Pertussis vaccine

Pertussis vaccine
Vaccine description
Target disease Bordetella pertussis
Type ?
Clinical data
MedlinePlus a682198
ATC code J07AJ01 (WHO) J07AJ02 (WHO)
Legal status
Legal status
  • ℞ (Prescription only)
Identifiers
ChemSpider none
 NYesY (what is this?)  (verify)

Pertussis vaccine is a vaccine that protects against whooping cough.[1] There are two main types: whole-cell vaccines and acellular vaccines.[1] The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective.[1][2] The effectiveness of the vaccines appears to decrease by between 2 and 10% per year with a more rapid decrease with the acellular vaccines. Vaccinating during pregnancy may protect the baby.[1] The vaccine is estimated to have saved over half a million lives in 2002.[3]

The World Health Organization and Center for Disease Control and Prevention recommend all children be vaccinated for pertussis and that it be included in routine vaccinations.[1][4] This includes for people who have HIV/AIDS. Three doses starting at six weeks of age are typically recommended in young children. Additional doses may be given to older children and adults. The vaccine is only available in combination with other vaccines.[1]

The acellular vaccines are more commonly used in the developed world due to less side effects. Between 10 and 50% of people given the whole-cell vaccines develop redness at the injection site and fever. Febrile seizures and long periods of crying occur in less than 1% of people. With the acellular vaccines a brief period of non serious swelling of the arm may occur. Side effects with both types of vaccines, but especially the whole-cell vaccine, are less the younger the child. The whole-cell vaccines should not be used after six years of age. Serious long term neurological problems are not associated with either type.[1]

The pertussis vaccine was developed in 1926.[5] It is on the World Health Organization's List of Essential Medicines, the most important medication needed in a basic health system.[6] A version that also includes tetanus, diphtheria, polio, and Hib vaccine is available wholesale in the developing world at a costs 15.41 USD per dose as of 2014.[7]

Medical uses

Acellular pertussis vaccine (aP) with three or more antigens prevents around 85% of typical whooping cough cases in children.[2] It has higher or similar efficacy to the previously-used whole cell pertussis vaccine, however the efficacy of the acellular vaccine declines faster.[2] Rates of side effects are also less aP.[2]

Despite widespread vaccination, pertussis has persisted in vaccinated populations and is one of the most common vaccine-preventable diseases.[8] The recent resurgence in pertussis infections is put down to a combination of waning immunity and new mutations in the pathogen that existing vaccines are unable to effectively control.[8][9]

Children

For children, the immunizations are commonly given in combination with immunizations against tetanus, diphtheria, polio, and haemophilus influenzae type B at ages two, four, six, and 15–18 months.[10] A single later booster is given at four to six years of age (US schedule). In the UK, pertussis vaccinations are given at 2, 3, and 4 months, with a pre-school booster at 3 years 4 months.

Adults

In 2006 the CDC recommended adults receive pertussis vaccination along with the tetanus and diphtheria toxoid booster.[11] In 2011 they began recommended boosters during each pregnancy.[11] In the UK vaccination of pregnant women (between 28 and 38 weeks of pregnancy) is also recommended.[12]

The pertussis booster for adults is combined with a tetanus vaccine and diphtheria vaccine booster; this combination is abbreviated "Tdap" (Tetanus, diphtheria, acellular pertussis). It is similar to the childhood vaccine called "DTaP" (Diphtheria, Tetanus, acellular Pertussis), with the main difference that the adult version contains smaller amounts of the diphtheria and pertussis components—this is indicated in the name by the use of lower-case "d" and "p" for the adult vaccine. The lower-case "a" in each vaccine indicates that the pertussis component is acellular, or cell-free, which improves safety by dramatically reducing the incidence of side effects. Adults should request the Tdap instead of just a tetanus vaccination in order to receive the multi-vaccine. The pertussis component of the original DPT vaccine accounted for most of the minor local and systemic side effects in many vaccinated infants (such as mild fever or soreness at the injection site). The newer acellular vaccine, known as DTaP, has greatly reduced the incidence of adverse effects compared to the earlier "whole-cell" pertussis vaccine, however the efficacy of the acellular vaccine declines faster than the whole-cell vaccine.[13][14]

Side effects

Local reactions, such as fever, redness and swelling at the injection site, and soreness and tenderness where the shot was given, are not uncommon in children and adults. These minor local and systemic adverse reactions are much less common with acellular DTaP vaccine; however, a determination of more rare adverse effects can only be made when additional data are available following extended use of DTaP.

Modern formulations

As of 2009 there were four acellular TDaP/Tdap vaccines licensed for use in USA: Infanrix and DAPTACEL – for children, Boostrix and ADACEL – for adolescents and adults.[15]

Composition of the pertussis component of selected vaccines[15]
Vaccine Producer Licensed for Pertussis toxin (PT), μg Filamentous hemagglutinin (FHA), μg Pertactin (PRN), μg Fimbriae (FIM), μg
Infanrix GlaxoSmithKline 6 weeks to 7 years 25 25 8 –
Boostrix GlaxoSmithKline older than 10 years 8 8 2.5 –
DAPTACEL Sanofi Pasteur 6 weeks to 7 years 10 5 3 5
ADACEL Sanofi Pasteur 11 to 64 years 2.5 5 3 5

