In the U.S., the whooping cough (pertussis), diphtheria and tetanus vaccines are combined into one licensed vaccine called the diphtheria, tetanus toxoid and whole-cell pertussis (DTP) vaccine. Show
1991The diphtheria-tetanus-acellular pertussis (DTaP) vaccine is licensed. This vaccine is an acellular vaccine, which causes fewer side effects than the whole-cell DTP vaccine. The DTaP vaccine eventually replaces the DTP vaccine. In 1996, the Advisory Committee on Immunization Practices (ACIP) will recommend DTaP in infants. About 200,000 cases of whooping cough (pertussis) occurred each year in the U.S. in the 20th century compared with about 5,000 cases in 2020. Likewise, about 21,000 annual cases of diphtheria occurred each year in the U.S. compared with none in 2020. 2006ACIP recommends that teens get a booster dose of the tetanus, diphtheria and pertussis (Tdap) vaccine. Information about pertussis (whooping cough) disease, vaccines and recommendations for vaccination from the Australian Immunisation Handbook
Recently added This page was added on 06 June 2018. Updates made This page was updated on 07 December 2022. View history of updates Vaccination for certain groups of people is funded under the National Immunisation Program and by states and territories. On this page: On this page OverviewWhatPertussis, commonly known as ‘whooping cough’, is a disease of the respiratory tract caused by the bacterium Bordetella pertussis. It is highly infectious in unvaccinated people. In Australia, pertussis epidemics usually occur every 3–4 years. WhoAcellular pertussis–containing vaccine is recommended for:
HowPertussis-containing vaccines are only available in Australia as combination vaccines that include other antigens such as diphtheria and tetanus. Pertussis-containing vaccines are recommended for children at 2, 4, 6 and 18 months, and 4 years of age, and adolescents at 11–13 years of age. Pertussis-containing vaccines are recommended for adults at ages 50 years and 65 years. Vaccination of pregnant women is recommended during each pregnancy, preferably between 20 and 32 weeks gestation. Vaccination is recommended every 10 years for healthcare workers, early childhood educators and carers, and people in close contact with infants. WhyEvery year in Australia, an average of 1 death and more than 200 hospitalisations related to pertussis occur in infants <6 months of age. These infants are too young to be fully immunised. Older children and adults who have not received pertussis vaccination are at risk of infection, and are often the source of infection in infants. RecommendationsInfants and childrenPertussis-containing vaccine is recommended in a 5-dose schedule at 2, 4, 6 and 18 months, and 4 years of age. Infants can have their 1st dose of pertussis-containing vaccine as early as 6 weeks of age. Before maternal vaccination was widespread, this strategy was estimated to prevent an extra 8% of infant pertussis cases at a population level.1,2 See Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances in Catch-up vaccination. If the 1st dose of pertussis-containing vaccine is given at the age of 6 weeks, infants should still receive their next scheduled doses at 4 months and 6 months of age. Doses of pertussis-containing vaccine at 18 months and 4 years of age are needed because pertussis immunity wanes after receiving the infant doses.3 Preschool and school-aged children can be an important source of infection for infants.4-6 The vaccines usually received at each schedule point are: Infants and children <10 years of age who have not received pertussis-containing vaccines at the recommended schedule points may need extra doses of vaccine and/or an alternative schedule. See Catch-up vaccination for more details, including minimum intervals between doses. AdolescentsA booster dose of pertussis-containing vaccine is recommended for adolescents, using the reduced antigen dTpa vaccine. The optimal age for administering this dose is 11–13 years. Adolescents need a booster dose because pertussis immunity wanes after the childhood dose at 4 years of age.7,8 The booster is essential for maintaining immunity to pertussis into adulthood.9 Adolescents are recommended to receive 1 dose of pertussis-containing vaccine, regardless of the number of previous doses of pertussis-containing vaccine they received before 10 years of age. See Catch-up vaccination for more details. AdultsVaccination with dTpa is recommended for any adult who wants to reduce their likelihood of becoming ill with pertussis. If protection against pertussis is needed as soon as possible, adults can receive 1 dose of dTpa vaccine at least 4 weeks after a dose of dT (diphtheria-tetanus) vaccine. Studies indicate that short intervals between doses are not associated with increased injection site reactions.10-13 See Catch-up vaccination for more details. Adults of any age who need a tetanus-containing vaccine can have