Next-generation Pertussis Vaccines with Special Focus on Intranasal Vaccination

Pertussis is a highly contagious respiratory disease caused by the gram-negative bacterium Bordetella pertussis (Bp). The disease is most severe in infants and young children, whereas adolescents and adults typically experience milder symptoms but serve as important reservoirs for transmission. Despite widespread vaccination efforts, pertussis continues to pose a significant public health challenge. Historically, the first generation of pertussis vaccines, formulated as inactivated whole cell pertussis (wP) vaccines, were associated with notable side effects, prompting the development of safer acellular pertussis (aP) vaccines. The second generation of pertussis vaccines contains purified components of Bp and provides protection comparable to that of the older whole-cell vaccines. However, recent studies have reported a resurgence of pertussis, attributed to several factors, including improved diagnostic methods, waning immunity following vaccinations, and the emergence of antigenically divergent or vaccine-adapted strains. To address these challenges, researchers are developing next-generation pertussis vaccines using various approaches, such as transitioning from intramuscular to intranasal administration, formulating outer membrane vesicle (OMV)-based vaccines, designing live attenuated pertussis vaccines, and exploring nucleic acid-based vaccines and novel adjuvants aimed at inducing long-lasting mucosal and systemic immunity. This review primarily focuses on assessing the efficacy of the next-generation intranasally administered pertussis vaccines in both pre-clinical and clinical settings.