While waiting for better pertussis vaccines, let's use the ones we have.
نویسندگان
چکیده
TO THE EDITOR—The excellent study by Koepke et al [1] on rapidly waning immunity of tetanus-diphtheria-acellular pertussis (Tdap) vaccines given in adolescence adds to the list of other well-done studies demonstrating that the duration of protection provided by acellular pertussis vaccines is substantially lower than that provided by whole-cell pertussis vaccines [2, 3]. We agree with the authors that their results reinforce the need for enhanced understanding of the correlates of protection against pertussis and for pertussis vaccines that induce more-durable immunity [4]. While whole-cell pertussis vaccines provided more-durable protection , they were also associated with a high incidence of local and systemic side effects [5]. Thus, any new pertussis vaccine will likely need to be an acellular one. The authors' data suggest that pertussis toxin and filamentous hemagglutinin may be more important for immunity and perhaps higher doses of these components might provide more durable protection. This is certainly worth further study. However, immunity with any vaccine is unlikely to be superior to that afforded by natural infection, and reinfection with Bordetella pertussis is well-described. It has been documented to occur as recently as 3.5 years after initial infection [6]. Thus, until a more durable vaccine is available, we believe a more aggressive vaccination strategy with our currently available vaccines is indicated. We propose starting Tdap vaccination at age 9 years instead of age 11 years. In addition, we recommend booster vaccinations for all persons every 5–10 years. Finally, we suggest providing booster vaccinations every 2–3 years during a local pertussis outbreak. In 2012 and 2013 combined, there were >72 000 cases of documented per-tussis in the United States [7]. The highest rates were in infants in the first year of life, who also have the highest rates of severe disease and death. Many of these infants contract pertussis before they are old enough to complete the primary vaccine series. To address this issue, the Advisory Committee on Immunization Practices has recommended Tdap vaccine for all women during their third trimester of pregnancy [8]. While this strategy may allow for some protection of infants via transfer of maternal antibody [9], it will not allow for sufficient herd immunity to protect infants from community exposures. In addition, it will not impact the substantial morbidity that pertussis causes outside the period of infancy. Not so long ago, influenza vaccination was recommended only for those at high risk for complications. Later, the …
منابع مشابه
Subcutaneous administration of a fusion protein composed of pertussis toxin and filamentous hemagglutinin from Bordetella pertussis induces mucosal and systemic immune responses
Objective(s): After decades of containment, pertussis disease, caused by Bordetella pertussis seems to be re-emerging and still remains a major cause of reported vaccine-preventable deaths worldwide. The current licensed whole-cell vaccines display reactogenicity while acellular vaccines are expensive and do not induce Th1-type immune responses that are required for optimum protection against t...
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Whooping cough and diphtheria are vaccine preventable diseases. Diphtheria, due to Corynebacterium diphtheriae or Corynebactium ulcerans, two Gram positive bacteria, is a serious upper respiratory tract disease with high morbidity and mortality rates. Vaccination, via an acellular vaccine composed only of purified, detoxified diphtheria toxin, has significantly reduced the incidence of the dise...
متن کاملPediatric advocacy: yesterday, today, and tomorrow.
periences gained in the study of DTaP vaccines has led to better laboratory diagnosis of B pertussis infection. In general, B pertussis culture is now performed better, polymerase chain reaction is widely available, and adolescent and adult disease can be diagnosed by single-serum serology. Pertussis will continue to be a problem until we address the epidemiology of B pertussis. The coming avai...
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U nlike many other severe epidemic infectious diseases, pertussis lacks an ancient history. Perhaps the earliest mention of pertussis, or whooping cough, is of a 1414 outbreak in Paris in Moulton’s The Mirror of Health, published in 1640. A contemporary observer, Guillaume de Baillou, described a 1578 epidemic of pertussis in Paris and, by the middle of the 18th century, pertussis was well reco...
متن کاملEvaluation of Pertussis Toxin Expression in B2 and THIJS Media
Whole-cell pertussis vaccine (wP) has been imperative and highly effective in preventing childhood deaths due to pertussis. Pertussis toxin is one of the virulence factors of Bordetella pertussis in all available pertussis vaccines. wP production in Razi Vaccine and Serum Research Institute is according to bioreactor culture of B. pertussis strains in B2 medium. The aim ...
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عنوان ژورنال:
- The Journal of infectious diseases
دوره 211 7 شماره
صفحات -
تاریخ انتشار 2015