Ward Joel I, Cherry James D, Chang Swei-Ju, Partridge Susan, Keitel Wendy, Edwards Kathryn, Lee Martin, Treanor John, Greenberg David P, Barenkamp Stephen, Bernstein David I, Edelman Robert
University of California-Los Angeles (UCLA) Center for Vaccine Research, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, David Geffen School of Medicine UCLA, Torrance, California 90502-2502, USA.
Clin Infect Dis. 2006 Jul 15;43(2):151-7. doi: 10.1086/504803. Epub 2006 Jun 5.
Acellular pertussis (aP) booster immunizations have been recommended for adolescents and older persons to enhance long-term protection and to possibly reduce community transmission of infections.
This was a multicenter, randomized, double-blind vaccine trial in which one-half of the subjects received aP vaccine and one-half received hepatitis A vaccine (control subjects). All subjects were observed for almost 2 years for cough illnesses, and all underwent microbiologic and serologic studies for detection of pertussis infection. Immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies to pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae 2/3 were measured by enzyme-linked immunosorbent assay in serum samples obtained 1 and 12 months after immunization. Infection rates were determined with a variety of serologic criteria for control and vaccinated subjects. The incidence of prolonged cough illness was ascertained for subjects with and subjects without serologic evidence of infection.
Infection rates among control subjects are particularly representative of those in nonimmunized adults. Among control subjects, 0.4%-2.7% had increases in pertussis antibody of various types and degrees over 1 year, and 20%-46% had prolonged cough illnesses during this interval. Pertussis toxin antibody had the greatest specificity for detecting increases in antibody levels. Asymptomatic infections were approximately 5 times more common than clinical illnesses that met a strict clinical and microbiologic case definition. Relative to control subjects, aP-immunized subjects may have fewer increases in the antibody level (i.e., infections), especially for antibodies to fimbriae 2/3 (an antigen not in the vaccine).
Pertussis infections in older persons are largely asymptomatic. aP boosters confer protection for adolescents and adults against symptomatic pertussis and likely confer protection against mild and asymptomatic infections, and use of boosters may reduce transmission to others, especially infants.
已建议对青少年及年长者进行无细胞百日咳（aP）加强免疫，以增强长期保护并可能减少社区感染传播。
这是一项多中心、随机、双盲疫苗试验，其中一半受试者接受aP疫苗，另一半接受甲型肝炎疫苗（对照受试者）。所有受试者被观察近2年的咳嗽疾病情况，并全部接受微生物学和血清学研究以检测百日咳感染。通过酶联免疫吸附测定法在免疫后1个月和12个月采集的血清样本中检测针对百日咳毒素、丝状血凝素、百日咳杆菌黏附素和2/3型菌毛的免疫球蛋白G（IgG）和免疫球蛋白A（IgA）抗体。根据多种血清学标准确定对照受试者和接种疫苗受试者的感染率。确定有和没有血清学感染证据的受试者中持续性咳嗽疾病的发病率。
对照受试者中的感染率特别能代表未免疫成年人中的感染率。在对照受试者中，0.4% - 2.7%在1年期间各种类型和程度的百日咳抗体有所增加，在此期间20% - 46%有持续性咳嗽疾病。百日咳毒素抗体在检测抗体水平升高方面具有最大特异性。无症状感染比符合严格临床和微生物学病例定义的临床疾病常见约5倍。相对于对照受试者，接受aP免疫的受试者抗体水平升高（即感染）可能较少，尤其是针对2/3型菌毛的抗体（一种疫苗中不含的抗原）。
年长者中的百日咳感染大多无症状。aP加强免疫可为青少年和成年人提供针对有症状百日咳的保护，可能也能提供针对轻度和无症状感染的保护，并且使用加强免疫可能减少向他人尤其是婴儿的传播。
