Blanchard Rohner
, et al
Boosting teenagers with acellular pertussis vaccines containing recombinant or chemically inactivated pertussis toxin: a randomized clinical trial
Clin Infect Dis.
; doi:

Investigators from multiple institutions conducted a randomized controlled trial to assess the immunogenicity of a recombinant acellular pertussis vaccine (r-aP) that included genetically detoxified pertussis toxin (PT) and filamentous hemagglutinin (FHA), compared to that of a licensed acellular pertussis (aP) vaccine with chemically detoxified PT (cd/Tdap) in previously immunized adolescents. Healthy adolescents, 11–15 years old, from the Geneva, Switzerland area who had received 5 previous aP immunizations were randomized to receive either r-aP and tetanus-diphtheria (Td) vaccines or cd/Tdap. Blood was obtained at baseline and at 28 and 365 days after immunization for measurement of anti-PT neutralizing antibodies, and PT, FHA, tetanus toxoid (TT), and diphtheria toxoid (DT) specific immunoglobulin (IgG) antibodies. The primary outcome was concentration of PT neutralizing antibodies at days 28 and 365. Secondary outcomes included levels of IgG antigen-specific antibodies and seroresponse to each antigen (defined as a 4-fold increase in levels of antigen-specific antibodies from baseline) at days 28 and 365. Changes from baseline for the outcomes among participants in each vaccine group were assessed with paired t-tests or signed-rank tests, and t-tests or chi-square tests were used to compare results between groups.

Data on 60 adolescents, including 31 receiving r-aP and Td and 29 randomized to cd/Tdap, were included in study analyses. The mean age of study participants was 12 years. At baseline, levels of PT neutralizing and PT IgG antibodies were low among those in each group and undetectable in most. Antibody levels increased significantly in both groups by day 28. However, levels of PT neutralizing and PT IgG antibodies were significantly higher in those receiving r-aP and Td vaccines than in those randomized to cd/Tdap (P=.016 and P=.0006, respectively). There were no significant differences between groups at day 28 for levels of FHA, DT, or TT antibodies. At day 28, PT neutralizing and PT IgG seroresponse rates were significantly higher in those receiving r-aP and Td than among those receiving cd/Tdap (97% and 97%, respectively, vs 79% and 93%, respectively). By day 365, FHA, TT, and DT antibodies declined to similar levels in both groups, but PT neutralizing and PT IgG seroresponse rates were 79% and 71%, respectively, in those receiving r-aP and Td compared to 39% and 39%, respectively, among those in the cd/Tdap group (P=.006 and P=.03, respectively).

The authors conclude that the r-aP vaccine induced higher levels of anti-PT antibodies than the licensed cd/Tdap vaccine in previously immunized adolescents.

Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Licensed pertussis vaccines in the United States contain PT that has been chemically detoxified (cd) with formaldehyde and/or glutaraldehyde to minimize...

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