Intended for healthcare professionals


Perhaps it is not time to switch from whole cell to acellular pertussis vaccine

BMJ 2000; 321 doi: (Published 12 August 2000) Cite this as: BMJ 2000;321:451
  1. David Elliman, consultant in community child health,
  2. Helen Bedford, senior research fellow
  1. St George's Hospital, London SW17 0QT
  2. Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH

    EDITOR—Although we agree with Finn and Bell that it is an opportune moment to review the British policy on the use of pertussis vaccines, we cannot agree with their conclusion.1 There is ample evidence that in older children adverse events are less common after the acellular than after the whole cell vaccine, but this difference becomes less significant when the vaccine is given at two, three, and four months as in the United Kingdom.

    Miller et al showed that using the current British schedule, of the relatively minor reactions only fever was significantly commoner in those receiving the whole cell vaccine, whereas in older children other mild or moderate reactions were also significantly more common.2 The study performed by Bell et al looked only at relatively minor adverse events such as local reactions and fever. The study cited by Finn and Bell as showing a difference in incidence of febrile seizures and hypotonic-hyporesponsive episodes was, we assume, conducted at two, four, and six months, as is the norm for Canada. These results cannot therefore be extrapolated to the United Kingdom schedule where one would expect a lesser difference, if any, between the two sorts of pertussis vaccines.

    In considering the use of any vaccine, it goes without saying that the efficacy of the vaccine should also be taken into account, but this seems to have been overlooked in the present discussion. The whole cell vaccines used in the United Kingdom have been shown to be more efficacious than all but the acellular vaccines with five components, which is not available in the United Kingdom.3 While pertussis still kills children in the United Kingdom, this is an important consideration. 4 5 Uptake of whole cell vaccine is currently 94% overall, and there is no evidence to suggest that by adopting an acellular vaccine, the number of children being immunised would increase. If this turns out to be true in practice the protection afforded to the community would in effect be reduced. Before this can be accepted it would have to be shown that there was a substantial gain in terms of fewer side effects. We are not convinced that this has been done.

    The voice in the wilderness is not always wrong, and we should resist the temptation to change our policy just to conform.


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