Whole cell and acellular pertussis vaccines - rethinking the evidence

Pertussis remains an unsolved public health problem. We have synthesized recent evidence on the immunogenicity, effectiveness, and safety of the two available vaccines, whole-cell (wP) and acellular (aP). We aimed to reorient current thinking and critically address some widely held misconceptions about pertussis vaccines.

We conducted a targeted literature review to identify studies published in the last 10 years, describing aspects of effectiveness, safety, and the immune response to wP and aP.

Vaccines containing wP and aP continue to successfully achieve their historical goal of preventing pertussis deaths in children. Contrary to widely held beliefs, wP vaccines do not completely prevent colonization and have not been proven to prevent transmission. Both vaccines demonstrate clinically significant effectiveness against pertussis disease, hospitalization, complications, and death. However, neither provides long-term protection, interrupts pertussis transmission, or prevents cyclic outbreaks. Both require periodic boosters. Differences in the immune response have not been linked to adverse clinical outcomes or reduced efficacy in young children. Both wP and aP demonstrate a favorable benefit-risk profile for preventing severe pertussis in children. However, the reactogenicity and safety profile of aP is clearly superior, which may be a decisive factor for optimal vaccine uptake.