dTpa vaccine rather than dT vaccine. This is especially important if they have not previously had a dTpa dose in adulthood.14 This includes people at 50 years of age who are recommended to receive a tetanus booster (see Tetanus and Diphtheria). Adults aged ≥65 years are recommended to receive a dTpa dose if they have not had one in the past 10 years.15,16 This is because pertussis is associated with increased morbidity in older people.15 Women who are pregnant or breastfeedingdTpa vaccine is recommended as a single dose in each pregnancy. See Table. Recommendations for vaccines that are routinely recommended in pregnancy: inactivated vaccines in Vaccination for women who are planning pregnancy, pregnant or breastfeeding for more details. Vaccination during pregnancy reduces the risk of pertussis in young infants by 90%.17,18 This results from direct passive protection by transplacental transfer of pertussis antibodies from the mother to the fetus during pregnancy. Vaccination is recommended with each pregnancy, including pregnancies that are closely spaced, to provide maximal protection to every infant. This is because: The optimal time for pertussis vaccination in pregnancy is between mid 2nd trimester and early 3rd trimester (between 20 and 32 weeks gestation). This is because: Pregnant women typically have a routine morphology scan by ultrasound at around 20 weeks gestation and present to a maternity care provider in relation to this scan. Providers may use the 20 week scan as a prompt to provide pertussis vaccine or schedule a vaccination visit. There are no safety concerns if a pregnant woman receives pertussis vaccine before 20 weeks gestation. If pregnant women are not vaccinated between 20 and 32 weeks, they should receive pertussis-containing vaccine as soon as possible and at any time up to delivery. If given within 2 weeks of delivery, the newborn may not be adequately protected.22 If pregnant women receive the vaccine earlier than 20 weeks, they do not need a repeat dose during the same pregnancy. Evidence shows transfer of pertussis antibodies to the infant in women who received dTpa vaccine as early as 13 weeks gestation.22 If a mother was not vaccinated during pregnancy and her last dose was more than 10 years ago, vaccination is recommended as soon as possible after birth and preferably before hospital discharge. If the mother was not vaccinated immediately after giving birth, there may still be some benefit in her being vaccinated at any time until the infant is 6 months of age. This is when the infant has received all infant doses of a pertussis-containing vaccine. Vaccinating the mother after delivery reduces the likelihood of pertussis in the mother and indirectly protects the infant. However, infant protection will be substantially less than if the mother had been vaccinated in the 3rd trimester of pregnancy.18 Breastfeeding women can receive dTpa vaccine. Healthcare workersAll healthcare workers are recommended to receive dTpa vaccine every 10 years because of the significant risk of transmitting pertussis to vulnerable patients.23-26 See Recommended vaccines for people at increased risk of certain occupationally acquired vaccine preventable diseases in Vaccination for people at occupational risk. Early childhood educators and carersAdults who provide early childhood education and care for infants and young children aged <4 years are recommended to receive dTpa vaccine every 10 years. See Recommended vaccines for people at increased risk of certain occupationally acquired vaccine-preventable diseases in Vaccination for people at occupational risk. TravellersTravellers are recommended to receive a booster dose of dT vaccine if their last dose was more than 10 years ago. If they have not had a pertussis dose in the past 10 years, it is recommended that they receive dTpa vaccine to also protect against pertussis. Travellers at high risk of acquiring tetanus or diphtheria are recommended to receive a booster dose of dT vaccine if their last dose was more than 5 years ago. See Tetanus and Diphtheria. It is recommended that they receive dTpa vaccine to also protect against pertussis. For adults who need extra protection against polio, use dTpa-IPV vaccine. See Poliomyelitis. See also Vaccination for international travellers. Adult travellers who have a higher risk of exposure to polio are recommended to receive dTpa-IPV. See Poliomyelitis. See also Vaccination for international travellers. Adult household contacts and carers of infantsAdult household contacts and carers of infants <6 months of age are recommended to receive dTpa vaccine at least 2 weeks before they have close contact with the infant if their last dose was more than 10 years ago.27,28 Pertussis infection in infants <6 months of age is associated with significant morbidity. The infection source in infants is often a household contact.29 See Epidemiology. People with a history of