Acellular vaccines for preventing whooping cough in children

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Acellular pertussis vaccines with three or more components are more effective than low‐efficacy whole‐cell vaccines, but may be less effective than the highest‐efficacy whole‐cell vaccines. Acellular vaccines have fewer side effects than whole‐cell vaccines. 

Acellular pertussis (AP) vaccines, containing purified or recombinant Bordetella pertussis antigens, were developed in the hope that they would be as effective but less reactogenic than the whole-cell vaccines. The review evaluates the efficacy and safety of acellular pertussis vaccines in children and compares them with the whole-cell vaccines. Six trials with 46,283 participants evaluating the efficacy and 52 trials with 136,541 participants assessing the safety of pertussis vaccines met inclusion criteria. The efficacy of acellular vaccines with three or more components varied from 84% to 85% in preventing typical whooping cough and from 71% to 78% in preventing mild pertussis disease. In contrast, the efficacy vaccines with one and two components varied from 59% to 78% in protecting against typical whooping cough and from 41% to 58% against mild pertussis disease. Most systemic and local side effects were significantly less common with acellular vaccines than with whole‐cell vaccines for the first doses and booster dose. Implications of these findings in clinical practice could vary based on country income level. More research surrounding whole-cell vaccines used in low-income countries is needed. 

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