What Is Wrong with Pertussis Vaccine Immunity?

Abstract

The high incidence of pertussis in vaccinated adolescents suggests the failing of immune memory. We argue that acellular pertussis vaccines generate memory cells that are effectively reactivated by boosters better than by exposure. We propose that there are two main causes. One is the induction of vaccine-specific immunity rather than pathogen-specific immunity. The second is that strictly mucosal infections such as poorly reactivate memory B and T cells residing deep in lymph nodes or tissues. Developing new vaccines for infants or adolescents will be immunologically and economically challenging. Let us hope that maternal and infant immunization, to date the most effective strategies against pertussis death, will remain so.

Whole-Cell or Acellular Pertussis Primary Immunizations in Infancy Determines Adolescent Cellular Immune Profiles

“…However, wP-primed children, vaccinated with the same DTaP and Tdap booster vaccines as the aP-primed children, showed higher pertussis-specific IgG levels 1 month after the preadolescent booster vaccination compared with 1 month after the preschool booster vaccination. This is in line with Eberhardt and Siegrist, who suggest that germinal center reactions induced by aP-priming vaccines are not effective enough to confer long-term memory responses ( 35 ). Furthermore, the more durable priming upon wP vaccination might especially be due to the presence of lipopolysaccharide, a highly immune-stimulatory bacterial cell wall component, operating as an adjuvant by activating innate immune cells via toll-like receptor 4 ( 36 ).…”

A Review on T Cell Epitopes Identified Using Prediction and Cell-Mediated Immune Models for Mycobacterium tuberculosis and Bordetella pertussis

“…It has to be underlined that pathogen escape by mutation is most effective for microbes with small genomes, or with responses of limited breadth, since simultaneous escape of a responses directed against large genomes and a large number of antigens/epitopes is by definition unlikely. It has indeed been proposed that the switch from wP to aP generated a response that is less diverse and created an opportunity for BP to escape vaccine responses ( 70 – 72 ). It will be important to compare mutation rates of epitopes and non-epitopes, in wP, and aP antigens, to potentially either refute or support this hypothesis.…”

Use of a Neonatal-Mouse Model to Characterize Vaccines and Strategies for Overcoming the High Susceptibility and Severity of Pertussis in Early Life

“…The weakness in the vaccines currently used lies in the duration of the induced immunity (shorter for aP-vaccinated individuals) together with the lack of optimal vaccination coverage. Furthermore, an evolution of the pathogen to greater vaccination resistance has contributed to the recent rise in the incidence of pertussis and fatalities (He and Mertsola, 2008;Klein et al, 2016;Eberhardt and Siegrist, 2017). While coverage has improved and better vaccines are designed, many countries have added vaccination boosters beyond the primary doses with the main aim being to reduce both the disease burden and the incidence in the most vulnerable populations.…”