title: Whooping cough, twenty years from acellular vaccines introduction.
abstract: Clinical pertussis resulting from infection with B. pertussis is a significant medical and public health problem, despite the huge success of vaccination that has greatly reduced its incidence. The whole cell vaccine had an undeniable success over the last 50 years, but its acceptance was strongly inhibited by fear, only partially justified, of severe side effects, but also, in the Western world, by the difficulty to enter in combination with other vaccines: today multi-vaccine formulations are essential to maintain a high vaccination coverage. The advent of acellular vaccines was greeted with enthusiasm by the public health world: in the Nineties, several controlled vaccine trials were carried out: they demonstrated a high safety and good efficacy of new vaccines. In fact, in the Western world, the acellular vaccines completely replaced the whole cells ones. In the last years, ample evidence on the variety of protection of these vaccines linked to the presence of different antigens of Bordetella pertussis was collected. It also became clear that the protection provided, on average around 80%, leaves every year a significant cohort of vaccinated susceptible even in countries with a vaccination coverage of 95%, such as Italy. Finally, it was shown that, as for the pertussis disease, protection decreases over time, to leave a proportion of adolescents and adults unprotected. Waiting for improved pertussis vaccines, the disease control today requires a different strategy that includes a booster at 5 years for infants, but also boosters for teenagers and young adults, re-vaccination of health care personnel, and possibly of pregnant women and of those who are in contact with infants (cocooning). Finally, the quest for better vaccines inevitably tends towards pertussis acellular vaccines with at least three components, which have demonstrated superior effectiveness and have been largely in use in Italy for fifteen years.
authors.affiliation: International Prevention Research Institute (IPRI), Lion, France.
authors.forename: D
authors.initials: D
authors.lastname: Greco
authors.affiliation: Pediatrics Unit High Intensity Care, University of Milan, Fondazione IRCCS Ca' Granda Hospital, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Tozzi
authors.affiliation: Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pandolfi
authors.affiliation: Department of Health Sciences, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Icardi
authors.affiliation: Microbiologist, Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" University of Palermo, Palermo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Giammanco
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007117:Immunization, Secondary; D007223:Infant; D007558:Italy; D010567:Pertussis Vaccine / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D014611:Vaccination / Q000639:trends; D022282:Vaccines, Acellular / Q000008:administration & dosage* / Q000009:adverse effects; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D010567:Pertussis Vaccine; D022282:Vaccines, Acellular
keywords: Acellular vaccines; Immunoprotection; Pertussis; Vaccine trials