Pertussis disease burden especially in infants, the history of whole-cell vs. acellular vaccine development, current effectiveness data, and Tdap recommendations for pregnant women.
Pertussis, commonly known as whooping cough, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. The disease is named for the characteristic "whoop" sound patients make when gasping for air after severe coughing fits.
Pertussis progresses through three stages: catarrhal (mild, cold-like symptoms), paroxysmal (severe coughing episodes), and convalescent (gradual recovery). The paroxysmal stage can last for weeks, with coughing fits so severe they can cause rib fractures, urinary incontinence, and even death in infants.
Before the introduction of pertussis vaccines in the 1940s, whooping cough was a major cause of childhood death worldwide.
Infants, especially neonates, can experience life-threatening pauses in breathing (apnea) as the primary symptom, without the characteristic cough.
Severe coughing fits make it difficult for infants to feed, leading to weight loss, dehydration, and failure to thrive.
Pneumonia, seizures, encephalopathy, and death. Infants under 3 months have the highest risk of severe complications and death.
The history of pertussis vaccination reflects the ongoing balance between efficacy and tolerability.
First licensed in the U.S. in 1914. Contains entire killed B. pertussis bacteria.
First licensed in U.S. in 1991. Contains purified pertussis antigens (PT, FHA, PRN, FIM).
Evidence shows that acellular pertussis vaccines provide protection for approximately 3-5 years, compared to the longer-lasting immunity from whole-cell vaccines. This waning immunity has contributed to resurgence of pertussis in adolescents and adults, who can then transmit to vulnerable infants. This is why Tdap boosters are now recommended for pregnant women (to protect newborns via placental antibodies) and for adolescents and adults.
5-dose series at: