What Protection Is Available
It is not possible to develop natural immunity to pertussis without getting the disease itself. The only way to protect your child is vaccination. Babies in the UK are protected by the 5-in-1 vaccine or the 6-in-1 vaccine . A follow-up dose is given in the Pre-school Booster vaccine.
Pregnant women should receive a dose of pertussis vaccine during their pregnancy to give protection to their newborn baby before his/her vaccines are due.
Adult Immunisation Against Whooping Cough
The whooping cough vaccine for adults also contains diphtheria and tetanus protection in a combination vaccine.
Adults who should be vaccinated with whooping cough vaccine if they have not had a dose in the last 10 years include:
- childcare workers
- pregnant women from 20 weeks gestation, in every pregnancy
- any adult who wants to reduce their likelihood of becoming ill with whooping cough
- family members, grandparents and people in contact with infants less than six months of age, including other household members
- all adults aged 65 years and older
- adults needing a tetanus boost at any time, and at 50 years of age when tetanus boosting is recommended
- people with a history of whooping cough infection people who have had whooping cough are still recommended to receive whooping cough vaccine as scheduled.
A booster dose of whooping cough vaccine is recommended for people who have not had one in the previous ten years. The vaccine takes about two weeks for immunity to develop after vaccination.
The following people should have a booster dose of whooping cough vaccine every ten years:
- all adults working with infants and young children less than four years of age
- all healthcare workers.
Possible Side Effects Of The Dtap Vaccine
Both Drs. Ascher and Raimo tell their patients to expect soreness and redness at the injection site, though those won’t occur in everyone. Other side effects are quite uncommon.
“Fatigue and a low-grade fever are possible but very rare,” says Dr. Ascher.
Also rare: allergic reactions to the vaccine. But you’ll want to tell your doctor if your child has had a reaction to a previous vaccine, says Dr. Ascher.
Your child will be monitored for up to 30 minutes after the shot to be sure that no serious side effects occur.
“It’s important to remember that any time there’s a side effect or your body feels a little bit different after getting the vaccine, that’s just your body’s way of showing that the vaccine is starting to work,” says Dr. Ascher. “Your body is picking up this immune response to protect you.”
Each of the vaccine components has different potential side effects:
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What Is Whooping Cough Vaccination
Australian children receive whooping cough vaccines as part of the standard childhood immunisation schedule.
In Australia, the vaccine for adults is only available in combination with diphtheria, tetanus and whooping cough, with or without another antigen, the inactivated poliomyelitis vaccine .
Whooping cough vaccines are recommended for any adult who wishes to reduce their likelihood of becoming infected and in particular for those in close contact with infants . Vaccination is also recommended for women between 20 and 32 weeks in each pregnancy as it confers protection to the newborn in these cases it is funded under the National Immunisation Program .
Risk Of Pertussis By Age
Infants 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 200811 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 .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
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How Does Vaccination Of Pregnant Women Help To Protect Their Babies
Vaccination during during weeks 16 to 32 of pregnancy helps the mother make antibodies to fight pertussis. It takes about two weeks for antibody levels to peak. These antibodies are then transferred through the placenta to the baby, who then has the mothers own protection against the disease in their blood right from birth. Very small quantities of pertussis antibodies may also be transferred to the baby through breast milk. In addition, the mother is protected against catching pertussis and passing it to her newborn baby. Pregnant women can be vaccinated any time up until they go into labour, but vaccination before week 32 is advised because it takes about two weeks for antibodies to pass across to the unborn baby. Overall, vaccinating women during pregnancy is the best way to protect newborn babies who are too young to be vaccinated themselves.
The protection offered by the mothers antibodies lasts only a few months. It is therefore important for babies to get their routine immunisations at 2, 3 and 4 months so that they continue to be protected .
It is recommended that women have the pertussis vaccine in each pregnancy, even if they have been vaccinated in a previous pregnancy.
When Do I Need To Get This Vaccine And How Often
“We vaccinate our children against whooping cough, of course, and that has been successful. But we’ve learned that once people become young adults, the immunity wanes a little, so now outbreaks are happening in various places around the country. There is a relatively new vaccine that adds whooping cough to the familiar diphtheria and tetanus shot. Next time you get this shot, it will likely be Tdap, which stands for tetanus, diphtheria, and pertussis. That will protect patients and help prevent them from transmitting the disease to others.”
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Treatment For Whooping Cough
In its early stages, the symptoms of whooping cough can be reduced by taking antibiotics. If treatment is given in the first 21 days of the illness, the risk of passing the infection to others might be reduced.
Members of the infected person’s household are at increased risk of getting the disease and are usually prescribed a strong antibiotic as a preventative measure, even if they are fully immunised.
