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Pertussis in adults: possible use of booster doses for control
1Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
Insights
Adults are increasingly susceptible to pertussis due to waning immunity. Acellular pertussis vaccines show promise for routine adult booster immunization, potentially aiding disease control.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- Adolescents and adults increasingly account for reported pertussis cases in the US.
- Waning immunity from childhood vaccination leaves adults susceptible.
- Current pertussis vaccines are not routinely recommended for individuals over six years old.
Purpose of the Study:
- To evaluate the feasibility and potential benefits of routine pertussis booster immunization in adults.
- To assess the safety and immunogenicity of acellular pertussis vaccines in adults.
Main Methods:
- Review of pertussis case data in the US.
- Analysis of reaction rates for whole cell pertussis vaccine in adults.
- Evaluation of Phase I trial data for acellular pertussis vaccines in adults.
Main Results:
- Whole cell pertussis vaccine shows equivalent reaction rates in adults compared to children.
- Acellular pertussis vaccines demonstrate minimal reactions and good immunogenicity in adults.
- Specific acellular vaccine components (pertussis toxin, filamentous hemagglutinin) may increase local reactions after initial doses.
Conclusions:
- Routine adult booster immunization with acellular pertussis vaccines, possibly every 10 years with tetanus-diphtheria toxoids (Td), is feasible.
- Acellular pertussis vaccines offer a viable option for adult immunization to control pertussis.
- Overcoming medical and public perception hurdles is crucial for implementing adult pertussis vaccination policies.
Abstract:
Adolescents and adults represent an increasing proportion of the relatively fixed number of reported pertussis cases in the United States each year. Widespread use of pertussis vaccine in the pediatric population has resulted in more individuals reaching adulthood without having had the disease. Since pertussis vaccine is not recommended for routine use in persons over 6 years of age, the loss of vaccine immunity with time after immunization provides a continuous supply of susceptibles (beginning during the teen years) in the population. It has been suggested that whole cell pertussis vaccine is more reactogenic in adults than in children. The data, however, indicate that the rates of local and systemic reactions are equivalent to those reported for children receiving routine pertussis immunization. Nevertheless, because pertussis is not a life-threatening illness in adults, the allegations against and perceptions about the vaccine cannot be overcome and whole cell PDT will never be used routinely in adults. The development of acellular pertussis vaccines, however, provides a novel opportunity for consideration of immunization of the adult population. In phase I trials, acellular pertussis vaccine has been given to adults with minimal reactions and good immunogenicity. Preparations containing pertussis toxin (PT) and filamentous hemagglutinin (FHA) were associated with greater frequency of local reactions to doses following the first. These data indicate that routine booster immunization of the adult population, probably every 10 years with tetanus-diphtheria toxoids (Td), is feasible and might be beneficial in control of pertussis. A major hurdle in consideration of such a policy will be theoretical acceptance by the medical community and lay public.