Pertussis Prevention: Reasons for Resurgence, and Differences in the Current Acellular Pertussis Vaccines

Abstract

Pertussis is an acute respiratory disease caused by Bordetella pertussis . Due to its frequency and severity, prevention of pertussis has been considered an important public health issue for many years. The development of the whole-cell pertussis vaccine (wPV) and its introduction into the pediatric immunization schedule was associated with a marked reduction in pertussis cases in the vaccinated cohort. However, due to the frequency of local and systemic adverse events after immunization with wPV, work on a less reactive vaccine was undertaken based on isolated B. pertussis components that induced protective immune responses with fewer local and systemic reactions. These component vaccines were termed acellular vaccines and contained one or more pertussis antigens, including pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN), and fimbrial proteins 2 (FIM2) and 3 (FIM3). Preparations containing up to five components were developed, and several efficacy trials clearly demonstrated that the aPVs were able to confer comparable short-term protection than the most effective wPVs with fewer local and systemic reactions. There has been a resurgence of pertussis observed in recent years. This paper reports the results of a Consensus Conference organized by the World Association for Infectious Disease and Immunological Disorders (WAidid) on June 22, 2018, in Perugia, Italy, with the goal of evaluating the most important reasons for the pertussis resurgence and the role of different aPVs in this resurgence.

Development and Validation of a Bordetella pertussis Whole-Genome Screening Strategy

“…These responses could be possibly blunted over time with repeated aP boosters. The data present in the literature also demonstrate that the aP vaccine despite waning over time is also effective in initial protection against whooping cough [3,[13][14][15], but by comparison to the wP vaccine, it could be expected that this vaccine would elicit a narrow response directed mostly against the four vaccine antigens. As a result, little or no response against non-aP vaccine BP antigens would be detected.…”

Acellular Pertussis Vaccine Components: Today and Tomorrow

“…Before inclusion as a vaccine component, pertussis toxin must be detoxified, and the reagents and processes used to accomplish this have differential effects on immunogenicity. Chemical detoxification includes formaldehyde and glutaraldehyde, which are more destructive to antigenic epitopes compared with hydrogen peroxide, another chemical detoxicant [ 27 ]. Detoxification can also be achieved through genetic modification, which does not change the antigenic characteristics and may be immunologically superior to chemical treatment [ 15 , 27 ]; however, few approved vaccines use genetically modified pertussis toxin.…”

Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement

“…The potential of maternal immunization in protecting young infants was made evident by tetanus vaccination during pregnancy contributing to the reduction in incidence of neonatal tetanus (3). This has also become evident by the decrease in the incidence of severe pertussis disease in young infants in countries that have implemented pertussis immunization programs in pregnancy (4)(5)(6)(7).…”