Whooping Cough Vaccination For Pregnant Women
In recent years, cases of whooping cough have risen sharply across the UK. You can help protect your unborn baby from getting whooping cough in the weeks after birth by having the whooping cough vaccination while you are pregnant.
Guidance for pregnant women and information on what is happening in their regional unit during the coronavirus outbreak can be found on NI Maternity
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Controversy In The 1970s
During the 1970s and 1980s, a controversy erupted related to the question of whether the whole-cell pertussis component caused permanent brain injury in rare cases, called pertussis vaccine encephalopathy. Despite this allegation, doctors recommended the vaccine due to the overwhelming public health benefit, because the claimed rate was very low , and the risk of death from the disease was high . No studies showed a causal connection, and later studies showed no connection of any type between the DPT vaccine and permanent brain injury. The alleged vaccine-induced brain damage proved to be an unrelated condition, infantile epilepsy. In 1990, the Journal of the American Medical Association called the connection a “myth” and “nonsense”.
However, negative publicity and fear-mongering caused the immunization rate to fall in several countries, including the UK, Sweden, and Japan. A dramatic increase in the incidence of pertussis followed.
Concerns about side effects led Sato to introduce an even safer acellular vaccine for Japan in 1981, that was approved in the U.S. in 1992, for use in the combination DTaP vaccine. The acellular vaccine has a rate of adverse events similar to that of a Td vaccine .
Coronavirus Vaccine And Dtap/ipv Vaccines
Over 50,000 women now report having been vaccinated whilst pregnant in England. Because of wider experience with the Pfizer BioNTech and Moderna vaccines, these 2 vaccines are the preferred vaccines to offer to pregnant women aged 18 years and over. Pfizer vaccine is recommended for use in those under the age of 18 years. Clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the limited evidence of safety for the vaccine in pregnancy. Further information on the COVID-19 vaccination programme can be found in chapter 14a of the Green Book the COVID-19 vaccination: information for healthcare practitioners.
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Who Should Get Immunised Against Whooping Cough
Anyone who wants to protect themselves against whooping cough can talk to their doctor about getting immunised.
Whooping cough immunisation is recommended for:
- children aged 2 months, 4 months, 6 months, 18 months, four years, and between 10 and 15 years , at no cost under the National Immunisation Program .
- pregnant women in the third trimester, ideally between weeks 20 and 32 of every pregnancy, at no cost through the NIP
- healthcare workers, if they have not had a whooping cough vaccine in the past 10 years
- people working in early childhood education and care, if they havent had a whooping cough vaccine in the past 10 years
- adult household contacts and carers of babies under 6 months old
- people who are travelling overseas, if they havent had a whooping cough vaccine in the past 10 years
- adults of any age who need a tetanus, diphtheria or polio dose
- people aged 50 years, at the same time as they get their recommended tetanus and diphtheria vaccine
- people aged 65 or over, if they have not had a whooping cough vaccine in the past 10 years.
People under 20 years old, refugees and other humanitarian entrants of any age, can get whooping cough vaccines at no cost through the NIP. This is if they did not receive the vaccines in childhood. This is called catch-up vaccination.
More Information About The Disease
Before a vaccine was introduced in the 1950s, the average number of suspected cases in England and Wales was over 100,000 each year, and in some years over 2000 people died from pertussis. By 1972, when over 80% of children were vaccinated, this had fallen to 2069 suspected cases and 2 deaths.
In 1975 unfounded concerns about the safety of the vaccine resulted in a fall in vaccination rates only 3 out of every 10 children were vaccinated against pertussis in 1975. This resulted in major epidemics in 1977-79 and 1981-83.
Since 1992, the UK vaccination rate has remained at around 94%. On average, between 2002 and 2011, 800 cases of pertussis were reported every year in England and Wales, 300 babies a year were hospitalised, and 4 babies died. Numbers are higher in epidemic years like 2012.
Some of the most serious cases of pertussis are in very young infants, before the age for immunisation, who may be infected by unvaccinated older siblings or their parents. It is possible to catch pertussis more than once, and the protection given by vaccination fades over time. This means that older people who have had pertussis or been vaccinated can still catch the disease and pass it on to more vulnerable people in the community.
There have been several outbreaks of whooping cough in the UK in recent years and work is ongoing to develop vaccines that will give even better protection.
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What’s In The Dtap Vaccine
To make the vaccine, scientists inactivate the toxins produced by the different disease-triggering bacteria. That process converts each toxin into what’s called a toxoid.
When the toxoid enters your bloodstream, it triggers an immune reaction and sends antibodies to fight the infection if you ever encounter it. But don’t worry: the toxoid is harmless, so it does not cause the diseases itself.
