Volume 4 • Issue 1 • 1000175 J Vaccines Vaccin ISSN:2157-7560 JVV an open access journal Review Article Open Access Vaccines & Vaccination Mukkur and Richmond, J Vaccines Vaccin 2013, 4:1 http://dx.doi.org/10.4172/2157-7560.1000175 Keywords: Bordetella pertussis; Live attenuated vaccines; DNA vaccines; Biodegradable nanoparticle vaccines; Pertussis Introduction Whooping cough (pertussis), a respiratory disease caused by Bordetella pertussis, accounts for more than 3,00,000 deaths annually worldwide [1,2] and its incidence has been rising [3]. B. pertussis is a non-invasive pathogen which localises mainly in the upper respiratory tract and produces a large array of potential virulence factors, many of which play signifcant roles in the pathogenesis of pertussis [1,4]. A killed whole cell pertussis vaccine, generally given in combination with diphtheria and tetanus toxoids, has been available in many countries for over 40 years. While its use seems to have controlled pertussis epidemics, concerns over the reactogenicity, ranging from high fever, persistent crying, pain and swelling at the site of injection [4,5] led to the development of the currently marketed acellular pertussis vaccines (DTaP) which is administered to infants in Australia at 2, 4, and 6 months with a booster at 4-6 years of age [5]. In other countries like the USA, children are also vaccinated at 12-18 months of age [4]. Children under the age of 2 months of age are highly susceptible to the complications of pertussis infection but are too young to be immunised. Te concern that young adults (vaccinated during their childhood) with waning immunity against whooping cough may serve as a reservoir for the pathogen for infecting infants (and children), has stimulated interest in the development of an alternative vaccine which can also be used safely in the adult population [6]. It is generally accepted that the protective efcacy of the acellular vaccine is short–term, not long-term [7]. Furthermore, given the frequency of local reactions [5,8], particularly the reported extensive limb swelling [5] that occured in a children receiving 4 th booster vaccinations with DTaP, may raise an alarm, albeit undue, in the community about the safety of this vaccine. Te alternatives suggested have been to either to reduce the number of booster immunisation show ever this would lead to reduced levels of immunity, use vaccines with reduced antigen content as has been done by introduction of adult acellular pertussis vaccine formulations, dTpa, for use in adolescents (http://immunise.health.gov.au), or to fnd a replacement adjuvant, which, unlike alum, favours the induction of T1 responses that has been proposed to be responsible for long-term protection against whooping cough [9]. Unfortunately, no such universally acceptable adjuvant for use with DTaP approved by the Food and Drugs Administration (FDA) is available, hence the continued use of the alum-based adjuvants in pertussis vaccine formulations. Comparison of the humoral and cellular immune responses of mice following vaccination with the killed whole cell pertussis vaccine (WCV:DTPw) versus the DTaP [10] has revealed that although the DTPw induced lower antibody titres to the pertussis toxin, flamentous haemagglutinin and pertactin, it was more efective in activating macrophages and more protective as judged in intracerebral challenge and bacterial lung clearance experiments than the DTaP [10]. Tese authors suggested that cell-mediated immunity might play a crucial role in eliminating bacteria that escape the humoral defence mechanisms. Tis suggestion is further supported by the fact that B. pertussis can survive within mammalian cells including macrophages [11,12]. It has also been suggested that circulating antibodies may play a role in toxin neutralisation and prevention of bacterial attachment to respiratory epithelial cells particularly in the early phase of infection [10]. Tere is now evidence that whole-cell pertussis priming in infancy may be more efective than DTaP priming on subsequent protection in childhood [13]. *Corresponding author: Trilochan Mukkur, School of Biomedical Sciences, Fa- culty of Health Sciences, Curtin Health Innovation Research Institute, Curtin Uni- versity, Bentley, Perth, Western Australia 6102, Australia, Tel: +61892667520; Fax: +61892662342; E-mail: T.Mukkur@curtin.edu.au Received December 31, 2012; Accepted January 29, 2013; Published January 31, 2013 Citation: Mukkur T, Richmond P (2013) Alternative Whooping Cough Vaccines: A Minireview. J Vaccines Vaccin 4: 175. doi:10.4172/2157-7560.1000175 Copyright: © 2013 Mukkur T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Alternative Whooping Cough Vaccines: A Minireview Trilochan Mukkur 1 *and Peter Richmond 2 1 School of Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, Perth, Western Australia 6102, Australia 2 School of Pediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Perth 6340, Western Australia Abstract Bordetella pertussis, the aetiological agent of an acute upper respiratory tract disease of humans, “whooping cough”, can infect all age groups with adolescents and adults acting as major source of transmission of this pathogen to infants. This transmission is promoted by the fact that adolescents and adults do not exhibit the characteristic cough, the infection being either asymptomatic or manifested as a mild but persistent upper respiratory tract infection. It is established now that both antibodies and cell-mediated immune [CMI] responses are crucial for protection against whooping cough, the former being important in the early phase of the disease, with the latter being important for long-term protection. The protection offered by vaccination with the currently-marketed acellular pertussis vaccines is predominantly due to antibodies against vaccine antigens associated with a Th2-polarised immune response and has been found to be relatively short-term protection. There is an urgent need to develop alternative vaccines capable of inducing both protective antibody and CMI responses particularly given the resurgence of this vaccine- preventable disease in infants and children worldwide. While current strategies are aimed at the development of recombinant vaccines using an adjuvant that may stimulate both arms of the immune response, no discovery of a cost-effective and non-toxic adjuvant to improve protection against pertussis has been reported thus far. This review details the oral presentation on alternative whooping cough vaccines and their future potential delivered at the 2 nd World Conference on Vaccines and Vaccination organised by the OMICS Publishing Group.