Which Strategy for Pertussis Vaccination Today?

Abstract

Pertussis (whooping cough) remains an epidemic disease responsible for infant and child morbidity and mortality, and is perceived as a serious public health problem. Since the widespread use of whole-cell pertussis vaccines in the 1940s, vaccination programs have varied greatly between countries. National specificity is a function of several factors. The most important are: vaccine efficacy and tolerability;vaccine coverage and distribution; and vaccine acceptance by parents and professionals. During the 1970s, Sweden, England, Wales and Japan provided contrasting examples of the attitude of health authorities to the use of whole-cell vaccines. The increase in pertussis incidence was noted as a consequence of active opposition to this vaccine. The re-emergence of pertussis in the 1990s, in countries with high vaccination coverage and increased incidence of disease in individuals >15 years and <6 months of age, has drawn attention to the role of booster doses of pertussis vaccines and their introduction into regular vaccination programs. The use of acellular vaccines for booster doses for adolescents and adults would seem unambiguous because of their decreased reactogenicity, although the exact schedule has yet to be established. The choice between the two kinds of vaccines is more difficult for primary courses, where safety and efficacy profiles are similar, and the attitude towards acellular vaccines varies from country to country. In this case, the strategy adopted results from the national history of pertussis infection and from the quality of the available whole-cell vaccine. Two contrasting examples are the US, where acellular vaccines were licensed for the primary series in the 1990s, and the UK, where whole-cell vaccines are exclusively used for primary immunization. The changing epidemiology of pertussis, and its local diversification, would suggest that at present it is difficult to define a single worldwide strategy with only one kind of vaccine and one schedule. In order to control pertussis incidence, each country should continue to determine the best national vaccination program established in very close relation to the past and present epidemiological situation and available healthcare resources.

Association of Interacting Genes in the Toll-Like Receptor Signaling Pathway and the Antibody Response to Pertussis Vaccination

“…Vaccination with both whole-cell (WCV) and acellular vaccine (ACV) limits the occurrence and severity of pertussis, but is unable to completely prevent infection and disease in vaccinated populations. Indeed, despite widespread vaccination B. pertussis remains endemic and has even re-emerged in many populations [1], [2]. Previous studies provided evidence for the role of the gene coding for Toll-like receptor 4 ( TLR4 ) in both the infection process (in mice), and the response to vaccination (in mice and men) [3]–[10].…”

Global burden of pediatric respiratory illness and the implications for management and prevention

“…14,15 Globally, pertussis remains a public health problem, causing much childhood morbidity and infant mortality, particularly in developing countries. 16 The number of children under 15 years of age who are infected with tuberculosis is estimated at approximately 3.1 million. 17 There are currently more than 1.5 million HIVinfected children, 90% of whom will develop a respiratory illness sometime in the course of their HIV disease.…”

“…10 Similarly, widespread pertussis vaccination, either with the whole-cell or acellular vaccine, has had a large impact in reducing the incidence of this infection. 16,19 The epidemiology of pertussis infection in developed countries with high vaccination coverage has shifted towards an increasing burden of disease in young adults and infants. 20 The HIV pandemic, particularly in sub-Saharan Africa, has resulted in an increase in acute severe respiratory illness.…”