Waning immunity – Pertussis vaccination resource page

A resurgence of pertussis or whooping cough has been observed in highly immunized populations. Studies have shown that there are other causes beyond increased awareness of disease, use of better diagnostic tools and improved surveillance methods. Waning vaccine-induced immunity (secondary failure) has been identified in many countries. Secondary failure is when a person produces antibodies after vaccination, but the levels decline or wane over time.(Primary failure is when a person fails to make antibodies or doesn’t reach a level considered to be protective.)

Here are links to some of the studies that refer to waning immunity / secondary failure associated with the Pertussis vaccination.


Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010.

In 2010, California experienced its largest pertussis epidemic in more than 60 years; a substantial burden of disease was noted in the 7- to 10-year-old age group despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage, indicating the possibility of waning protection.


Characteristics of pertussis outbreaks in Catalonia, Spain, 1997 to 2010.

Between 2003 and 2010, after the introduction of the acellular vaccine, the index case was vaccinated with DTwP vaccine in 25 outbreaks (0.43 × 10-6 persons-year) and with DTaP vaccine in 32 outbreaks (0.55 × 10-6 person-year) (RR = 0.78, 95% CI 0.46-1.31; P = 0.35). Of cases, 37.2% were correctly vaccinated, suggesting waning immunity of pertussis vaccine protection and endogenous circulation of pertussis. A greater number of outbreaks had an index case aged


Duration of pertussis immunity after DTaP immunization: a meta-analysis

Pertussis incidence is increasing, possibly due to the introduction of acellular vaccines, which may have decreased the durability of immune response.

Assuming 85% vaccine efficacy, we estimated that 10% of children vaccinated with DTaP would be immune to pertussis 8.5 years after the last dose.


Effectiveness of routine and booster pertussis vaccination in children and adolescents, federal State of Brandenburg, Germany, 2002-2012.

In Germany whole-cell pertussis vaccines (wP) were rapidly replaced by high-concentration acellular pertussis-containing vaccines (aP, 3+1 doses) starting in 1995. Boosters were recommended for 9-17 year-olds (2000) and for 5-6 year-olds (2006). Pertussis incidence remains high despite rising vaccination coverage


Imperfect vaccine-induced immunity and whooping cough transmission to infants

However, by the 1970s, most people obtained immunity through vaccination rather than transmissible natural infection. With so little circulating pathogen people’s immunity wasrarely boosted, thereby creating a large pool of people susceptible to pertussis, and allowing epidemic outbreaks in the current era despite high vaccine coverage. Another potential explanation is that vaccine-driven pathogen evolution selected for a strain that can infect more quickly or symptomatically after vaccination [26].


Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children

….indicating that after the fifth dose of DTaP, the odds of acquiring pertussis increased by an average of 42% per year.


Protection against pertussis waned during the 5 years after the fifth dose of DTaP.


Waning Immunity to Pertussis Following 5 Doses of DTaP

CONCLUSIONS: This evaluation reports steady increase in risk of pertussis in the years after completion of the 5-dose DTaP series. This rise is likely attributable in part to waning immunity from DTaP vaccines. Continuing to monitor disease burden and vaccine effectiveness in fully vaccinated children in coming years will be important to assess ongoing risk as additional cohorts vaccinated solely with acellular pertussis vaccines are introduced.


Licensed pertussis vaccines in the United States.

….to review evidence that waning protection following licensed acellular pertussis vaccines have been significant factors in the widespread reappearance of pertussis.


Pertussis. A reemerging and an underreported infectious disease.

Pertussis resurgence has been observed in highly vaccinated populations of Western countries since 1990s. Poor vaccine quality, waning vaccine induced immunity, pathogen adaptation, and enhanced surveillance as well as advancements in diagnostic facilities are some of the reasons considered responsible for the increased reporting of pertussis cases.


Pertussis outbreak in northwest Ireland, January – June 2010

Epidemiological  investigations  suggest  that waning  immunity  and  the  absence  of  a  booster  dose during  the  second  year  of  life  could  have  contributed to the outbreak.


Pertussis vaccines: state-of-the-art and future trends.

Waning vaccine-induced immunity and antigenic divergence in circulating strains seem to be the major problems accounting for resurgence of pertussis.


Reduced risk of pertussis among persons ever vaccinated with whole cell pertussis vaccine compared to recipients of acellular pertussis vaccines in a large US cohort

Unexpected waning of immunity after pertussis vaccination is now well described

We found a markedly increased risk of disease associated with an entirely aP series.


Resurgence of pertussis calls for re-evaluation of pertussis animal models.

Pertussis has recently re-emerged in well-vaccinated populations most likely due to a combination of pathogen adaptation and waning of vaccine-induced pertussis immunity.


Epidemic Pertussis in 2012 — The Resurgence of a Vaccine-Preventable Disease

Recent data from California also suggest waning of vaccine-induced immunity after the fifth dose of DTaP vaccine.5 Certainly the major epidemics in 2005, in 2010, and now in 2012 suggest that failure of the DTaP vaccine is a matter of serious concern.


Waning vaccine immunity in teenagers primed with whole cell and acellular pertussis vaccine: recent epidemiology.

These epidemics demonstrated a new pattern, with particularly high rates of disease among pre-adolescents and early adolescents. These high rates of pertussis coincided with the first cohorts vaccinated with purely acellular pertussis vaccine


Are vaccination programs and isolate polymorphism linked to pertussis re-emergence?

More likely explanations for the re-emergence of pertussis include the change in the epidemiology and transmission patterns of pertussis in highly vaccinated populations, and a shift of disease from young children to adolescents and adults due to waning protective immunity.


Substantial gaps in knowledge of Bordetella pertussis antibody and T cell epitopes relevant for natural immunity and vaccine efficacy.

The recent increase in whooping cough in vaccinated populations has been attributed to waning immunity associated with the acellular vaccine.

We conclude that the cumulative data is yet insufficient to address many fundamental questions related to vaccine failure and this underscores the need for further investigation of B. pertussis immunity at the molecular level.


Unexpectedly Limited Durability of Immunity Following Acellular Pertussis Vaccination in Preadolescents in a North American Outbreak

Our unvaccinated and under-vaccinated population did not appear to contribute significantly to the increased rate of clinical pertussis. Surprisingly, the highest incidence of disease was among previously vaccinated children in the eight to twelve year age group. We sought to examine the factors that resulted in this peak.

Conclusions. Our data suggests that the current schedule of acellular pertussis vaccine doses is insufficient to prevent outbreaks of pertussis. We noted a markedly increased rate of disease from ages 8–12 years, proportionate to the interval since the last scheduled vaccine. Stable rates of testing ruled out selection bias. The possibility of earlier or more numerous booster doses of acellular pertussis vaccine either as part of routine immunization or for outbreak control should be entertained.