Longevity & AgingWhy whooping cough keeps coming back despite widespread vaccination
Pertussis (whooping cough) remains endemic and has resurged since the 1990s despite high vaccine coverage. This expert review, based on a 2025 Global Pertussis Initiative meeting, argues this is not vaccine failure. Instead, the bacterium is extremely contagious (R0 12-17), immunity wanes within 3-10 years, parenteral vaccines poorly prevent nasal colonization, adolescents and adults carry mild or silent infections, and B. pertussis is evolving under vaccine and antibiotic pressure. Acellular (aP) vaccines skew toward Th2 responses, while whole-cell (wP) vaccines and natural infection produce Th1/Th17 responses and tissue-resident memory T cells, which are key to mucosal protection. Next-generation vaccines should deliver durable, Th1/Th17-polarized, mucosal immunity to reduce transmission.
