Elsevier

Vaccine

Volume 20, Issues 5–6, 12 December 2001, Pages 641-646
Vaccine

Short communication
Recommendations are needed for adolescent and adult pertussis immunisation: rationale and strategies for consideration

https://doi.org/10.1016/S0264-410X(01)00393-0Get rights and content

Abstract

Pertussis vaccination of infants has dramatically reduced disease, complications and deaths in infancy and early childhood. But there is still a major public health challenge — to deal with the morbidity and economic burden of illness in older children, adolescents and adults. Furthermore, it is these groups that form a major source of infection for non-immunised and partially immunised infants who are at high risk of severe complications.

Adult-type acellular pertussis vaccine confers safe and effective protection against pertussis. There are several strategies to consider for immunising older individuals. Universal vaccination of all age groups would be the best available strategy for protecting individuals. It would also reduce the potential for transmitting the disease to other susceptibles, particularly infants. However, such a policy may be difficult both logistically and economically at this time.

More easily achievable as a first step would be a strategy of universal adolescent booster vaccination combined with a programme targeted at adults most likely to have contact with very young babies including healthcare and childcare workers, parents and close family contacts. There is also potential for offering vaccination to adults (and their carers and close contacts) whose medical conditions or advanced age may place them at increased risk of more severe pertussis disease.

Specific details of immunisation programmes must be made on a country by country basis depending on local circumstances.

Introduction

Bordetella pertussis are transmitted from person to person in airborne droplets. The bacteria are highly infectious and unprotected close contacts are liable to become infected. Neither vaccination-acquired nor natural immunity from pertussis is life-long and protection is thought to be minimal after 10 years without boosting [1], [2], [3].

Childhood pertussis immunisation programmes are highly successful at reducing morbidity and mortality in infants and young children [4], [5], however, there is less opportunity for natural boosting of immunity. As a result, an increasing number of adults and adolescents with waning immunity are now susceptible to infection.

Although generally milder in adolescents and adults, pertussis infection can cause substantial, prolonged illness with associated economic costs, both for management of the illness and loss of productivity due to reduced efficiency and time off work. Even more important these groups act as a source of infection for young infants who have not yet completed their primary vaccinations.

Until recently adult/adolescent booster vaccination was not a practical proposition as whole cell vaccines have unacceptable side effects when administered past early childhood. However, the advent of acellular vaccines offers the opportunity to extend pertussis prevention throughout the community (Table 1).

Section snippets

Epidemiological aspects of pertussis

Age-related statistics for pertussis are very limited and, in any case, it is most likely that the incidence of pertussis is grossly underestimated [6], [7]. In some countries pertussis is not a notifiable disease and in cases where pertussis is reported, the information is inconsistent and scanty.

The problem is compounded by the non-specific nature of symptoms of adult pertussis and poor physician awareness. It is clear that reported cases are just the tip of the iceberg. Many

Acknowledgements

GlaxoSmithKline Biologicals provided an educational grant towards the organisation of this Consensus Meeting.

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