Whole-Cell and Acellular Pertussis Vaccines: A Narrative Review of Biological, Clinical, Safety and Programmatic...

Background/Objectives: Pertussis has resurged worldwide despite long-standing vaccination programs. Whole-cell (wP) and acellular (aP) pertussis vaccines differ in immunobiology, durability, reactogenicity, and programmatic use. Poland is the only European Union/European Economic Area (EU/EEA) country that routinely primes infants with wP while using aP products for boosters, pregnancy, and selected indications, providing an informative programmatic context. This review compares both platforms across biological, clinical, safety, epidemiological, and supply domains. Methods: We conducted a narrative review of PubMed/MEDLINE literature and documents from the World Health Organization, European Centre for Disease Prevention and Control, national public health institutes, and regulatory authorities through July 2026. No protocol was registered and no quantitative synthesis was performed. Results: wP priming induces a persistent T-helper 1/T-helper 17-oriented response and an immunoglobulin G1-dominant profile, whereas aP vaccination produces higher, higher-avidity antibody concentrations, an increasing immunoglobulin G4 fraction, and substantially lower reactogenicity. Historical trials demonstrated marked product-level heterogeneity: efficacy ranged from 36-48% for poorly performing wP vaccines to 84-85% for multicomponent aP vaccines, while one United Kingdom wP product performed comparably to a five-component aP vaccine. Protection after aP schedules wanes within several years, no validated correlate of protection exists, and neither intramuscular platform reliably prevents colonization or transmission. In 2024, eight aP-using EU/EEA countries had higher pertussis notification rates than Poland despite stable Polish infant coverage. Conclusions: Neither platform is uniformly superior across products, schedules, and clinically relevant outcomes. Program performance depends primarily on timely infant vaccination, maternal vaccination, appropriate boosters, product-specific effectiveness evidence, and secure vaccine supply.