Indications for acellular pertussis vaccines in adults: The case for selective, rather than universal, recommendations

The availability of acellular pertussis vaccines, which appear to be both s afe and immunogenic in adults, will require that vaccine advisory groups ma ke recommendations regarding their use. Pertussis in adults has negligible mortality but is responsible for about one-quarter of cases of chronic coug h syndrome in young adults. Parents and other infant caregivers are importa nt transmitters of pertussis to infants, the group who have the highest mor bidity and mortality. Assuming that further studies confirm the immunogenic ity and;safety profile of acellular pertussis vaccines in adults, recommend ations can be made for its use for universal immunization of adolescents, e pidemic control, and strongly considered targeted-adults who give care to i nfants. Factors that mitigate against including acellular pertussis vaccine in the recommended decennial tetanus-diphtheria toxoids booster include th e short duration of the;immune response to, the acellular pertussis vaccine , increased cost and reactogenicity, and the lack of vaccine delivery syste ms to most adults. The elderly and the infirm, who are the current focus of -adult immunization programs, are unlikely candidates, for pertussis immuni zation. Therefore; recommendations for use;of acellular pertussis vaccine i n adults should be selective, rather than universal.