Whole-Cell and Acellular Pertussis Vaccine: Reflections on Efficacy

Abstract

Pertussis is a common respiratory infection caused by the bacterium Bordetella pertussis. Although most cases occur in developing countries, it is considered endemic globally. The World Health Organization estimates there are 20 to 40 million cases of pertussis annually. Pertussis vaccines played a pivotal role in reducing the burden of pertussis disease as well as in infant morbidity and mortality. Although the two forms of pertussis vaccine are effective, each has its advantages and drawbacks. This paper aims to review the current knowledge on pertussis vaccine, emphasizing vaccine effectiveness in different populations in a community. Clinical trials have shown favorable vaccine efficacy with acellular pertussis (aP) vaccine. However, observation and population-level studies showed that introducing at least a single dose of whole-cell pertussis (wP) vaccine within the routine immunization schedule is associated with better disease protection and a longer duration of immunity. On the other hand, wP vaccine is more reactogenic and associated with higher adverse events. Therefore, the selection of vaccine should be weighed against the effectiveness, reactogenicity, and cost-effectiveness. Due to its safety profile, aP vaccine can be offered to wider population groups. Booster adolescent and pregnant immunization programs have been implemented globally to control outbreaks and protect vulnerable infants. Due to the variable effectiveness performance of both vaccines, different countries adopted distinctive immunization programs. Determining the right vaccination approach depends on financial consideration, immunization program infrastructure, adverse event monitoring, and pertussis surveillance in the community.

Two centuries of vaccination: historical and conceptual approach and future perspectives

“…An example is the hepatitis B vaccine, which employs a protein from the surface of the virus as a subunit ( 156 ). Another example is the acellular pertussis vaccine, which uses several purified proteins from B. pertussis ( 219 ).…”

“…This method increases the immunogenicity of polysaccharides, especially in infants < 2 years of age. Polysaccharide-protein conjugation allows the immune system to recognize and respond more effectively, producing polysaccharide-specific antibodies and generating memory cells ( 219 ). The pneumococcal, meningococcal, and H. influenza type b conjugate vaccines are successful examples of this type of vaccine ( 220 ).…”

Current and next-generation formulation strategies for inactivated polio vaccines to lower costs, increase coverage, and facilitate polio eradication

“…Although both antigens provide overall comparable immunogenicity, wP is much less expensive to produce than aP (requiring manufacturing of up to five different individual antigens), making it preferable for use in LMICs. 65 The development of combination pediatric vaccines containing both IPV and wP is thus a challenging formulation goal. 62 , 66 , 67 Kraan et al observed immediate temperature-dependent loss of efficacy upon resuspension of lyophilized IPV, with pentavalent vaccine suggesting that the thimerosal-induced destabilization occurs too quickly for resuspension to be a feasible option.…”

BECC438b TLR4 agonist supports unique immune response profiles from nasal and muscular DTaP pertussis vaccines in murine challenge models

“…The structure of lipid A determines the downstream immune response; therefore, in the case of vaccination, the ability to generate novel lipid A structures that activate specific inflammatory pathways would make for powerful adjuvants ( 43 , 48 , 49 ). It has been appreciated that the potent immune response of the wP formulation results from both the number of antigens available and the immunostimulatory effect of B. pertussis ’ lipooligosaccharide (LOS) molecule ( 50 , 51 ). We hypothesize that the use of a vaccine formula containing an engineered lipid A mimetic could confer the ideal aspects of both types of pertussis vaccines: the protective immunity of wP and the safety of aP.…”