Priming with Whole-Cell versus Acellular Pertussis Vaccine

New England Journal of Medicine (Impact Factor: 55.87). 02/2013; 368(6):581-2. DOI: 10.1056/NEJMc1212006
Source: PubMed

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    • "Another worrisome feature of recent outbreaks is that many teens have become ill despite Tdap immunization. Among the hypotheses suggested to explain the resurgence in teen pertussis are rapid waning of immunity from pertussis vaccination, inadequate herd immunity due to vaccine refusal, increased testing and reporting of pertussis, shifts from whole cell to acellular vaccine, and genetic drift of pertussis strains that skirt vaccine-derived immunity [3] [4] [5] [6] [7] [8]. It is also possible that sociodemographic features such as income may affect reported rates of pertussis. "
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    ABSTRACT: That disease and poverty are connected is a cornerstone of public health thought. In the case of pertussis, however, it is possible that the expected relationship to poverty is reversed. Grounds exist for considering that increases in income are associated with increases in pertussis rates, both in terms of real risk through social and network features and through the possibility of greater likelihood of care seeking and detection based on income. Using reported adolescent pertussis cases from a 2012 outbreak in Oregon, pertussis incidence rates were determined for areas grouped by zip code into higher, middle, and lower median household income. Adolescents of ages 13–16 years in higher income areas were 2.6 times (95% CI 1.8–3.8) more likely as all others to have reported pertussis during the 2012 outbreak and 3.1 (95% CI 1.4–6.5) times as likely as those in lower income areas. The higher pertussis rates associated with higher income areas were observed regardless of Tdap rate differences. These results suggest that income may be associated with disease risk, likelihood of diagnosis and reporting, or both. Further evaluation of this finding is warranted.
    Full-text · Article · Dec 2015
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    • "Therefore, it is 60 possible that the immune responses induced by 3-5 antigens from the single isolate used to 61 manufacture the aP vaccine do not protect against at least some of the current circulating 62 strains. Secondly, the waning protective immunity observed following immunization with aP 63 vaccines suggests that these vaccines fail to generate effective immunological memory (Klein 64 et al., 2012), (Sheridan et al., 2012, Klein et al., 2013, Liko et al., 2013, Witt et al., 2013). "
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    ABSTRACT: Current acellular pertussis vaccines have various shortcomings, which may contribute to their sub-optimal efficacy and waning immunity in vaccinated populations. This calls for the development of new pertussis vaccines capable of inducing long-lived protective immunity. Immunization with whole cell pertussis vaccines and natural infection with Bordetella pertussis induce distinct and more protective immune responses when compared with immunization with acellular pertussis vaccines. Therefore, the immune responses induced with whole cell vaccine or after infection can be used as a benchmark for the development of third generation vaccines against pertussis. Here, we review the literature on the immunology of B. pertussis infection and vaccination and discuss the lessons learned that will help in the design of improved pertussis vaccines.
    Full-text · Article · Sep 2015 · Pathogens and Disease
    • "Both the US and Australia replaced whole-cell pertussis vaccines (wP) with aP in the late 1990s, and the high pre-adolescent pertussis reporting rates coincided with the first birth cohorts to have received purely aP [1] [2] [3]. More rapidly waning protection from aP compared to wP has been proposed as a contributing factor to this epidemiology, with several studies providing evidence that aP vaccines are less protective against disease than wP [10] [11] [12] [13] [14]. "
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    ABSTRACT: Several observational studies provide evidence that acellular pertussis vaccines (aP) are less protective against pertussis disease than highly effective whole-cell pertussis vaccines (wP), however, concerns have been raised that some of these findings may be confounded by age. By undertaking age-stratified and restricted analyses on a cohort of Australian children primed with either aP-only, wP-only or mixed pertussis vaccine schedules, we demonstrate that compared to aP the association of wP with increased protection from pertussis is not confounded by age, nor by aP booster-dose receipt. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Aug 2015 · Vaccine
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