Number and Order of Whole Cell Pertussis Vaccines in Infancy and Disease Protection

Sheridan, Sarah; Ware, Robert S.; Grimwood, Keith; Lambert, Stephen B.

doi:10.1001/jama.2012.6364

Cited by 236 publications

(194 citation statements)

References 7 publications

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“…Several observational studies recently concluded that children primed with aP vaccine are at greater risk for pertussis diagnosis compared with wP-primed children (19)(20)(21)(22). Although these data suggest aP vaccine is less effective than wP vaccine at preventing colonization, the rate of undiagnosed B. pertussis carriage in vaccinated individuals is unknown.…”

Section: Resultsmentioning

confidence: 99%

“…This correlation has led many to hypothesize that aP vaccines are less effective on a population scale than the wP vaccines they replaced (10,12,13). Consistent with this notion, several recent observational studies concluded that children primed with aP vaccine had a twofold to fivefold greater risk of pertussis diagnosis compared with wP-primed children (19)(20)(21)(22). Our results in nonhuman primates add to these findings by showing that animals vaccinated with wP cleared infection by a direct challenge twice as fast as animals vaccinated with aP.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

Warfel

Zimmerman

Merkel

2013

Proc. Natl. Acad. Sci. U.S.A.

530

531

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Pertussis is a highly contagious respiratory illness caused by the bacterial pathogen Bordetella pertussis. Pertussis rates in the United States have been rising and reached a 50-y high of 42,000 cases in 2012. Although pertussis resurgence is not completely understood, we hypothesize that current acellular pertussis (aP) vaccines fail to prevent colonization and transmission. To test our hypothesis, infant baboons were vaccinated at 2, 4, and 6 mo of age with aP or whole-cell pertussis (wP) vaccines and challenged with B. pertussis at 7 mo. Infection was followed by quantifying colonization in nasopharyngeal washes and monitoring leukocytosis and symptoms. Baboons vaccinated with aP were protected from severe pertussis-associated symptoms but not from colonization, did not clear the infection faster than naïve animals, and readily transmitted B. pertussis to unvaccinated contacts. Vaccination with wP induced a more rapid clearance compared with naïve and aP-vaccinated animals. By comparison, previously infected animals were not colonized upon secondary infection. Although all vaccinated and previously infected animals had robust serum antibody responses, we found key differences in T-cell immunity. Previously infected animals and wP-vaccinated animals possess strong B. pertussis-specific T helper 17 (Th17) memory and Th1 memory, whereas aP vaccination induced a Th1/Th2 response instead. The observation that aP, which induces an immune response mismatched to that induced by natural infection, fails to prevent colonization or transmission provides a plausible explanation for the resurgence of pertussis and suggests that optimal control of pertussis will require the development of improved vaccines.whooping cough | T-cell memory | animal models | adaptive immunity |

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

Warfel

Zimmerman

Merkel

2013

Proc. Natl. Acad. Sci. U.S.A.

530

531

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“…Observational data from Canada, Australia and the US have shown greater protection with whole-cell infant priming. [7][8][9] We were surprised to see a significant protective effect, given the estimated low effectiveness of this particular whole-cell vaccine of 49%-61%. [3][4][5] However, our results showed that receiving 1 or more doses of whole-cell vaccine as an infant provided significant protection from pertussis more than a decade later.…”

Section: Discussionmentioning

confidence: 99%

“…6 Other jurisdictions in Canada, the United States and Australia have reported lower effectiveness with the acellular product and rapidly waning immunity. [7][8][9][10][11] Canada has a unique history of using a whole-cell vaccine with lower effectiveness, and also has different secular trends in pertussis incidence and vaccination coverage, necessitating local evaluation of the effectiveness of the pertussis vaccine to inform vaccination policy. Our objective was to study the effectiveness of the pertussis vaccine in Ontario while characterizing the effect of waning immunity and whole-cell vaccine priming.…”

mentioning

confidence: 99%

Effectiveness of pertussis vaccination and duration of immunity

Schwartz

Kwong

Deeks

et al. 2016

CMAJ

106

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Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming. Methods:We used the test-negative design, a nested case-control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 -OR) × 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine.Results : Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 testpositive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15-364 days, 84% (95% CI 77% to 89%) at 1-3 years, 62% (95% CI 42% to 75%) at 4-7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57). Interpretation:We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent. AbstractSee also www.cmaj.ca/lookup

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“…We and others subsequently demonstrated that the effectiveness of DTaP vaccines wanes substantially in school age and younger children [8][9][10][11][12] and that DTaP provides reduced long-term protection against pertussis when compared with whole cell pertussis vaccines. [13][14][15] We estimated that DTaP protection wanes 42% per year on average after the fifth dose at 4 to 6 years of age 8 and predicted that there would be larger pertussis outbreaks as the cohort of children vaccinated exclusively with DTaP vaccines expanded and became older and more distant from their fifth DTaP dose. 8,16 This growing cohort of adolescents who have only received DTaP vaccines therefore relies on the booster dose of Tdap for protection against pertussis.…”

mentioning

confidence: 99%

Waning Tdap Effectiveness in Adolescents

et al. 2016

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BACKGROUND AND OBJECTIVE: Because the effectiveness of diphtheria-tetanus-acellular pertussis (DTaP) vaccine wanes substantially after the fifth dose at ages 4 to 6 years, there is a growing cohort of adolescents who rely on tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) for protection against pertussis. Yet despite high Tdap vaccine coverage among adolescents, California experienced large pertussis outbreaks in 2010 and 2014. We investigated Tdap vaccine effectiveness (VE) and waning within Kaiser Permanente Northern California among adolescents exclusively vaccinated with DTaP vaccines.

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Number and Order of Whole Cell Pertussis Vaccines in Infancy and Disease Protection

Cited by 236 publications

References 7 publications

Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

Effectiveness of pertussis vaccination and duration of immunity

Waning Tdap Effectiveness in Adolescents

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