PEDIATRICS

OBJECfIVE: To provide a review of pertussis vaccines, including information on efficacy, adverse reactions, and antibody production following administration of both whole-cell and acellular pertussis vaccmes, DATA SOURCES: A MEDLINE search and extensive review of journals was conducted to identify the information for this review. DATA EXTRAC,.110N: Pertinent studies reporting experience with pertussis vaccinations were reviewed. DATA SYNTHESIS: The differences in efficacy, adverse reactions, and antibody responses between whole-cell and acellular pertussis vaccines are emphasized. The status of acellular pertussis vaccination in the US is defined. CONCLUSIONS: Acellular (chemically detoxified or recombinant) pertussis vaccine formulation appears to cause fewer adverse reactions than whole-cell vaccine in most studies. Clinical efficacy and safety in the very young has not been well established. Thus, acellular pertussis vaccine is reserved for the 4th and 5th doses in the US. Oral or intranasal formulations of the pertussis vaccine are being evaluated. Ann Phannacother 1994;28:925-39. BORDETELLA PERTUSSIS, isolated by Bordet and Gengou in 1906, is the cause of pertussis in humans. This fastidious gram-negative bacillus has a distinct affinity for the ciliat-ed epithelium cells of the respiratory tract.'> The crucial step in disease propagation appears to be the attachment of the pertussis toxin to a specific glycoprotein receptor o