pertussis infectionIt is safe to give pertussis-containing vaccine to children, adolescents or adults who have had laboratory-confirmed pertussis infection. These people should receive all routinely scheduled pertussis-containing vaccines because natural immunity does not provide lifelong protection. This is particularly important for infants <6 months of age who develop pertussis because they may not mount an adequate immune response after infection. Vaccines, dosage and administrationPertussis vaccines available in AustraliaThe Therapeutic Goods Administration website provides product information for each vaccine. See also Vaccine information and Variations from product information for more details. Combination vaccinesSponsor: Sanofi-Aventis Australia Administration route: Intramuscular injection, Subcutaneous injection Registered as a booster in people aged ≥10 years. dTpa — diphtheria-tetanus-acellular pertussis combination vaccine (reduced antigen formulation) Each 0.5 mL monodose vial contains: Also contains traces of: For Product Information and Consumer Medicine Information about Adacel visit the Therapeutic Goods Administration website. Sponsor: Sanofi-Aventis Australia Administration route: Intramuscular injection Registered as a booster in people aged ≥4 years. dTpa-IPV — diphtheria-tetanus-acellular pertussis-inactivated poliovirus combination vaccine (reduced antigen formulation) Each 0.5 mL monodose vial or pre-filled syringe contains: Also contains traces of: For Product Information and Consumer Medicine Information about Adacel Polio visit the Therapeutic Goods Administration website. Sponsor: GlaxoSmithKline Australia Administration route: Intramuscular injection Registered as a booster in people aged ≥4 years. dTpa — diphtheria-tetanus-acellular pertussis combination vaccine (reduced antigen formulation) Each 0.5 mL monodose vial or pre-filled syringe contains: Adsorbed onto 0.5 mg aluminium as aluminium hydroxide and aluminium phosphate. Also contains traces of: For Product Information and Consumer Medicine Information about Boostrix vaccine visit the Therapeutic Goods Administration website. Sponsor: GlaxoSmithKline Australia Administration route: Intramuscular injection Registered as a booster in people aged ≥4 years. dTpa-IPV — diphtheria-tetanus-acellular pertussis-inactivated poliovirus combination vaccine (reduced antigen formulation) Each 0.5 mL monodose pre-filled syringe contains: Adsorbed onto 0.5 mg aluminium as aluminium hydroxide hydrate and aluminium phosphate. Also contains traces of: For Product Information and Consumer Medicine Information about Boostrix IPV vaccine visit the Therapeutic Goods Administration website. Sponsor: Sanofi-Aventis Australia Administration route: Intramuscular injection Registered for use in infants and children aged ≥6 weeks. DTPa-hepB-IPV-Hib — diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b combination vaccine Each 0.5 mL monodose pre-filled syringe contains: Adsorbed onto 0.6 mg aluminium as aluminium hydroxide. May contain traces of: For Product Information and Consumer Medicine Information about Hexaxim visit the Therapeutic Goods Administration website. Sponsor: GlaxoSmithKline Australia Administration route: Intramuscular injection Registered for primary immunisation in infants aged 2–12 months and as a booster in children aged 15 months to 6 years. DTPa — diphtheria-tetanus-acellular pertussis combination vaccine Each 0.5 mL monodose vial or pre-filled syringe contains: Adsorbed onto 0.5 mg aluminium as aluminium hydroxide. For Product Information and Consumer Medicine Information about Infanrix visit the Therapeutic Goods Administration website. Sponsor: GlaxoSmithKline Australia Administration route: Intramuscular injection Registered for use in infants and children aged ≥6 weeks. DTPa-hepB-IPV-Hib — diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b combination vaccine The vaccine consists of both a 0.5 mL monodose pre-filled syringe and a vial containing a lyophilised pellet. The pre-filled syringe contains: Adsorbed onto aluminium hydroxide/phosphate. Also contains traces of: The vial containing a lyophilised pellet contains: May contain yeast proteins. For Product Information and Consumer Medicine Information about Infanrix Hexa visit the Therapeutic Goods Administration website. Sponsor: GlaxoSmithKline Australia Administration route: Intramuscular injection Registered for primary immunisation in infants aged ≥6 weeks and as a booster in children aged ≤6 years. DTPa-IPV — diphtheria-tetanus-acellular pertussis-inactivated poliovirus combination vaccine Each 0.5 mL monodose pre-filled syringe contains: Adsorbed onto aluminium hydroxide hydrate. Also contains traces of: For Product Information and Consumer Medicine Information about Infanrix IPV visit the Therapeutic Goods Administration website. Sponsor: Sanofi Pasteur Pty Ltd Administration route: Intramuscular injection