D&P Replacement of DTP w/Genetically Inactivated Toxin

无细胞百日咳疫苗大大减少了与百白破细胞疫苗观察到的全身反应，但并没有消除第五次注射百白破后观察到的广泛肿胀（有时涉及整个肢体）。这种反应是由于与DTaP反应的高水平抗体引起的Arthus超敏反应，可能会阻碍成人使用DTaP，因为成人是婴儿百日咳的主要储藏库。百日咳毒素（PT）抗体的临界水平是必要的和足够的，以防止感染百日咳博德泰拉。我们指出白喉和百日咳类毒素引起的免疫有相似之处。基因灭活的百日咳和白喉毒素具有更强的免疫原性，因此与经福尔马林处理的天然毒素相比，在蛋白质水平较低的情况下产生相当水平的抗毒素。此外，化学灭活的百日咳类毒素具有轻微但持续的免疫抑制活性。用这些改进的抗原替换D和aP成分将减少DTaP中蛋白质的数量，并且很可能减少青少年和成人局部反应的发生率和严重程度。

Acellular pertussis vaccines have reduced considerably the systemic reactions observed with cellular vaccines of DTP but have not eliminated the extensive swelling (sometimes involving an entire limb) observed after the fifth injection of DTaP. This reaction, an Arthus hypersensitivity due to high levels of antibodies reacting with DTaP, could discourage its use in adults who serve as the major reservoir of pertussis for infants. A critical level of pertussis toxin (PT) antibodies is both essential and sufficient to prevent infection with Bordetella pertussis. We point out the similarities between the immunity induced by diphtheria and pertussis toxoids. The genetically-inactivated pertussis and diphtheria toxins are more immunogenic and therefore induce comparable levels of anti-toxin at lower protein levels than the formalin-treated native toxins. In addition the chemically inactivated pertussis toxoids exert mild but constant immunosuppressive activity. Replacement of the D and aP components with these improved antigens will reduce the amount of protein in DTaP and, most likely, the incidence and severity of local reactions in teenagers and adults.