This study is important for developing countries which currently use whole cell vaccine. Should they follow the lead of developed countries, which have traded more reactogenic vaccines for less effective ones?

Clin Infect Dis. 2016 Feb 7. pii: ciw051. [Epub ahead of print]

Protective Effect of Contemporary Pertussis Vaccines: A Systematic Review and Meta-analysis

Fulton TR¹, Phadke VK², Orenstein WA³, Hinman AR⁴, Johnson WD⁵, Omer SB⁶.

Author information

• ¹Departments of Global Health Epidemiology, Rollins School of Public Health, Emory University.
• ²Division of Infectious Diseases, Emory University School of Medicine.
• ³Emory Vaccine Center Department of Pediatrics, Emory University School of Medicine, Atlanta.
• ⁴The Task Force for Global Health, Decatur, Georgia.
• ⁵Epidemiology, Rollins School of Public Health, Emory University.
• ⁶Departments of Global Health Epidemiology, Rollins School of Public Health, Emory University Emory Vaccine Center Department of Pediatrics, Emory University School of Medicine, Atlanta.

Abstract below; full text is available to journal subscribers.

BACKGROUND:

 Acellular pertussis (aP) and whole-cell (wP) pertussis vaccines are presumed to have similar short-term (<3 years after completion of the primary series) efficacy. However, vaccine effect varies between individual pertussis vaccine formulations, and many originally studied formulations are now unavailable. An updated analysis of the short-term protective effect of pertussis vaccines limited to formulations currently on the market in developed countries is needed.

METHODS:

 We conducted a systematic review and meta-analysis of published studies that evaluated pertussis vaccine efficacy or effectiveness within 3 years after completion (>3 doses) of a primary series of a currently available aP or wP vaccine formulation. The primary outcome was based on the World Health Organization (WHO) clinical case definitions for pertussis. Study quality was assessed using the approach developed by the Child Health Epidemiology Research Group. We determined overall effect sizes using random-effects meta-analyses, stratified by vaccine (aP or wP) and study (efficacy or effectiveness) type.

RESULTS:

 Meta-analysis of 2 aP vaccine efficacy studies (assessing the 3-component GlaxoSmithKline and 5-component Sanofi-Pasteur formulations) yielded an overall aP vaccine efficacy of 84% (95% confidence interval [CI], 81%-87%). Meta-analysis of 3 wP vaccine effectiveness studies (assessing the Behringwerke, Pasteur/Mérieux, and SmithKline Beecham formulations) yielded an overall wP vaccine effectiveness of 94% (95% CI, 88%-97%) (both I² = 0%).

CONCLUSIONS:

 Although all contemporary aP and wP formulations protect against pertussis disease, in this meta-analysis the point estimate for short-term protective effect against WHO-defined pertussis in young children was lower for currently available aP vaccines than wP vaccines.

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

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