History

Pertussis vaccine is usually administered as a component of the diphtheria-tetanus-pertussis (DTP) vaccines. There are several types of DTP vaccines. The first vaccine against pertussis was developed in the 1930s by pediatrician Leila Denmark. It included whole-cell killed Bordetella pertussis bacteria. Until the beginning of the 1990s it was used as a part of the DTwP vaccine for the immunization of children. It, however, contained pertussis endotoxin (surface lipooligosaccharide) and produced side effects.[16]

New acellular pertussis vaccines were developed in the 1980s, which included only a few selected pertussis antigens (toxins and adhesins).[16] Acellular vaccines are less likely to provoke side effects.[17] They became a part of DTaP vaccines for children.[16] In 2005, two new vaccine products were licensed for use in adolescents and adults that combine the tetanus and diphtheria toxoids with acellular pertussis vaccine.[18] These (Tdap) vaccines contain reduced amounts of pertussis antigens compared to DTaP vaccines.[15]

Both WHO and the CDC found that the acellular pertussis vaccines were effective at prevention of the disease, but had a limited impact on infection and transmission, meaning that vaccinated people could act as asymptomatic reservoirs of infection.[19][20]

References

  1. 1 2 3 4 5 6 7 "Pertussis vaccines: WHO position paper - September 2015." (PDF). Wkly Epidemiol Rec. 90 (35): 433–58. Aug 2015. PMID 26320265.
  2. 1 2 3 4 Zhang, L; Prietsch, SO; Axelsson, I; Halperin, SA (Sep 17, 2014). "Acellular vaccines for preventing whooping cough in children.". The Cochrane database of systematic reviews. 9: CD001478. doi:10.1002/14651858.CD001478.pub6. PMID 25228233.
  3. ↑ "Annex 6 whole cell pertussis" (PDF). World Health Organization. Retrieved 5 June 2011.
  4. ↑ "Pertussis: Summary of Vaccine Recommendations". Centre for Disease Control and Prevention. Retrieved 12 Dec 2015.
  5. ↑ Macera, Caroline (2012). Introduction to Epidemiology: Distribution and Determinants of Disease. Nelson Education. p. 251. ISBN 9781285687148.
  6. ↑ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  7. ↑ "Vaccine, Pentavalent". International Drug Price Indicator Guide. Retrieved 8 December 2015.
  8. 1 2 Mooi; et al. (Feb 2013). "Pertussis resurgence: waning immunity and pathogen adaptation—two sides of the same coin". Epidemiology and Infection. Oxford University Press. 142: 1–10. doi:10.1017/S0950268813000071.
  9. ↑ van der Ark; et al. (Sep 2012). "Resurgence of pertussis calls for re-evaluation of pertussis animal models.". Expert Reviews. 11 (9): 1121–1137. doi:10.1586/erv.12.83.
  10. ↑ "Immunisation and Pentavalent Vaccine". UNICEF.
  11. 1 2 Kline, JM; Lewis, WD; Smith, EA; Tracy, LR; Moerschel, SK (15 October 2013). "Pertussis: a reemerging infection.". American family physician. 88 (8): 507–14. PMID 24364571.
  12. ↑ "Whooping cough outbreak: Pregnant women to be vaccinated". BBC News.
  13. ↑ "Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Adsorbed, ADACEL, Aventis Pasteur Ltd". Archived from the original on 2007-02-16. Retrieved 2006-05-01.
  14. ↑ Allen A (2013). "Public health. The pertussis paradox". Science. 341 (6145): 454–5. doi:10.1126/science.341.6145.454. PMID 23908204.
  15. 1 2 3 Cherry, J. D. (2009). "How Can We Eradicate Pertussis". Hot Topics in Infection and Immunity in Children V. Advances in Experimental Medicine and Biology. 634. pp. 41–51. doi:10.1007/978-0-387-79838-7_4. ISBN 978-0-387-79837-0.
  16. 1 2 3 Cherry, J. D. (2013). Heitman, Joseph, ed. "Pertussis: Challenges Today and for the Future". PLoS Pathogens. 9 (7): e1003418. doi:10.1371/journal.ppat.1003418. PMC 3723573Freely accessible. PMID 23935481.
  17. ↑ Patel SS, Wagstaff AJ (Aug 1996). "Acellular pertussis vaccine (Infanrix-DTPa; SB-3). A review of its immunogenicity, protective efficacy and tolerability in the prevention of Bordetella pertussis infection". Drugs. 52 (2): 254–275. doi:10.2165/00003495-199652020-00010. PMID 8841742.
  18. ↑ Karen R. Broder, Margaret M. Cortese, John K. Iskander et al. (24 March 2006). "Recommendations of the Advisory Committee on Immunization Practices (ACIP)". CDC. Retrieved 18 December 2013.
  19. ↑ Srugo, Isaac; Benilevi, Daniel; Madeb, Ralph; Shapiro, Sara; Shohat, Tamy; Somekh, Eli; Rimmar, Yossi; Gershtein, Vladimir; Gershtein, Rosa; Marva, Esther; Lahat, Nitza (October 2000). "Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel".
  20. ↑ "Pertussis Vaccines:WHO Position Paper" (PDF). August 2015. It is plausible that in humans, as in nonhuman primates, asymptomatic or mildly symptomatic infections in DTaP-immunized persons may result in transmission of B. pertussis to others and may drive pertussis outbreaks.
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