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Lessons from a mature acellular pertussis vaccination program and strategies to overcome suboptimal vaccine
Ousseny Zerbo1, Bruce Fireman1, Nicola P Klein1
1Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA.
Insights
Pertussis outbreaks persist despite high vaccination rates. Strategies like maternal vaccination and updated schedules are crucial for protecting infants and adolescents against pertussis (whooping cough).
Area of Science:
- Immunology
- Public Health
- Vaccinology
Background:
- Pertussis (whooping cough) remains a significant public health concern globally, characterized by periodic large-scale outbreaks.
- High vaccination coverage in children and adolescents has not eliminated pertussis, indicating challenges with current vaccine strategies.
Purpose of the Study:
- To review the effectiveness of acellular pertussis vaccines over two decades.
- To propose strategies for optimizing acellular pertussis vaccine use in preventing widespread outbreaks.
- To address the increasing incidence and age-shift of pertussis cases.
Main Methods:
- Analysis of pertussis incidence trends over the past decade.
- Examination of disease burden shifts across age groups.
- Evaluation of vaccine immunity duration and effectiveness.
Main Results:
- Incidence of pertussis has increased, with a notable shift in disease burden towards vaccinated adolescents and adults.
- Waning vaccine immunity is identified as a primary driver for this age shift.
- Maternal pertussis vaccination during pregnancy is effective in protecting infants.
Conclusions:
- Current acellular pertussis vaccination schedules may require modification to enhance protection in adolescents.
- New vaccination strategies, including maternal immunization, are essential to curb pertussis outbreaks.
- Promoting maternal vaccination programs is critical for infant protection against pertussis.
Introduction:
Despite high vaccination coverage among children and adolescents, pertussis remains a public health problem, with large outbreaks occurring periodically in the US and other developed countries.
Areas Covered:
We examine lessons learned more than 20 years after implementation of programs which use only acellular pertussis vaccines and propose avenues for possible effective use of acellular pertussis vaccine to prevent large outbreaks.
Expert Opinion:
Acellular pertussis vaccines were introduced more than 20 years ago, yet the incidence of pertussis has been increasing over the past decade, with periodic large outbreaks marked by notable shifts in disease burden from infants and young children toward fully vaccinated adolescents and young adults. This age shift is mainly driven by the waning of vaccine immunity. To better protect adolescents against pertussis, modification of the current acellular pertussis vaccination schedule or adoption of new vaccination strategies should be considered. For infants not yet eligible to be vaccinated, maternal vaccination against pertussis during pregnancy is an effective way to protect infants from infection, severe disease and death. Implementation of maternal vaccination programs should be encouraged in countries without one or efforts to improve coverage should be supported in countries with existing program.
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