You get the benefit of training your immune system to fight these infections should you or your child be exposed to them, but no one gets sick. It’s a win-win.
Vaccines used to contain thimerosal, a mercury-based preservative. Although it was safely used for decades, manufacturers removed thimerosal from pretty much all childhood vaccines in 2001 in an abundance of caution.
Vaccines for people of any age are now available in thimerosal-free versions. If a vaccine does contain the preservative, it makes up a vanishingly small amount of the vaccine.
“There’s more mercury involved in getting a filling at the dentist,” says Dr. Ascher. “It’s so minimal in regards to long-term exposure, and we know these vaccines are safe from many long years of using them.”
Pertussis Vaccination Programme For Pregnant Women: Information For Healthcare Practitioners
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This publication is available at https://www.gov.uk/government/publications/vaccination-against-pertussis-whooping-cough-for-pregnant-women/pertussis-whooping-cough-vaccination-programme-for-pregnant-women
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Should Babies Who Cry Uncontrollably After Dtap Vaccine Receive Additional Doses
Babies who experience uncontrollable crying after the DTaP vaccine are considered to have a precaution to getting future doses of the vaccine, meaning that they can still receive future doses of the DTaP vaccine however, the relative risks and benefits should be discussed with the childs doctor before the vaccination is given.
Because pertussis, in particular, circulates in many parts of the country each year and young infants are most susceptible to complications from the disease, the relative benefits of the vaccine may still outweigh the risks. Previous experience has shown that in most cases, infants who experience inconsolable crying after the first dose of DTaP do not experience the same reaction after subsequent doses.
Vaccine Development In The 1980s Hepatitis B And Haemophilus Influenzae Type B
The vaccine for Haemophilus influenzae type b was licensed in 1985 and placed on the recommended schedule in 1989. When the schedule was published again in 1994, the hepatitis B vaccine had been added.
The hepatitis B vaccine was not new, as it had been licensed in 1981 and recommended for high-risk groups such as infants whose mothers were hepatitis B surface antigen positive, healthcare workers, intravenous drug users, homosexual men and people with multiple sexual partners. However, immunization of these groups didn’t effectively stop transmission of hepatitis B virus. Thats because about one-third of patients with acute disease were not in identifiable risk groups. The change of recommendation to immunize all infants in 1991 was the result of these failed attempts to control hepatitis B by only immunizing high-risk groups. Following this recommendation, hepatitis B disease was virtually eliminated in children less than 18 years of age in the United States.
1985 – 1994 | Recommended Vaccines
* Given in combination as DTP** Given in combination as MMR
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What Are The Risks Of Dtap And Tdap
The risks of DTaP, Tdap, and other common vaccines are low. The most common side effect is redness or soreness on the part of the body where you got the shot. You may feel out of sorts or have a low-grade fever.
Allergic reactions to vaccines can be serious, but they are rare. The risk to your health from getting tetanus, diphtheria, or pertussis is higher than the risk of a reaction to the vaccines.
Safety And Adverse Events
Refer to Adverse events following immunization in Part 2 for additional general information. Refer to Diphtheria Toxoid, Tetanus Toxoid, Poliomyelitis Vaccine, Haemophilus influenzae type b Vaccine and Hepatitis B Vaccine in Part 4 for additional information regarding other components in pertussis-containing combination vaccines.
Common adverse events
- Local reactions at and near the site of injection: 10-40%
- Extensive limb swelling: 2-6% of children more commonly associated with the 4th or 5th dose but resolve spontaneously
- Fever, irritability and/or fussiness: 8 29%
- Drowsiness: 40-52%
Uncommon and rare adverse events
- Anaphylaxis following vaccination with pertussis-containing vaccine may occur, but is very rare
- Severe arthus-type injection site reactions
- Hypotonic hyporesponsive episodes : The case definition of HHE includes sudden onset of hypotonia , hyporesponsiveness , and pallor or cyanosis. However, there is evidence that there are no adverse consequences to these events and the adverse consequences of being incompletely immunized have been well documented.
- High fever with or without seizure: High fever and convulsions, both febrile and afebrile, are rarely reported and are not contraindications to further immunization with acellular pertussis-containing vaccine.
Other safety issues
Epidemiological studies do not support allegations of a causal relationship between pertussis-containing vaccines and either permanent neurological injury or Type 1 diabetes.
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Dtap/ipv Administered Before 16 Weeks Of Pregnancy
If the dose was given before 16 weeks of pregnancy, it should be repeated once the woman reaches 16 weeks of pregnancy or around the time of her fetal anomaly scan. A minimum interval of 4 weeks between doses should be observed to reduce the risk of a local reaction. Repeating the dose will ensure that the unborn baby benefits from optimal transfer of maternal antibodies.