Clinical and serologic responses to acellular pertussis vaccine in infants and young children

Which strategy for pertussis vaccination today?

Pertussis (whooping cough) remains an epidemic disease responsible for infant and child morbidity and mortality, and is perceived as a serious public health problem. Since the widespread use of whole-cell pertussis vaccines in the 1940s, vaccination programs have varied greatly between countries. National specificity is a function of several factors. The most important are: vaccine efficacy and tolerability;vaccine coverage and distribution; and vaccine acceptance by parents and professionals. During the 1970s, Sweden, England, Wales and Japan provided contrasting examples of the attitude of health authorities to the use of whole-cell vaccines. The increase in pertussis incidence was noted as a consequence of active opposition to this vaccine. The re-emergence of pertussis in the 1990s, in countries with high vaccination coverage and increased incidence of disease in individuals >15 years and <6 months of age, has drawn attention to the role of booster doses of pertussis vaccines and their introduction into regular vaccination programs. The use of acellular vaccines for booster doses for adolescents and adults would seem unambiguous because of their decreased reactogenicity, although the exact schedule has yet to be established. The choice between the two kinds of vaccines is more difficult for primary courses, where safety and efficacy profiles are similar, and the attitude towards acellular vaccines varies from country to country. In this case, the strategy adopted results from the national history of pertussis infection and from the quality of the available whole-cell vaccine. Two contrasting examples are the US, where acellular vaccines were licensed for the primary series in the 1990s, and the UK, where whole-cell vaccines are exclusively used for primary immunization. The changing epidemiology of pertussis, and its local diversification, would suggest that at present it is difficult to define a single worldwide strategy with only one kind of vaccine and one schedule. In order to control pertussis incidence, each country should continue to determine the best national vaccination program established in very close relation to the past and present epidemiological situation and available healthcare resources.

Immunoglobulin A antibodies to pertussis toxin and filamentous hemagglutinin in saliva from patients with pertussis

Immunoglobulin A (IgA) antibodies against pertussis toxin (PT) and filamentous hemagglutinin (FHA) in 181 saliva samples obtained during various stages of pertussis from 112 patients were determined. Saliva samples obtained within 5 days after the onset of symptoms did not have detectable IgA antibodies against either of the two antigens. Of the samples obtained between 6 and 50 days after the onset of symptoms, 72% had antibodies against FHA but only 40% had antibodies against PT. With few exceptions, saliva samples obtained more than 50 days after the onset of symptoms contained antibodies against both antigens. In the 59 patients from whom paired saliva samples were obtained at intervals of 2 to 5 weeks, a significant increase in the geometric mean FHA antibody titers but not PT antibody titers occurred. However, increases that were fourfold or greater were observed against FHA in only 19 patients and against PT in 14 patients. Thus, IgA antibodies against FHA and PT in saliva develop during pertussis, and the importance of secretory IgA antibodies for protection against infection and disease should be investigated. Determination of these antibodies in paired saliva samples is, however, of little value for the laboratory diagnosis of pertussis.