Registered for primary immunisation in infants aged 2–12 months and as a booster in children aged 15 months to 6 years. DTPa-IPV — diphtheria-tetanus-acellular pertussis-inactivated poliovirus combination vaccine Each 0.5 mL monodose vial contains: Also contains traces of: For Product Information and Consumer Medicine Information about Quadracel visit the Therapeutic Goods Administration website. Sponsor: Sanofi-Aventis Australia Administration route: Intramuscular injection Registered for primary immunisation in infants aged 2–12 months and as a booster in children aged 15 months to 8 years. DTPa — diphtheria-tetanus-acellular pertussis combination vaccine Each 0.5 mL monodose vial contains: For Product Information and Consumer Medicine Information about Tripacel visit the Therapeutic Goods Administration website. Dose and routeThe dose of all pertussis-containing vaccines is 0.5 mL given by intramuscular injection. Co-administration with other vaccinesDo not mix DTPa- or dTpa-containing vaccines with any other vaccine in the same syringe, unless specifically registered for use in this way. Pertussis-containing vaccines can be co-administered with most other vaccines. Pertussis-containing vaccines can be co-administered with influenza vaccine to pregnant women. If a person needs to receive Nimenrix and a vaccine containing tetanus toxoid, co-administration of these vaccines is preferred. Giving Nimenrix after a vaccine containing tetanus toxoid may interfere with the immune response against some meningococcal serogroups. There is uncertainty about whether this reduced immune response affects clinical protection, and there are no data on the optimal interval between the vaccines. Therefore, Nimenrix should be given as scheduled, even if it is being given shortly after a vaccine containing tetanus toxoid. Contraindications and precautionsContraindicationsThe only absolute contraindications to acellular pertussis–containing vaccines are:
PrecautionsPeople with latex allergyThe product information for Adacel states that the tip cap of the syringe contains latex. Consider using an alternative product in people with an allergy or sensitivity to latex. Adverse eventsPertussis-containing vaccines in childrenAcellular pertussis–containing vaccines are associated with a lower incidence of fever (approximately 20%) than whole-cell pertussis–containing vaccines (approximately 45%). Acellular pertussis–containing vaccines are also associated with a lower incidence of local adverse events (approximately 10%) than whole-cell pertussis–containing vaccines (approximately 40%).30-32 Whole-cell pertussis–containing vaccines are no longer available in Australia. Extensive limb swellingExtensive limb swelling occurs in <2% of children after booster doses of DTPa.33 It is defined as swelling and/or redness involving:
Extensive limb swelling is not always associated with pain. Such reactions usually start within 48 hours of vaccination, last for 1–7 days and resolve completely without sequelae.33 The pathogenesis of extensive limb swelling is poorly understood. One analysis reported entire thigh swelling in 2% of 1015 children who had their 4th and 5th doses using the same brand of DTPa vaccine. All these resolved completely without intervention.33 A history of extensive limb swelling after a booster dose of pertussis-containing vaccine is not a contraindication to further pertussis-containing vaccine doses during childhood or later in life.34 See Recommendations. Parents of children about to receive a booster dose of a pertussis-containing vaccine should be told about the small but well-defined risk of extensive limb swelling. They should be told that it is usually not associated with significant pain or limitation of movement, and needs no specific treatment. Febrile convulsionsFebrile convulsions are reported rarely after receiving an acellular pertussis–containing vaccine, within 48 hours of vaccination. The risk is even lower in infants who complete their primary course at 6 months of age. This is because febrile convulsions are uncommon in children <6 months of age. Hypotonic-hyporesponsive episodesA hypotonic-hyporesponsive episode (HHE) is an episode of pallor, limpness and unresponsiveness. It may also include shallow breathing and cyanosis. HHEs occur rarely after receiving a pertussis-containing vaccine, 1–48 hours after vaccination. An HHE may last from a few minutes to 36 hours. In Australia during 2012, 2.2 cases of HHE were reported per 100,000 doses of pertussis-containing vaccine given to children <1 year of age.35 Follow-up of children with HHE shows no long-term neurologic or other sequelae.36 Children who have an HHE after receiving a pertussis-containing vaccine should receive further doses of routinely scheduled pertussis-containing vaccines. They may need medical supervision at the time of vaccination. Contact your state or territory health department for more details about services for adverse events following immunisation. Other reported adverse eventsPertussis-containing vaccines, including acellular pertussis–containing vaccines, do not cause infantile spasms, epilepsy or encephalopathy.37 Infants and children who have active or progressive neurologic disease, or a family history of a neurologic disorder, can be safely vaccinated with pertussis-containing vaccines. For infants and children with the following conditions, the risk of adverse events after receiving a pertussis-containing vaccine is the same as for other infants of the same age:
