Waning vaccine immunity in teenagers primed with whole cell and acellular pertussis vaccine: recent epidemiology

Abstract

The recent epidemics of pertussis (whooping cough) in parts of the USA and Australia have led to the largest numbers of annual cases reported in over half a century. These epidemics demonstrated a new pattern, with particularly high rates of disease among pre-adolescents and early adolescents. These high rates of pertussis coincided with the first cohorts vaccinated with purely acellular pertussis vaccine, which replaced whole-cell pertussis (wP) vaccine in the later 1990s in the USA and Australia. Studies undertaken during these epidemics provide new evidence of more rapid waning of acellular pertussis-containing vaccines and longer-term protection from effective wP-containing vaccines. There is evidence that receiving wP as at least the first dose of pertussis-containing vaccine provides greater and more long-lived protection, irrespective of the nature of subsequent doses. This evidence will be reviewed together with the immunobiology associated with both vaccines, and the implications for pertussis control discussed.

Sources of Infant Pertussis Infection in the United States

“…Waning immunity in cohorts that received aP vaccines for their childhood series has been welldocumented in recent studies. [6][7][8][9][10][11][12] Infants are at greatest risk for disease and death from pertussis, especially during the first 2 months of life before pertussis immunizations begin. Numerous studies have evaluated the source of pertussis transmission to infants and typically report an unknown source of infection for $50% of infant cases.…”

Pertussis vaccines

“…The limitations associated with the two classes of vaccines (whole cell vaccines [WCVs] and acellular vaccines [ACVs]) that are currently available are considered [11,12]. Potential improvements to vaccines and vaccine schedules are outlined [13][14][15][16][17][18][19] as well as the challenges inherent in diagnosing pertussis [20].…”

Assessing vaccine effectiveness of publicly funded vaccination programs in Queensland

“…More rapidly waning protection from aP compared to wP has been proposed as a contributing factor to this epidemiology, with several studies providing evidence that aP vaccines are less protective against disease than wP (123,(129)(130)(131)(132).…”