Improving pertussis vaccination

Despite a high vaccine coverage, pertussis has re-emerged and has become the most prevalent vaccine preventable disease in developed countries. The re-emergence of pertussis has been attributed to various factors, including increased awareness, improved diagnostics, suboptimal vaccines, waning vaccine-induced immunity and pathogen adaptation. Waning immunity in combination with pathogen adaptation are probably the main factors which contribute to the continued circulation of B. pertussis strains. The switch from whole cell vaccines ( Pw) to acellular vaccines ( Pa) has been successful in reducing side-effects and restoring the public confidence in pertussis immunizations. It has also facilitated the introduction of booster vaccinations at later ages with favorable effects. However, there is still significant circulation of B. pertussis among adolescents and adults who are a major source of infection of infants to young to be ( fully) vaccinated. In the short term, the introduction of cocooning vaccination is the most ( cost-)effective way to reduce the pertussis burden in infants. In the long term, improved pertussis vaccines should be developed which induce long lasting immunity.