Pertussis: the trials and tribulations of old and new pertussis vaccines.

The mortality from pertussis in unvaccinated infants is significantly greater than that reported. Most present day whole-cell pertussis vaccines are efficacious. Although they cause frequent reactions, studies during the last 15 years reveal no evidence that they cause brain damage. Acellular pertussis vaccines have been used successfully in Japan since 1981. In spite of this, five vaccine efficacy trials in three countries are presently in progress. Of the six vaccines being studied, three seem to be less than optimal choices for study because they are similar to the two vaccines evaluated in the original Swedish efficacy trial which had disappointing efficacy. The lessened reactions associated with acellular pertussis vaccines make routine adult booster immunization possible. A future immunization programme with vaccines that elicit antibodies which completely block bacterial attachment to ciliary epithelial cells, and which includes universal childhood immunization and adult booster doses can be expected to have a dramatic effect upon disease incidence and the circulation of Bordetella pertussis in the community.