Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity

Abstract

After the pertussis vaccine had been introduced in the 1940s and was shown to be very successful in reducing the morbidity and mortality associated with the disease, the possibility of improving both vaccine composition and vaccination schedules has become the subject of continuous interest. As a result, we are witnessing a considerable heterogeneity in pertussis vaccination policies, which remains beyond universal consensus. Many pertussis-related deaths still occur in low- and middle-income countries; however, these deaths are attributable to gaps in vaccination coverage and limited access to healthcare in these countries, rather than to the poor efficacy of the first generation of pertussis vaccine consisting in inactivated and detoxified whole cell pathogen (wP). In many, particularly high-income countries, a switch was made in the 1990s to the use of acellular pertussis (aP) vaccine, to reduce the rate of post-vaccination adverse events and thereby achieve a higher percentage of children vaccinated. However the epidemiological data collected over the past few decades, even in those high-income countries, show an increase in pertussis prevalence and morbidity rates, triggering a wide-ranging debate on the causes of pertussis resurgence and the effectiveness of current pertussis prevention strategies, as well as on the efficacy of available pertussis vaccines and immunization schedules. The current article presents a systematic review of scientific reports on the evaluation of the use of whole-cell and acellular pertussis vaccines, in the context of long-term immunity and vaccines efficacy.

Keywords: Bordetella pertussis; DTaP; DTwP; Tdap; acellular pertussis vaccine; pertussis; whole cell pertussis vaccine.

Figure 1

Plausible causes of the increased incidence of whooping cough in the last decades.

Figure 2

Different immune response to natural B. pertussis infection and immunization with vaccines containing a whole-cell pertussis component or an acellular pertussis component.

Figure 3

Different T and B cell response, depending on use whole-cell (wP) or acellular (aP) pertussis component during priming and booster immunization. Gray boxes show the effect of priming and booster immunization with aP vaccines. Green boxes show the same effect on T and B cells after prime immunization with wP, irrespective of aP or wP use as a booster, while reversion of the B cell profile after using as a booster wP after priming with aP. Stronger and faster effects of the boost dose on either T or B cell response are shown on a green background. Non-or negative effect on lymphocyte stimulation after boost vaccination is shown in red background. Trm—tissue-resident memory CD4 T cells; PCs—plasma cells; GCs—germinal centers.