Mucosal Immunization Against Pertussis: Lessons From the Past and Perspectives

Area of Science:

• Immunology
• Vaccinology
• Microbiology

Background:

• Current pertussis vaccines are sub-optimal, failing to induce mucosal immunity against Bordetella pertussis.
• Existing vaccines do not prevent colonization of the upper respiratory tract and have short-lived immune responses.
• Development of mucosal vaccines is essential for improved and long-lasting pertussis protection.

Purpose of the Study:

• To systematically review and analyze published literature on mucosal immunization strategies against pertussis.
• To summarize the immune responses elicited by different mucosal pertussis vaccines.
• To identify effective mucosal vaccine candidates for pertussis.

Main Methods:

• A systematic literature search was conducted using the PubMed Library database.
• Eligibility criteria included mucosal administration and evaluation of efficacy, immunogenicity, and safety.
• 63 eligible studies were included from an initial search of 349 publications.

Main Results:

• Initial human trials of mucosal whole-cell vaccines showed promise but were not pursued.
• Various novel vaccine candidates, including non-replicating and replicating types, were tested via oral, nasal, or rectal routes, mainly in animal models.
• Acellular vaccines with specific adjuvants, outer membrane vesicles, and the live attenuated BPZE1 vaccine demonstrated protective and durable respiratory tract immunity.

Conclusions:

• Three strategies—adjuvanted acellular vaccines, outer membrane vesicles, and the BPZE1 vaccine—showed potential for conferring protective and durable immunity in the respiratory tract.
• The live attenuated BPZE1 vaccine is the most advanced experimental mucosal vaccine, having entered clinical development.