Hewlett E L
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
Tokai J Exp Clin Med. 1988;13 Suppl:125-8.
Adolescents and adults represent an increasing proportion of the relatively fixed number of reported pertussis cases in the United States each year. Widespread use of pertussis vaccine in the pediatric population has resulted in more individuals reaching adulthood without having had the disease. Since pertussis vaccine is not recommended for routine use in persons over 6 years of age, the loss of vaccine immunity with time after immunization provides a continuous supply of susceptibles (beginning during the teen years) in the population. It has been suggested that whole cell pertussis vaccine is more reactogenic in adults than in children. The data, however, indicate that the rates of local and systemic reactions are equivalent to those reported for children receiving routine pertussis immunization. Nevertheless, because pertussis is not a life-threatening illness in adults, the allegations against and perceptions about the vaccine cannot be overcome and whole cell PDT will never be used routinely in adults. The development of acellular pertussis vaccines, however, provides a novel opportunity for consideration of immunization of the adult population. In phase I trials, acellular pertussis vaccine has been given to adults with minimal reactions and good immunogenicity. Preparations containing pertussis toxin (PT) and filamentous hemagglutinin (FHA) were associated with greater frequency of local reactions to doses following the first. These data indicate that routine booster immunization of the adult population, probably every 10 years with tetanus-diphtheria toxoids (Td), is feasible and might be beneficial in control of pertussis. A major hurdle in consideration of such a policy will be theoretical acceptance by the medical community and lay public.
在美国，青少年和成年人在每年报告的相对固定数量的百日咳病例中所占比例日益增加。小儿群体中广泛使用百日咳疫苗，导致更多人在未患过该病的情况下成年。由于不建议6岁以上人群常规使用百日咳疫苗，免疫接种后随着时间推移疫苗免疫力的丧失使得人群中（从青少年时期开始）易感人群持续存在。有人认为全细胞百日咳疫苗在成年人中比在儿童中更易引起不良反应。然而，数据表明局部和全身反应发生率与接受常规百日咳免疫接种的儿童报告的发生率相当。尽管如此，由于百日咳在成年人中并非危及生命的疾病，针对该疫苗的指控和看法无法消除，全细胞百日咳疫苗永远不会在成年人中常规使用。然而，无细胞百日咳疫苗的研发为考虑对成年人群进行免疫接种提供了新机会。在I期试验中，无细胞百日咳疫苗接种于成年人后反应轻微且免疫原性良好。含有百日咳毒素（PT）和丝状血凝素（FHA）的制剂在首剂之后的各剂次接种中局部反应发生率更高。这些数据表明，成年人群常规加强免疫（可能每10年用破伤风-白喉类毒素（Td）进行一次）是可行的，并且可能有助于控制百日咳。考虑实施这样一项政策的一个主要障碍将是医学界和普通公众在理论上的接受程度。
