Pertussis: Where did we go wrong and what can we do about it?

Area of Science:

• Infectious Diseases
• Vaccinology
• Microbiology

Background:

• Pertussis (whooping cough), caused by Bordetella pertussis, is a severe respiratory illness particularly dangerous for infants.
• Recent years have seen a resurgence of pertussis in highly vaccinated populations, coinciding with the shift from whole-cell to acellular vaccines.
• Waning immunity and the inability of current acellular vaccines to prevent B. pertussis infection are suspected causes for this resurgence.

Purpose of the Study:

• To address the resurgence of pertussis by exploring new vaccine strategies.
• To evaluate novel approaches for prolonged immunity and improved protection against Bordetella pertussis infection and disease.

Main Methods:

• Review of hypotheses explaining pertussis resurgence, including vaccine waning and lack of infection-blocking immunity.
• Exploration of optimized current vaccine strategies like cocooning, neonatal, and maternal immunization.
• Assessment of a novel live attenuated nasal vaccine candidate, BPZE1, a genetically modified B. pertussis derivative.

Main Results:

• Acellular vaccines may induce protection against disease but not infection, contributing to pertussis spread.
• Current vaccination strategies have limitations in controlling the resurgence.
• The BPZE1 nasal vaccine candidate demonstrated safety in a Phase I trial, inducing transient nasopharyngeal colonization and antibody responses.

Conclusions:

• New vaccine development is critical for effective long-term control of pertussis.
• The BPZE1 vaccine candidate offers potential for protection against both pertussis disease and B. pertussis infection.
• BPZE1 represents a promising advancement in pertussis prevention, potentially addressing the limitations of current vaccines.