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November 2018

Protecting Infants From Pertussis Disease

Author Affiliations
  • 1Vanderbilt University School of Medicine, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
JAMA Pediatr. 2018;172(11):1012-1013. doi:10.1001/jamapediatrics.2018.2363

It is widely known that the time between birth and initiation of the primary pertussis vaccination series at 6 to 8 weeks of age is the period of the greatest morbidity and mortality associated with pertussis disease.1 For this reason, there have been a number of attempts to bridge the pertussis immunity gap between these 2 periods. Initial studies of neonatal immunization with whole-cell pertussis vaccines at birth were conducted in the 1940s, but were largely abandoned owing to concerns of immune tolerance or suppression of the immune responses to primary immunizations.2 With the advent of the acellular pertussis (aP) vaccines that were less reactogenic and more immunogenic, studies of pertussis vaccine in newborns were again pursued. A small study from Italy documented that the administration of a 3-component aP vaccine at birth enhanced the pertussis immune responses and provided higher antibody titers than seen in children given only primary pertussis immunizations.3 A study reported in 2008 demonstrated a similar enhanced immune response in infants given aP vaccine at birth.4 In contrast, another small study also from 2008 that used the diphtheria and tetanus toxoids and aP vaccine (DTaP) administered at birth demonstrated that the vaccine was safe and immunogenic, but immune interference was noted to several vaccine antigens after subsequent doses of the primary immunization series.5 The biological relevance of this interference was unclear, but 1 author hypothesized that it was due to the effect of the tetanus and diphtheria components of DTaP.6