Lessons from a mature acellular pertussis vaccination program and strategies to overcome suboptimal vaccine effectiveness

Abstract

Introduction: Despite high vaccination coverage among children and adolescents, pertussis remains a public health problem, with large outbreaks occurring periodically in the US and other developed countries. Areas covered: We examine lessons learned more than 20 years after implementation of programs which use only acellular pertussis vaccines and propose avenues for possible effective use of acellular pertussis vaccine to prevent large outbreaks. Expert Opinion: Acellular pertussis vaccines were introduced more than 20 years ago, yet the incidence of pertussis has been increasing over the past decade, with periodic large outbreaks marked by notable shifts in disease burden from infants and young children toward fully vaccinated adolescents and young adults. This age shift is mainly driven by the waning of vaccine immunity. To better protect adolescents against pertussis, modification of the current acellular pertussis vaccination schedule or adoption of new vaccination strategies should be considered. For infants not yet eligible to be vaccinated, maternal vaccination against pertussis during pregnancy is an effective way to protect infants from infection, severe disease and death. Implementation of maternal vaccination programs should be encouraged in countries without one or efforts to improve coverage should be supported in countries with existing program.

Differences in Mean Anti-Pertussis Antibody Levels in Children with Acellular Pertussis Immunization and Whole Pertussis Without Booster

“…The clinical aspect of the results of this research is how important it is for booster vaccines to be given to children in an effort to maintain antibodies at levels that can provide protection against pertussis because antibody levels will decrease as age increases. [9][10][11][12][13][14] The results of the study showed that there were more subjects in the DPaT vaccine group with antibody titer levels ≥24 IU/mL than in the DPwT vaccine group, although this result was not statistically significant. Only 25% of all samples from both groups had antibody results that were considered to provide protective value.…”