Pertussis Vaccine Overview

Pertussis , also called whooping cough, is a highly contagious bacterial infection of the lining and airways of the respiratory tract. It is caused by the bacterium Bordetella pertussis.

Pertussis is spread by:

• Inhaling wet droplets from the sneeze or cough of a person infected with pertussis
• Having direct contact with the person’s respiratory secretions

This infection is most common in infants and children. People at most risk are those who:

• Have not been immunized
• Live or work with someone who has pertussis
• Live in close quarters (eg, dormitory, nursing home)
• Live in crowded or unsanitary conditions
• Are pregnant

Symptoms include:

• Runny nose and congestion
• Sneezing
• Watery, red eyes
• Dry cough
• Severe coughing spells that may end with a noisy inhale, or "whoop" (may not be heard in young infants)
• Vomiting

Symptoms usually begin within 3-12 days after exposure. Cold-like symptoms can last for up to two weeks. A dry, hacking cough usually follows, which progresses to severe coughing spells. The illness usually lasts six weeks, but can range from three weeks to three months. In severe cases, the following can occur:

• Seizures
• Periods of apnea
• Pneumonia
• Collapsed lungs
• Abdominal and inguinal hernias
• Encephalitis
• Death

Treatment includes antibiotics. To help reduce vomiting and dehydration , patients may be advised to eat small, frequent meals and drink plenty of water. Infants may need to be hospitalized.

The pertussis vaccine contains small, purified pieces of the pertussis germ. It is not available as a single vaccine, but is given in combination with diphtheria and tetanus vaccines.

The vaccine is given as an injection, usually into the arm or thigh.

All children (with few exceptions) should receive this vaccine. DTaP (for children) and Tdap (for adolescents and adults) protect against diphtheria, tetanus, and pertussis. The regular immunization schedule (for children and adults) is as follows:

• DTaP vaccines at 2, 4, and 6 months, 15-18 months, and 4-6 years of age
• Booster dose of Tdap given at 11 or 12 years old—Those aged 13-18 years who missed the above booster dose can receive one dose of Tdap five years after the last dose.
• Booster of Tdap (one time dose for ages 19-64 years)

For children aged 4 months to 6 years who have not yet received the vaccination, the Centers for Disease Control and Prevention (CDC) recommends the following catch-up schedule:

Doses

Minimum Interval Between Doses

First and second dose

4 weeks

Second and third dose

4 weeks

Third and fourth dose

6 months

Fourth and fifth dose

6 months

• Fifth dose is not necessary if the fourth dose was administered at age 4 years or older
• DTaP is not indicated for people aged 7 years or older

Children seven years and older and adults who have not been vaccinated should also be vaccinated. The choice and timing of the vaccine depends on how old you are and if you have received a dose before.

People who meet the following criteria should also get the vaccine:

• Adults who expect to have close contact with an infant younger than 12 months should get a dose of Tdap (with a waiting time of two years since the last dose of Td).
• Healthcare workers who have direct patient contact with hospitals or clinics should get a dose of Tdap (with a waiting time of two years since the last dose of Td).
• Pregnant women:

• If the last dose of Td was 10 years ago or longer, they should get a dose of Td.
• If the last dose of Td was less than 10 years ago, they should get a dose of Tdap after giving birth.

Most people tolerate the vaccines without any trouble. The most common side effects are:

• Pain, redness, or swelling at the injection site
• Mild fever
• Headache
• Tiredness
• Nausea
• Vomiting
• Diarrhea
• Stomach ache

Uncommon symptoms include:

• Fever over 102ºF
• Severe gastrointestinal problems
• Severe headache
• Nervous system problems or a severe allergic reaction, such as anaphylaxis (extremely rare)

Acetaminophen (eg, Tylenol) is sometimes given to reduce pain and fever that may occur after getting a vaccine. In infants, the medicine may weaken the vaccine's effectiveness. Discuss the risks and benefits of taking acetaminophen with your doctor.

Most people should receive their vaccinations on schedule. However, individuals in whom the risks of vaccination outweigh the benefits include people who:

• Have had a life-threatening allergic reaction to DTP, DTap, DT, Tdap, or Td vaccine
• Have had a severe allergy to any component of the vaccine to be given
• Have gone into a coma or long seizure within seven days after a dose of DTP or DTaP

Talk with your doctor before getting the vaccine if you have:

• Allergy to latex
• Epilepsy or other nervous system problem
• Severe swelling or severe pain after a previous dose of any component of the vaccination to be given
• Guillain-Barre syndrome
• Moderate or severe illness (Wait until you recover to get the vaccine.)

Isolating those with any contagious disease has long been the main approach to prevent its spread. It is essential, for example, to keep people with pertussis at home until the illness has run its course.

If you have come in close contact with someone who is infected, you may need to take antibiotics.

In the event of an outbreak, all people who may have been exposed should be brought up to date with the vaccination. It is important to protect infants by isolating those who have the infection. Diagnosing the disease as quickly as possible can help control future outbreaks.

WHERE CAN I GET MORE INFORMATION?

National Immunization Program
Centers for Disease Control and Prevention
http://www.cdc.gov/vaccines/

National Network of Immunization Information
http://www.immunizationinfo.org/index.cfm

References:

Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009. Ann Intern Med. 2009;150:40-44.

Free CDC immunization resources. American Medical Association website. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/36/flukitresources.pdf . Accessed February 2, 2007.

Pertussis (whooping cough) vaccination. Centers for Disease Control and Prevention, National Immunization Program website. Available at: http://www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm . Accessed February 2, 2007.

Immunization issues. National Network of Immunization Information website. Available at: http://www.immunizationinfo.org/immunizationissuesdetail.cfv?id=96 . Accessed February 2, 2007.

1/31/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm . Updated January 10, 2008. Accessed January 28, 2008.

10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Prymula R, Siegrist C, Chlibek R, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. Lancet. 2009;374(9698):1339.