Global variations in immunisation strategies against pertussis in infancy.

INTRODUCTION: The World Health Organisation (WHO) introduced the Expanded Programme on Immunisation (EPI) in 1974 to reduce morbidity and mortality from a range of vaccine-preventable infectious diseases including pertussis. However, almost 50 years later pertussis infection continues to be a public-health concern in high- and low-and-middle-income countries. AREAS COVERED: We review: the clinical heterogeneity of disease in an immunized population and the current estimates of global disease burden; the vaccine-types currently used to prevent pertussis infection and the evidence behind the current schedules of immunization recommended by the WHO; the current understanding of the immune responses relating to protection from disease and colonization; the regional differences in routinely used schedules of immunization. EXPERT OPINION: The current heterogeneity of schedules and vaccines reflects uncertainty about the best strategies for long-term control of pertussis infection. Whole cell pertussis vaccines are associated with sustained population control of infection but are reactogenic; acellular pertussis vaccines are less reactogenic but do not appear to give sustained protection against transmission. Continuing to develop and apply emerging insights into the nature of the immune responses needed to provide robust protection against pertussis may enable the development of novel vaccines and optimal schedules of immunization.