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Prevention of pertussis
1Marshall University School of Medicine, Huntington, WV.
Insights
Pertussis, a severe respiratory illness caused by Bordetella pertussis, poses risks globally, especially to unvaccinated infants. Vaccination remains the key control, with ongoing development of safer and effective acellular vaccines.
Area of Science:
- Bacteriology
- Immunology
- Public Health
Background:
- Pertussis (whooping cough) is a highly contagious respiratory infection caused by Bordetella pertussis, posing significant global health risks.
- It disproportionately affects infants under one year old in regions with low immunization rates, leading to severe morbidity and mortality.
- Characteristic symptoms include severe coughing fits, potential hypoxia, pneumonia, and seizures, with prolonged illness stages.
Purpose of the Study:
- To review the epidemiology, clinical presentation, and control strategies for pertussis.
- To discuss the evolution of pertussis vaccines, from whole-cell to acellular formulations.
- To highlight the challenges in developing and evaluating new pertussis vaccines.
Main Methods:
- Literature review of pertussis epidemiology, transmission, and clinical manifestations.
- Analysis of historical and current pertussis vaccination strategies.
- Discussion of vaccine reactogenicity, efficacy, and challenges in clinical trials.
Main Results:
- Pertussis remains a significant threat, particularly in under-immunized populations.
- Whole-cell pertussis vaccines, while effective, have been associated with adverse reactions and waning public acceptance.
- Acellular pertussis vaccines, used in Japan since 1981, show promise for reduced reactogenicity and maintained efficacy.
Conclusions:
- Vaccination is the cornerstone of pertussis control.
- Development of less reactogenic and highly efficacious acellular pertussis vaccines is a priority.
- Careful design and execution of clinical trials are crucial for the successful introduction of new pertussis vaccines.
Abstract:
Pertussis (whooping cough) is an acute respiratory disease caused by Bordetella pertussis. It occurs worldwide and is an important cause of morbidity and mortality in areas where immunization rates are low, particularly among children less than 1 year of age. The characteristic presentation of pertussis is paroxysmal coughing followed by a long inspiratory effort that produces the classic whoop. Lymphocytosis is frequently present. Complications include pneumonia and seizures secondary to hypoxia. The paroxysmal and convalescent stages of the illness can each last several weeks. Transmission occurs readily by respiratory droplets, and atypical or mild cases in older children and adults can be important in spread of the infection. Isolation, early erythromycin therapy, and erythromycin prophylaxis can reduce transmission, but vaccination is the primary means of control. An inactivated whole cell suspension of the bacterium has been an effective vaccine for protecting against pertussis since the 1950s, but whole cell vaccine may allow mild infections to occur and has been associated with local and systemic reactions that have eroded public acceptance. Component or acellular pertussis vaccines that are less reactogenic have been in use in Japan since 1981 and appear to be effective there. Development of an acellular preparation that is equally or more efficacious than whole cell vaccine may be possible, but clinical trials for measurement of protection against pertussis are difficult and trials with new pertussis vaccines will have to be carefully performed to avoid the controversies generated by earlier trials.