Sudden infant death syndrome (SIDS) is not associated with pertussis-containing vaccines.38 Some studies suggest a decreased risk of SIDS in children who have been vaccinated.39-41 Pertussis-containing vaccines in adolescents and adultsPertussis-containing vaccines are safe and well tolerated in adults when given as a booster dose.42-45 The incidence of fever is low, and comparable in vaccine and placebo recipients in clinical trials.42-44 Revaccination of adolescents and adults within 10 years after a tetanus-containing vaccine (dT or dTpa) is associated with:27,28
Adverse reactions to a single dose of dTpa vaccine are similar whether a person receives the vaccine shortly after, or at a longer interval after, a previous dT vaccine.10-13,46 Limb swelling reactions after pertussis-containing booster doses were reported in 1% of adolescent and adult clinical trial participants.27,28 Some adults have a history of adverse event(s) after receiving a whole-cell pertussis–containing vaccine in childhood. These adults can almost always receive acellular pertussis–containing vaccines, which do not have the same risk of adverse events. See Vaccination for people who have had an adverse event following immunisation. Brachial neuritis may occur after receiving pertussis-containing vaccines as a result of the presence of tetanus toxoid. This is inflammation of a nerve in the arm, causing weakness or numbness. The excess risk is approximately 0.5–1 in 100,000 doses in adults.47,48 dTpa vaccines in pregnant womenVaccination with dTpa during pregnancy does not increase the risk of adverse pregnancy outcomes. Studies have excluded any association with stillbirth, pre-eclampsia, fetal distress, low birth weight or neonatal renal failure.49-55 There may be a small risk of significant injection site reactions after repeat vaccine doses in some women who have dTpa vaccines during successive, closely spaced pregnancies. However, a retrospective study of more than 29,000 women who received dTpa vaccine during pregnancy looked at acute adverse events, including fever, allergy and injection site reactions. The risk of these events was similar in women who had received a tetanus-containing vaccine in the previous 5 years and women who had received a dose more than 5 years previously.55 Nature of the diseasePertussis (whooping cough) is caused by Bordetella pertussis, a fastidious gram-negative pleomorphic bacterium. Other bacteria can also cause a pertussis-like syndrome. 56 These include B. parapertussis, Mycoplasma pneumoniae and Chlamydophila pneumoniae. Pathogenesis and transmissionPertussis is a respiratory infection that spreads by aerosols. It has an incubation period of 7–20 days. It is highly infectious in unvaccinated people, and can infect 90% of susceptible household contacts.57 Natural infection does not provide long-term protection. Repeat infection can occur.57 DiagnosisPertussis infection can be confirmed by either:
The appropriate diagnostic test depends on age, vaccination history and duration of symptoms. Nucleic acid testing is usually the diagnostic method of choice. Serology can be used to help confirm the diagnosis, but ideally should not be used as the only diagnostic test in someone who has had a pertussis-containing vaccine in the past 5 years.58 Clinical featuresSymptoms of pertussisUnvaccinated children can have a characteristic paroxysmal cough with a ‘whoop’ when breathing in. This is less common in people who have immunity as a result of vaccination or infection. 59 In very young infants, the cough may be minimal or absent, and the only symptoms may be apnoea or cyanosis. Each year, more than 25% of adults have a cough that lasts at least 5 days. Bordetella pertussis may cause up to 7% of these illnesses.60 Patients and physicians may not be aware of the disease, and diagnostic tests sometimes have limited sensitivity. Because of this, pertussis is likely to be underdiagnosed (see Public health management). Complications of pertussisComplications in infants include pneumonia, seizures and hypoxic encephalopathy. These complications can lead to death.59 The case-fatality rate in unvaccinated infants <6 months of age is 0.8%.61,62 Pertussis can also cause significant morbidity in children and adults. The cough can persist for up to 3 months. Other significant symptoms can include:63
