Indications for acellular pertussis vaccines in adults: the case for selective, rather than universal, recommendations.

The availability of acellular pertussis vaccines, which appear to be both safe and immunogenic in adults, will require that vaccine advisory groups make recommendations regarding their use. Pertussis in adults has negligible mortality but is responsible for about one-quarter of cases of chronic cough syndrome in young adults. Parents and other infant caregivers are important transmitters of pertussis to infants, the group who have the highest morbidity and mortality. Assuming that further studies confirm the immunogenicity and safety profile of acellular pertussis vaccines in adults, recommendations can be made for its use for universal immunization of adolescents, epidemic control, and strongly considered targeted adults who give care to infants. Factors that mitigate against including acellular pertussis vaccine in the recommended decennial tetanus-diphtheria toxoids booster include the short duration of the immune response to the acellular pertussis vaccine, increased cost and reactogenicity, and the lack of vaccine delivery systems to most adults. The elderly and the infirm, who are the current focus of adult immunization programs, are unlikely candidates for pertussis immunization. Therefore, recommendations for use of acellular pertussis vaccine in adults should be selective, rather than universal.