Short communicationRecommendations are needed for adolescent and adult pertussis immunisation: rationale and strategies for consideration
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).
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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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