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Acellular vaccines for preventing whooping cough in children

  • Review
  • Intervention

Authors

  • ON Tinnion,

  • M Hanlon


Mr Mark Hanlon, Immunology and Infectious Diseases, The New Children's Hospital, Westmead, PO Box 3515, Parramatta, NSW, 2142, AUSTRALIA. markh@nch.edu.au.

Abstract

Background

Routine use of whole cell pertussis vaccines was suspended in some countries in the late 1970s and early 1980s, leading to a resurgence of whooping cough. Acellular pertussis vaccines containing purified or recombinant Bordetella pertussis antigens were developed in the hope that they would be as effective but less toxic than the whole cell vaccines.

Objectives

The objective of this review was to assess the effects of acellular pertussis vaccines in children.

Search strategy

The Cochrane Controlled Trials Register and Medline were searched up to January 1998.

Selection criteria

Double-blind randomised efficacy and safety trials of acellular pertussis vaccines in children, with active follow-up of participants and laboratory verification of pertussis cases.

Data collection and analysis

One reviewer assessed trial quality and extracted data.

Main results

Six efficacy trials and 45 safety trials were included. Acellular pertussis vaccines with three or more pertussis vaccines were more effective than those with one or two antigens. They were also more effective than one type of whole cell pertussis vaccine, but less effective than two other types of whole cell vaccines. Differences in trial design precluded pooling of the efficacy data and results should be interpreted with caution. Most systemic and local adverse events were significantly less common with acellular than with whole cell pertussis vaccines.

Authors' conclusions

Multi-component acellular pertussis vaccines are effective, and show less adverse effects than whole cell pertussis vaccines. However in areas where whooping cough is more likely to be fatal, the higher toxicity of some whole cell vaccines may be offset by their increased effectiveness.

Plain language summary

Plain language summary

New types of whooping cough vaccines with fewer adverse effects can prevent whooping cough

Whooping cough (pertussis) can be a serious respiratory infection. Vaccines made from killed whole Bordetella pertussis were developed, but they often produced adverse effects. This caused immunisation rates to fall, so the disease has spread. Some people are concerned that the whole cell pertussis vaccines (WPV) might cause serious and permanent nerve disorders. There are now new vaccines containing acellular purified B. pertussis antigens which have fewer adverse effects (less fever, irritability and injection site pain). The review of trials found that multi-component vaccines which contain acellular pertussis components are effective, with less adverse effects than WPV.

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