Safer Pertussis Vaccines for Children: Trading Efficacy for Safety.

Abstract

* Abbreviations: DTaP — : diphtheria, tetanus, and acellular pertussis DTwP — : diphtheria, tetanus, whole-cell pertussis VAERS — : Vaccine Adverse Event Reporting System The decision to replace effective whole-cell vaccines for pertussis with less reactogenic but potentially less efficacious acellular vaccines for the primary immunization of children in the United States in the 1990s was carefully considered.1 The performance of the heat- or formalin-inactivated Bordetella pertussis whole-cell vaccine combined with diphtheria and tetanus toxoids (diphtheria, tetanus, whole-cell pertussis [DTwP]) licensed in the 1940s had resulted in a dramatic decrease in the number of cases of pertussis to a nadir in the mid-1970s.2 However, parallel to this success, the occurrence of rare but potentially serious adverse events associated with DTwP administration became unacceptable. Particularly concerning was the occurrence of high fever, febrile seizures, prolonged crying, and acute encephalopathy that sometimes followed whole-cell pertussis vaccination in some young infants. The development and licensure of diphtheria, tetanus, and acellular pertussis (DTaP) vaccines in the United States in the 1990s was an anticipated event for pediatric providers and parents who feared the reactogenicity associated with the administration of DTwP vaccines in infants and toddlers. … Address correspondence to Flor M. Munoz, MD, Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Texas Children’s Hospital, Feigin Tower, 1102 Bates, Houston, TX 77030. E-mail: florm{at}bcm.edu