Novel approaches to reactivate pertussis immunity

ABSTRACT

Introduction

Whole cell and acellular pertussis vaccines have been very effective in decreasing the deaths of neonates and infants from Bordetella pertussis. Despite high vaccine coverage worldwide, pertussis remains one of the most common vaccine-preventable diseases, thus suggesting that new pertussis vaccination strategies are needed. Several candidates are currently under development, such as acellular pertussis vaccines that use genetically detoxified pertussis toxin, acellular pertussis vaccines delivered with new adjuvants or new delivery systems, or an intranasally delivered, live attenuated vaccine.

Areas covered

This review discusses the different possibilities for improving current pertussis vaccines and the present state of knowledge on the pertussis vaccine candidates under development.

Expert opinion

Until there is a safe, effective, and affordable alternative to the two types of existing vaccines, we should maintain sufficient childhood coverage and increase the vaccination of pregnant women, adolescents, and young adults.

KEYWORDS:

• Bordetella pertussis
• vaccine-preventable
• vaccine
• vaccine effectiveness
• neonates
• delivery routes

Article highlights

• Increasing rates of pertussis worldwide, despite high vaccine coverage, emphasize the need for new vaccine strategies.

• New pertussis vaccines should have low reactogenicity as aP vaccines and suitable cell-mediated immunity as wP vaccines.

• Th2-type immune responses induced by aP vaccines are sufficient to protect against disease, but the induction of Th1- and Th17-type immune responses is required for the clearance of bacteria from the airways and the prevention of asymptomatic carriage.

• New vaccine candidates are explored, such as less reactogenic live vaccines or improved aP vaccines that contain genetically detoxified pertussis toxin, or those containing new adjuvants and antigens or combined with new delivery systems, or aP vaccine-based outer membrane vesicles.

• Until a better pertussis vaccine is found, it should be recognized that adults are the main reservoir for the ongoing circulation of B. pertussis and the source of infections of infants and efforts must be focused on the vaccination of pregnant women, a cocooning strategy and vaccinating regularly young adults, as well as maintaining sufficient childhood vaccine coverage.

Declaration of interest

G Blanchard Rohner has conducted two investigator-driven proof-of concept randomized controlled trial in Geneva to assess the immunogenicity and reactogenicity of a genetically detoxified PT containing aP vaccine (manufactured by BioNet-Asia). The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.