Abstract
Immunization against pertussis (whooping cough) has been part of the routine childhood immunization program for over 50 years. Until 1997, a whole cell pertussis vaccine was used, most often combined with diphtheria and tetanus toxoids; in some jurisdictions it was combined with inactivated poliovirus vaccine and later withHaemophilus influenzaetype b (Hib)-conjugate vaccine. Vaccine doses were given at two, four, six and 18 months of age, and again at four to six years of age. Use of the whole cell vaccine in children seven years of age and older was not recommended because "the incidence and severity of the disease greatly decrease with age, and because adverse reactions are (may be) more common in older children and adults..." (1-3). Over a one-year period in 1997/98, all provinces in Canada began using an acellular pertussis vaccine, again combined with diphtheria and tetanus toxoids, inactivated poliovirus vaccine and Hib-conjugate vaccine. In 1999, an acellular pertussis vaccine that was combined with tetanus and diphtheria toxoids (TdaP) (Adacel, Aventis Pasteur, Canada) was licensed for use in individuals 12 to 54 years of age in Canada. In Germany, a similar adolescent and adult TdaP was licensed in 2000 (Boostrix, SmithKline Beecham, Belgium). With the availability of a TdaP product in Canada, should routine universal immunization against pertussis be provided for all adolescents and adults? Some of the key issues to be considered when answering this question are addressed in the questions and answers that follow. The focus of the present paper is on the adolescent population; however, similar issues about adult immunization need to be addressed by internal medicine and family practice practitioners.
Highlights
Immunization against pertussis has been part of the routine childhood immunization program for over 50 years
There were no differences in the rates of reactions between recipients of the TdaP vaccine and those who were given the standard tetanusdiptheria toxoid (Td) vaccine; this suggests that the addition of the acellular pertussis vaccine component did not significantly increase the adverse events associated with the immunization
Acellular pertussis vaccines induce a vigorous antibody response in adolescents to all of the antigens contained in the vaccine [26,27,28]
Summary
Immunization against pertussis (whooping cough) has been part of the routine childhood immunization program for over 50 years. Large community outbreaks of pertussis in adolescents have been reported in New Brunswick, British Columbia and the United States [6,7]. These passive surveillance systems most likely under-report the incidence of pertussis in the population. In the United States, pertussis in adolescents is increasingly being recognized and reported [8] Both seroepidemiological studies [9,10,11], and studies of cough illness in adolescents and adults [12,13,14,15,16,17] suggest that pertussis is a frequent cause of prolonged cough. Estimates of the role of pertussis in prolonged cough illness in adolescents and adults range from 1% to 25% [12,13,14,15,16,17,18]
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