Death from pertussis is rare in people aged 10–70 years. EpidemiologyDespite a longstanding pertussis immunisation program, and a substantial decline in morbidity and mortality from the disease, pertussis remains highly prevalent in Australia. Epidemics occur every 3–4 years. Outbreaks can be very large in unvaccinated populations. Outbreaks are smaller in vaccinated populations, and have much lower morbidity and mortality. Outbreaks in vaccinated populations may also occur every 3–4 years, or may be more widely spaced.64 Several epidemics of pertussis occurred in Australia between 1995 and 2017. The timing and frequency of these varied by geographical location. The highest annual incidence of notifications (173 cases per 100,000 population) was in 2011. 65,66 Risk of pertussis by ageInfants who are too young to be fully immunised have the highest risk of infection and severe illness.67 A high proportion of hospitalisations, and almost all deaths, from pertussis occur in this group.15,68 In highly immunised communities, pertussis can occur in adults and adolescents as a result of waning immunity.64,69 These people are a significant reservoir of infection. Household contacts and carers are often the source of infection in infants. Parents are the source in more than 50% of cases.29 Siblings are also a significant source of infant infections.4,5 Young infants can also acquire the disease from healthcare workers.23-26 In contrast to previous epidemics, during the 2008–11 epidemic period in Australia, notification rates were highest in children <15 years of age. The proportion of notifications in older adolescents and adults was lower during this epidemic than in other epidemics. Pertussis notifications were notably higher for children between 3 and 9 years of age.65,66 More accessible and sensitive diagnosis with nucleic acid testing contributed to the rise in notified cases.70 Waning of immunity induced by pertussis-containing vaccine was also a factor (see Vaccine information).3,7,8,71 Although notification rates were higher in this epidemic, hospitalisation and death rates from pertussis were not substantially higher.72 People aged ≥65 years have higher rates of hospitalisation from pertussis than younger adults.65 Vaccine informationPertussis vaccine is only available in Australia in combination with diphtheria and tetanus. Vaccines may also include inactivated poliovirus, hepatitis B and Haemophilus influenzae type b. The acronym DTPa, using capital letters, signifies a child formulation of diphtheria, tetanus and acellular pertussis–containing vaccine. The acronym dTpa signifies a formulation that contains substantially less diphtheria toxoid and pertussis antigens than the child formulation. Adolescents and adults are recommended to receive dTpa vaccine. Pertussis vaccines used in AustraliaAcellular pertussis–containing vaccines registered in Australia contain 2 or more purified components of Bordetella pertussis:
Vaccine effectiveness in childrenPertussis-containing vaccines protect against severe and typical pertussis. They provide substantially less protection against milder coughing illness.30,31DTPa vaccines with 3 or more antigens have vaccine efficacy of:31
The 1st dose of the childhood schedule significantly reduces the incidence of severe pertussis disease in young infants.1,73-75 Protection increases further with the doses given at 4 and 6 months of age, as measured by hospitalisation rates and mortality. Duration of immunity in childrenImmunity after receiving a pertussis-containing vaccine wanes over time. In Australian children aged 1–3 years who had not had an 18-month booster dose, the effectiveness of 3 doses of pertussis-containing vaccine declined progressively from 2 years of age, to less than 50% by 4 years of age.3 Studies in older children suggest that vaccine effectiveness decreases with time since the dose of pertussis-containing vaccine given before starting school.7,8,71 Vaccine effectiveness in adolescents and adultsPertussis-containing vaccines with reduced antigen content (dTpa) are immunogenic, including in older people.42,76-78 A randomised trial in adults reported a point estimate of 92% efficacy against culture-positive or nucleic acid test–positive disease within 2.5 years of vaccination with a 3-component monovalent pertussis vaccine.60 Duration of immunity in adolescents and adultsData on the duration of immunity to pertussis after a single booster dose of dTpa are limited. Long-term follow-up of adults showed a rapid decline in pertussis antibody levels within 2 years after vaccination. This decline continued steadily to 10 years after vaccination, although antibody levels remained above baseline.27 Long-term follow-up of adolescents showed a more rapid decline. Pertussis antibody levels decreased to, or approached, pre-vaccination levels after 10 years.28 The rate of decline in clinical protection is unknown, but some protection against clinical disease may persist for up to 10 years. Vaccine effectiveness in pregnant womenVaccinating pregnant women with dTpa can reduce the risk of pertussis in them and their young infants. This is a result of direct passive protection by transplacental transfer of high levels of pertussis antibodies from the mother to the fetus during pregnancy. In a landmark study, vaccination of mothers at least 7 days before delivery reduced pertussis disease by 91% in infants <3 months of age.17 However, it is not known:
