immunization against Pertussis: An Almost Solved Problem or a Headache in Public Health

Abstract

Whooping cough or pertussis is a serious infectious disease of the human respiratory tract, caused by Gram-negative bacteria Bordetella pertussis and Bordetella parapertussis HU . The current pertussis vaccines may consist of dead cells of B. pertussis (whole cell pertussis vaccines-wPs) or purified antigens from the bacterium (acellular pertussis vaccines-aPs). The aPs are less reactogenic and have been widely used in developed countries for more than two decades, but their high cost of production makes them prohibitive for developing countries, and the accelerated rate of epidemic outbreaks has led to the hypothesis that aPs are less effective than the wP ones. Considering cost-effectiveness, some authors have pointed out questions about the possibility of reintroduction of wP vaccines into the primary doses of pertussis vaccination. The Butantan Institute in São Paulo, Brazil, developed a wP vaccine with low endotoxicity (Plow) obtained by chemical extraction of the lipooligosaccharide (LOS) fraction from the outer membrane of the bacterial cell, showing to be less reactogenic and equally immunogenic and protective as the traditional wP vaccine. The Plow may possibly be introduced into the vaccination schedule for immunization of adolescents and young adults in Brazil, an important epidemiological contribution to reducing the circulation of B. pertussis.

Krztusiec I „Efekt Czerwonej Królowej”

“…Koszt wyprodukowania szczepionki DTaP jest ponad 300-krotnie wyższy niż szczepionki DTwP [14]. W pierwszej fazie badań klinicznych udało się obniżyć reaktogenność przy zachowaniu podobnego poziomu immunogenności i ochrony poszczepiennej w porównaniu ze standardowo stosowaną szczepionką DTwP [15]. Szczepionka "wPlow" musi przejść dodatkowe badania kliniczne przed wprowadzeniem do kalendarza szczepień, ale wiele wskazuje na to, że w Brazylii zastąpi szczepionkę DTwP.…”