Pertussis immunisation in adolescents and adults.

The burden of disease in affected adolescents and adults, their important contribution to the ongoing circulation of B. pertussis in the population, and the associated direct and indirect costs make prevention of pertussis by immunisation beyond childhood an attractive goal. The recent introduction of booster doses in adolescents in Austria, Australia, Canada, France, Germany, and the United States are an important step in the right direction. However, this most likely will not have a significant impact on reduction of disease in young infants and adults. It will be a challenge for the next few years to convince authorities, health care providers, and the general population about the necessity of regular pertussis vaccine booster doses in adults if better control of this potentially devastating disease is wanted. Although, as has recently been said (Cherry 2005), this "may be looked on by many as a pie-in-the-sky vision," the availability of tetanus toxoid, reduced diphtheria toxoid, and reduced acellular pertussis, adsorbed (Tdap) vaccines with proven tolerability and immunogenicity make this goal achievable. Introduction and enforcement of regular pertussis boosters, e.g. every 10 years, will not only reduce the overall morbidity of pertussis in the population but most likely--by use of combination vaccines--will also improve the less than optimal coverage of diphtheria and tetanus immunisations in adults.