Duration of immunity in pregnant womenSome studies suggest that pertussis antibody levels in the mother decline progressively in the year after delivery. 79,80 In another study, pertussis antibody levels were detectable in both mothers and their infants at the time of delivery, even though the mothers were vaccinated around 13 months earlier (pre-pregnancy).81 In some studies, children born to women who were vaccinated with dTpa during pregnancy had lower levels of pertussis antibodies a month after completing infant vaccination than children of mothers who were not vaccinated.49,82,83 But antibodies reached the same level after another dose at 12–18 months of age, regardless of whether the child’s mother was vaccinated during pregnancy.49,82 Pertussis vaccine for household contacts of infantsCocoon vaccination means vaccinating household contacts and carers, who are an important source of pertussis infection. This is an alternative vaccination strategy that may reduce the infection risk to infants, especially young infants. 29 However, the emerging data on the effectiveness of indirect protection to infants from the cocoon approach suggest only a modest benefit. 18,84 Transporting, storing and handling vaccinesTransport according to National Vaccine Storage Guidelines: Strive for 5.85 Store at +2°C to +8°C. Do not freeze. Protect from light. Infanrix hexa vaccine must be reconstituted. Add the entire contents of the syringe to the vial and shake until the pellet completely dissolves. Use the reconstituted vaccine as soon as practicable. If it must be stored, hold at room temperature for no more than 8 hours. Public health managementPertussis (both suspected and confirmed) is a notifiable disease in all states and territories in Australia. The Communicable Diseases Network Australia national guidelines for pertussis86 have details about the management of pertussis cases and contacts. State and territory public health authorities can also provide advice. Suspected cases of pertussis should be investigated, regardless of vaccination status. This is because immunisation is not 100% effective and immunity wanes over time. Managing suspected pertussisPeople with suspected pertussis infection should receive appropriate antibiotic therapy if coryza started less than 21 days ago. Antibiotic treatment does not shorten the course of the illness, but antibiotics reduce infectivity if given early, and reduce the risk of transmitting Bordetella pertussis. Details about appropriate macrolide antibiotics and dosing are in the national guidelines for pertussis 86 and Therapeutic Guidelines: Antibiotic.87 Managing contacts of casesVaccinationVaccination in response to an outbreak does not help control the outbreak, even in closed settings. However, unvaccinated or partially vaccinated contacts should receive:
See also Catch-up vaccination. Passive immunisation with normal human immunoglobulin does not prevent pertussis. ChemoprophylaxisOnly high-risk close contacts of cases should receive chemoprophylaxis. The benefit of chemoprophylaxis in preventing transmission is limited by: 88
Recommendations about chemoprophylaxis for close contacts are in the national guidelines for pertussis.86 Variations from product informationRoutine vaccination in children and adultsInfanrixThe product information for Infanrix states that this vaccine is for:
The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that Infanrix may also be used for catch-up of the primary schedule or as a booster in children <10 years of age. ATAGI also recommends that the primary schedule can start at 6 weeks of age. Infanrix hexaThe product information for Infanrix hexa states that this vaccine is for:
ATAGI recommends that Infanrix hexa may also be used for catch-up of the primary schedule or as a booster in children <10 years of age. Infanrix IPVThe product information for Infanrix IPV states that this vaccine is for:
ATAGI recommends that Infanrix IPV may also be used for catch-up of the primary schedule or as a booster in children <10 years of age. QuadracelThe product information for Quadracel states that this vaccine is for:
ATAGI recommends that Quadracel may also be used for catch-up of the primary schedule or as a booster in children aged <10 years. ATAGI also recommends that the primary schedule can start at 6 weeks of age. TripacelThe product information for Tripacel states that this vaccine is for:
