It is plausible based on the discussion above that high level pertussis-specific IgE in serum may serve as a biomarker of risk for breakthrough pertussis infection and disease amongst vaccinated children, and this possibility could be tested prospectively, or perhaps retrospectively with existing serum repositories. If this Sodium Phenylbutyrate is proven, it would provide a rationale for adjuvantising DTaP formulations, for example by the inclusion of a chemically defined TLR agonist of the type shown to be capable of binding to the Th2-skewing alum component of the vaccine with resultant attenuation of its Th2-stimulatory properties [45]. An alternative possibility would be to reintroduce DTwP as the first vaccine in the infant DTaP priming schedule, provided regulatory approval could be obtained.
Since submission of this manuscript a retrospective analysis capturing all nationally reported US pertussis cases 1990–2014 has appeared (editorialised in http://dx.doi.org.ezproxy.lib.ncyu.edu.tw/10.1001/jamapediatrics.2016.0157) suggesting that the waning of resistance to pertussis in previously vaccinated children during adolescence is significantly reduced in those who received at least some DTwP dose(s) during infant priming.
Since submission of this manuscript a retrospective analysis capturing all nationally reported US pertussis cases 1990–2014 has appeared (editorialised in http://dx.doi.org.ezproxy.lib.ncyu.edu.tw/10.1001/jamapediatrics.2016.0157) suggesting that the waning of resistance to pertussis in previously vaccinated children during adolescence is significantly reduced in those who received at least some DTwP dose(s) during infant priming.