Pertussis Vaccines Scarcely Provide Protection against Bordetella parapertussis Infection in Children-A Systematic Review and Meta-Analysis

Abstract

Background: Pertussis, or whooping cough, is a global public health concern. Pertussis vaccines have demonstrated good protection against Bordetella pertussis infections, but their effectiveness against Bordetella parapertussis remains debated due to conflicting study outcomes.

Methods: A systematic review and meta-analysis were conducted to assess the effectiveness of pertussis vaccines in protecting children against B. parapertussis infection. A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted, and randomized controlled trials (RCTs) and observational studies that met inclusion criteria were included in the analysis.

Results: The meta-analysis, involving 46,533 participants, revealed no significant protective effect of pertussis vaccination against B. parapertussis infection (risk ratio: 1.10, 95% confidence interval: 0.83 to 1.44). Subgroup analyses by vaccine type and study design revealed no significant protection. The dearth of recent data and a limited pool of eligible studies, particularly RCTs, underscore a critical gap that warrants future research in the domain.

Conclusions: These findings offer crucial insights into the lack of effectiveness of pertussis vaccines against B. parapertussis. Given the rising incidence of cases and outbreaks, coupled with the lack of cross-protection by the existing vaccines, there is an urgent need to develop vaccines that include specific antigens to protect against B. parapertussis.

Keywords: acellular pertussis vaccine; effectiveness; parapertussis; pertussis; protection; whole cellular pertussis vaccine.

Figure 1

PRISMA flowchart showing identification and screening process of studies.

Figure 2

Legend. (A) Forest plot depicting risk ratio, that is, a risk of B. parapertussis infection between the vaccinated and unvaccinated groups, weight% depicts individual weightage of each study to the overall risk ratio analysis [2,12,29,30,31,32,33]. (B) Funnel plot showing publication bias in included articles.

Figure 3

Legend. (A) Forest plot of risk ratio for B. parapertussis infection in DTP vaccinated and unvaccinated groups [2,12,30]. (B) Forest plot of risk ratio for B. parapertussis infection in DTaP vaccinated and unvaccinated groups [2,12,29,30]. (C) Forest plot of risk ratio for B. parapertussis infection in DTaP vaccinated and DTP vaccinated groups [2,12,30].

Figure 4

Legend. Forest plot of risk ratio for B. parapertussis infection between vaccinated and unvaccinated groups for both randomized controlled trials [2,12,29,30] and observational (non RCT) studies [31,32,33].