Pertussis and Rotavirus Vaccines – Controversies and Solutions
- 232 Downloads
Pertussis and rotavirus vaccines have been the subject of several controversies over the years. In this paper the authors discuss facts and myths behind these controversies and also suggest solutions to overcome some limitations of these vaccines. The whole-cell pertussis vaccine (wPV) came into disrepute due to the associated adverse reactions, resulting in its replacement by acellular pertussis vaccine (aPV) in industrialized nations in 1990s. Although wPV is known to have more side effects; but they are usually minor. Whole-cell pertussis containing vaccine is being used safely in the National Immunization programme in India from many years. Another controversy erupted during 2009–2010, when there were reports of resurgence of pertussis cases among adolescents and adults, from developed nations. Present literature review raises doubts about long term protection offered by aPV, when compared with wPV. In spite of prevailing controversy, acellular pertussis containing vaccines should be acceptable, if timely delivery of primary and booster doses is ensured; including vaccination of adolescents and pregnant women. Initial rotavirus vaccine was withdrawn from the market because of increased risk of intussusception. Although three new generation rotavirus vaccines are currently available for use in India, but doubts about their efficacy, long term protection and safety still exists. Present literature review found them to be safe and moderately efficacious because of reasonable good cross protection. Even a moderately efficacious vaccine like rotavirus vaccine could significantly improve the outcome if disease burden is high. Therefore, it is being included in National Immunization Programme of India.
KeywordsWhooping cough Gastroenteritis Immunization Health policy
ND reviewed the literature and drafted the initial manuscript. SV reviewed the literature, drafted the final manuscript and will act as guarantor for the paper. Both SV and ND approved the final manuscript.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 1.Pertussis vaccines. WHO position paper. Wkly Epidemiol Rec. 2015;90:433–60.Google Scholar
- 2.Pertussis vaccines. WHO position paper. Vaccine. 2016;34:1423–5.Google Scholar
- 3.Pertussis. WHO Programmes. Vaccines and Biologicals, Global figures. 2015. Available at: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/pertussis/en/. Accessed 22 Mar 2017.
- 4.WHO vaccine reaction rates information sheets. Available at: http://www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/. Accessed 22 Mar 2017.
- 7.Kulenkampff M, Schwartzman JS, Wilson J. Neurological complications of pertussis inoculation. Arch Dis Child. 1974;49:46–9.Google Scholar
- 8.Gangarosa EJ, Galazka AM, Wolfe CR, et al. Impact of anti-vaccine movement on pertussis control: the untold story. Lancet. 1998;351:356–61.Google Scholar
- 9.Coulter HL, Fisher BL. A shot in the dark: why the P in the DTP vaccination may be hazardous to your child's health. New York: Avery Publishing Group Inc; 1991.Google Scholar
- 11.Alderslade R, Bellman MH, Rawson NSB, Ross EM, Miller DL. The National Childhood Encephalopathy study: a report of 1000 cases of serious neurological disorders in infants and young children from the NCES research team. Department of Health and Social Security. Whooping cough: reports from the committee on the safety of medicines and the joint committee on vaccination and immunization. London: Her Majesty’s Stationery Office; 1981.Google Scholar
- 12.Stephenson JB. A neurologist looks at neurological disease temporally related to DTP immunization. Tokai J Exp Clin Med. 1988;13:S157–64.Google Scholar
- 14.Blumberg DA, Lewis K, Mink CM, Christenson PD, Chatfield P, Cherry JD. Severe reactions associated with diphtheria-tetanus-pertussis vaccine: detailed study of children with seizures, hypotonic-hyporesponsive episodes, high fevers, and persistent crying. Pediatrics. 1993;91:1158–65.PubMedGoogle Scholar
- 15.Institute of Medicine (US). Committee to study new research on vaccines. In: Stratton KR, Howe CJ, Johnston RB, editors. DPT vaccine and chronic nervous system dysfunction: a new analysis. Washington (DC): National Academy Press; 1994.Google Scholar
- 16.Institute of Medicine (US). Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. In: Howson CP, Howe CJ, Fineberg HV, editors. Adverse effects of pertussis and Rubella vaccines: a report of the committee to review the adverse consequences of pertussis and Rubella vaccines. Washington (DC): National Academy Press; 1991.Google Scholar
- 21.Hoffman HJ, Hunter JC, Damus K, et al. Diphtheria-tetanus-pertussis immunization and sudden infant death: results of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death Syndrome risk factors. Pediatrics. 1987;79:598–611.Google Scholar
- 22.Valdes-Dapena M. Sudden infant death syndrome: overview of recent research developments from a pediatric pathologist's perspective. Paediatrician. 1988;15:222–30.Google Scholar
- 23.Heininger U, Kleemann WJ, Cherry JD; Sudden Infant Death Syndrome Study Group. A controlled study of the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants. Pediatrics. 2004;114:e9–15.Google Scholar
- 25.Geier DA, Geier MR. An evaluation of serious neurological disorders following immunization: a comparison of whole-cell pertussis and acellular pertussis vaccines. Brain Dev. 2004;26:296–300.Google Scholar
- 26.WHO SAGE pertussis working group Background paper. SAGE April 2014. Available at: http://www.who.int/immunization/sage/meetings/2014/april/1_Pertussis_background_FINAL4_web.pdf. Accessed 22 Mar 2017.
- 35.Thorstensson R, Trollfors B, Al-Tawii N, et al. A phase I clinical study of a live attenuated Bordetella pertussis vaccine – BPZE1; a single centre, double-blind, placebo-controlled, dose-escalating study of BPZE1 given intranasally to healthy adult male volunteers. PLoS One. 2014;9:e83449.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Rotavirus vaccine. WHO position paper. Wkly Epidemiol Rec. 2013;88:49–64.Google Scholar
- 44.Tissera MS, Cowley D, Bogdanovic-Sakran N, et al. Options for improving effectiveness of rotavirus vaccines in developing countries. Hum Vaccin Immunother. 2016 Nov 11:1–7. doi: 10.1080/21645515.2016.1252493.
- 46.Bines JE, Danchin M, Jackson P, Handley A, et al. RV3 Rotavirus Vaccine Program. Safety and immunogenicity of RV3-BB human neonatal rotavirus vaccine administered at birth or in infancy: a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis. 2015;15:1389–97.CrossRefPubMedGoogle Scholar