Acellular pertussis vaccines--a solution to the pertussis problem.

Available data relating to pertussis and pertussis immunization are frequently overlooked or misinterpreted. Mortality due to pertussis is underreported. Most whole cell pertussis vaccines are effective; there is no evidence that pertussis vaccines cause brain damage. Moreover, acellular pertussis vaccines have been used successfully in Japan since 1981. Third-generation, genetically derived acellular pertussis vaccines have been developed, but knowledge of antigens and concentrations required has not kept pace with vaccine technology. There is substantial evidence that pertussis is not a single lymphocytosis-promoting factor (LPF) toxin disease. Pertussis vaccine efficacy studies suggest that monocomponent LPF toxoid or biocomponent LPF toxoid/filamentous hemagglutinin (FHA) vaccines are not as effective as vaccines that contain pertactin and fimbrial antigens as well as LPF toxoid and FHA. Future programs with multicomponent acellular vaccines and universal childhood immunization followed by booster doses in adults will effectively curtail disease incidence and the circulation of Bordetella pertussis.