Time to switch from whole cell to acellular pertussis vaccines?

EDITOR—In a letter to all doctors last December the chief medical and nursing officers and pharmacist announced that triple vaccines against diphtheria, tetanus, and pertussis containing acellular pertussis would, for the first time, but only temporarily, enter routine use for infants in the United Kingdom.1 Difficulties in obtaining supplies of triple vaccine containing whole cell pertussis during 1999 seem to have precipitated this decision.

We found a much lower rate of febrile reactions in infants in the United Kingdom giventriple vaccine combined with vaccine againstHaemophilus influenzae type b when the pertussis vaccine was acellular rather than whole cell; both groups were giveninjections at 2, 3, and 4 months.2 In November last year new data from Canada showed a noticeable reduction in more serious reactions to pertussis vaccine in infants after switching from whole cell to acellular vaccine.3 New combined formulations including vaccine against meningococcus group C and hepatitis B, pneumococcal conjugate vaccine, and inactivated poliovirus will certainly be based on or tested alongside triple vaccine containing acellular pertussis. As in its use of oral polio vaccine, 4 the United Kingdom is becoming increasingly isolated among its European neighbours in its routine use of whole cell pertussis vaccine. Health professionals and the public may also become confused and uncertain about the comparative merits of the whole cell and acellular preparations currently being used alongside one another.

We believe that the time has come in the United Kingdom to use acellular pertussis vaccines as the basis of the complex infant immunisation schedule of the future.