Prevention of pertussis: from clinical trials to Real World Evidence


Pertussis (P) is a highly contagious infectivedisease caused by the Gram-negative bacterium Bordetella pertussis(Bp). Following the introduction of a whole-cell vaccine (wP) in the 1940s, the fear of wP-related severe adverse events led to the formulation and subsequent diffusion of acellular pertussis (aP) vaccines. A few years after the introduction of aP vaccines, several epidemiological evaluations clearly indicated that the incidence of P was slowly, though steadily, rising, and had even reached higher values than those recorded in periods of widespread wP use. The information currently available enables us to draw some conclusions that can, at least in part, explain the re-emergence of P, and hence to propose some possible solutions to the problem. Analysis of the literature showed that aPs have proved to be highly safe and immunogenic, with high efficacy and effectiveness Strategies for the control and prevention of P must involve the achievement and maintenance of high vaccination coverage rates in the entire population. Nevertheless, recent evidence has revealed some limitations of the currently available aP vaccines, regardless of the number of Bp components they contain. It is to be hoped that future developments will result in the production of pertussis vaccines whose antigenic formulation also takes into account Bp mutations and the possibility of eliciting a Th1/Th17 immune response.


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