en Community Medicine Community Medicine Original Research Original Research <p style="text-align: justify;"><strong>Background: </strong>Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence.</p> <p style="text-align: justify;"><strong>&nbsp; Methods:</strong> We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package.</p> <p style="text-align: justify;"><strong>&nbsp; Results:</strong> Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55&ndash;0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60&ndash;0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85&ndash;0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64&ndash;0.93) in high-risk group.</p> <p style="text-align: justify;"><strong>&nbsp; Conclusion: </strong>The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended.</p> Whooping cough, Acellular vaccine, Whole cell vaccine. 1109 1119 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-1084&slc_lang=en&sid=1 Roxana Mansour-Ghanaei roxanaghanaie@yahoo.com 200319475328460025854 200319475328460025854 No Pediatric Infections Research Center, Mofid children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Maziar Moradi-Lakeh mazmoradi@yahoo.com 200319475328460025855 200319475328460025855 No Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran. Sareh Shakerian sarehshakareian@gmail.com 200319475328460025856 200319475328460025856 No School of Medical Education, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran. Abdollah Karimi dr_akarimi@yahoo.com 200319475328460025857 200319475328460025857 No Pediatric Infections Research Center, Mofid children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shooka Esmaeeli esmaeeli.sh@iums.ac.ir 200319475328460025858 200319475328460025858 No Tehran University of Medical sciences, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran, Iran. Farhad Shokraneh farhadshokraneh@gmail.com 200319475328460025859 200319475328460025859 No Cochrane Schizophrenia Group, the Institute of Mental Health, a partnership between the University of Nottingham and Notting-hamshire Healthcare NHS Trust, UK. Susan Mahmoudi sussanmahmoody@yahoo.com 200319475328460025860 200319475328460025860 No Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran. Mohsen Yaghoubi mohsenyaq@yahoo.com 200319475328460025861 200319475328460025861 Yes Clinical Knowledge Management Unit, Department of Community Medicine, Iran University of Medical Science, Tehran, Iran.