ATAGI recommends that Tripacel may also be used for catch-up of the primary schedule or as a booster in children aged <10 years. ATAGI also recommends that the primary schedule can start at 6 weeks of age. Adacel and BoostrixThe product information for Adacel (reduced antigen content dTpa) states that this vaccine is for use in people aged ≥10 years for booster doses. Adacel can be used for repeat vaccination, after a previous dose of dTPa or dTPa-IPV to boost immunity to diphtheria, tetanus and pertussis at 5 to 10 year intervals. The product information for Boostrix (reduced antigen content dTpa) states that this vaccine is for use in people aged ≥4 years for booster doses only. ATAGI recommends that, when an adolescent or adult receives a 3-dose primary course of diphtheria/tetanus toxoids:
If dT is not available, dTpa can be used for all 3 primary doses. The product information for Adacel and Boostrix states that there is no recommendation about the frequency of vaccination against pertussis in adults. ATAGI recommends that adults in contact with infants and/or at increased risk from pertussis should have received a vaccine within the past 10 years. Adacel Polio, Boostrix and Boostrix-IPVThe product information for Adacel Polio, Boostrix and Boostrix-IPV states that vaccine is for use in people aged ≥4 years for booster doses only. ATAGI recommends that Adacel Polio, Boostrix and Boostrix-IPV should not be used in people aged <10 years, except in certain circumstances. Vaccination during pregnancyThe product information for Boostrix states that the vaccine may be considered during the 3rd trimester of pregnancy when the possible advantages outweigh the possible risks for the fetus. The product information for Boostrix states that there is no recommendation about vaccination against pertussis in subsequent pregnancies. ATAGI recommends that pregnant women receive a dose of pertussis-containing vaccine with each pregnancy, preferably between 20 and 32 weeks gestation. Vaccination after tetanus-containing vaccinesThe product information for Adacel, Boostrix and Boostrix-IPV states that people should not receive dTpa-containing vaccine within 5 years of a tetanus-containing vaccine. ATAGI recommends that, if the person needs protection against pertussis, they can receive a dTpa-containing vaccine at least 4 weeks after a dT-containing vaccine. ContraindicationsThe product information for all pertussis-containing vaccines states that these vaccines are contraindicated in children with either:
ATAGI recommends that the only contraindications are:
References
Related vaccines Adacel Adacel Polio Boostrix Boostrix-IPV Hexaxim Infanrix Infanrix hexa Infanrix IPV Quadracel Tripacel Page historyLast updated 7 December 2022 Last reviewed 7 December 2022 7 December 2022 Updates made to Co-administration with other vaccines to remove information about co-administration of MenACWY vaccines. 8 March 2022 27 September 2021 Clarification of advice regarding the minimum interval between a dTpa-containing vaccine after a dT-containing vaccine. See vaccination after tetanus containing vaccines. 20 September 2019 Editorial changes to guidance about co-administration with other vaccines and timing of vaccination for women during pregnancy.
29 March 2019 Updates to the recommendation for pertussis vaccination during pregnancy. The recommendation for pertussis vaccination during pregnancy has been updated. The optimal timing for vaccination has been updated to 20 (previously 28) to 32 weeks gestation (mid 2nd trimester to early 3rd trimester). Please refer recommendations for Women who are pregnant or breastfeeding. 1 August 2017 Changes to 4.12.4 Vaccines and 4.12.12 Variations from product information. 4.12.4 Vaccines and 4.12.12 Variations from product information Amendment of text due to the discontinuation of a vaccine type, Pediacel. (Refer also Chapters, 4.2 Diphtheria, 4.3 Haemophilus influenzae type b, 4.14 Polio and 4.19 Tetanus). What is another name for the whooping cough vaccine?Two vaccines in the United States help prevent whooping cough: DTaP and Tdap. These vaccines also provide protection against tetanus and diphtheria.
How often should you get a whooping cough vaccine?All adults who have never received one should get a Tdap shot. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td or Tdap shot every 10 years.
What is whooping cough vaccine called Australia?It is recommended that they receive dTpa vaccine to also protect against pertussis. For adults who need extra protection against polio, use dTpa-IPV vaccine.
Is DTaP and Tdap the same?What is the difference between Tdap and DTaP? The Tdap and DTaP vaccines help protect against the same diseases but are used for different age groups. Tdap is recommended for older children and adults, and DTaP is recommended for infants and young children.
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