The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future.
Level 5 - mechanism / opinion, no new human data
Narrative review and historical commentary with no primary data synthesis or systematic methodology.
PubMed 30793754 · doi:10.1093/jpids/piz005
What was done
This paper provides a narrative historical review detailing the 112-year history of *Bordetella pertussis* research and vaccine development, focusing on the shift from whole-cell pertussis (DTwP) vaccines to acellular pertussis (DTaP) vaccines and the immunological consequences of that transition.
What was found
Routine DTwP use in the United States decreased reported pertussis rates from 157 per 100,000 in the prevaccine era to <1 per 100,000 by the 1970s. DTaP vaccines (containing 3–5 antigens compared to >3,000 in DTwP) replaced DTwP in the United States in 1997 due to lower reactogenicity. However, DTaP induces a predominantly T2 cellular response rather than the more protective response elicited by DTwP, resulting in lower efficacy and shorter protection duration. The author states this antigen disparity leads to linked-epitope suppression, causing individuals primed with DTaP to experience increased lifetime susceptibility to pertussis.
Why it matters
It outlines the immunological shortcomings of acellular pertussis vaccines that contribute to recent pertussis resurgences and highlights the long-term challenge of managing cohorts primed exclusively with DTaP.
Limits
The paper is a narrative review presenting expert commentary and historical perspective without systematic search criteria, quality appraisal of cited literature, or primary quantitative data synthesis.
Cited by
- supports The original whole-cell DTP vaccine was taken off the market because of potential encephalitis and neurological complications.