Abstract
Pertussis is a highly communicable acute respiratory infection caused by Bordetella pertussis. Immunity is not lifelong after natural infection or vaccination. Pertussis outbreaks occur cyclically worldwide and effective vaccination strategies are needed to control disease. Whole-cell pertussis (wP) vaccines became available in the 1940s but have been replaced in many countries with acellular pertussis (aP) vaccines. This review summarizes disease epidemiology before and after the introduction of wP and aP vaccines, discusses the rationale and clinical implications for antigen inclusion in aP vaccines, and provides an overview of novel vaccine strategies aimed at better combating pertussis in the future.
Highlights
Pertussis is a highly communicable, acute respiratory infection caused by Bordetella pertussis [1,2]
Pertussis toxin is a key virulence factor that is specific for B. pertussis and responsible for most systemic symptoms associated with pertussis disease [21,22]
This scenario was demonstrated in a baboon model in which vaccination with a 5-component acellular pertussis (aP) vaccine was protective against the symptoms of disease, but did not prevent colonization or speed clearance time compared with unvaccinated controls [62]
Summary
Pertussis (whooping cough) is a highly communicable, acute respiratory infection caused by Bordetella pertussis [1,2]. Over the past several decades, the inclusion of pertussis vaccines in global immunization programs of infants and young children has effectively reduced the incidence of pertussis in these age groups [7]. Pertussis has increased in older children, adolescents, adults and infants too young to be vaccinated. Due to the cyclic nature of pertussis outbreaks (~3–4 years) and the lack of lifelong immunity after pertussis vaccination and natural infection, immunization strategies are needed beyond the standard booster dosing recommended following the infant series. Centers for Disease Control and Prevention (CDC) include the following strategies to address ongoing pertussis concerns and complement 5-dose vaccination schedules for infants and children 2 months through 6 years of age: a universal adolescent vaccination at 11–18 years of age; vaccination for those. Limited data regarding correlates of protection are summarized, and an overview of novel strategies aimed at potentially improving longer-term protection, either through the use of new vaccines or modifications to existing aP vaccines, is provided
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