Whooping Cough Vaccines

Pertussis and Whooping Cough

Children with pertussis or whooping cough can have severe coughing spells.
Children with pertussis or whooping cough can have severe coughing spells, and more seriously, up to 1% of infected infants actually die from pertussis.. Photo courtesy of the CDC

The American Academy of Pediatrics endorsed the use of a whooping-cough vaccine way back in 1943.

In 1948, the whooping-cough vaccine (pertussis), was combined with vaccines for diphtheria and tetanus to make the DTP vaccine. This whole cell pertussis vaccine was used until it was replaced by the acellular pertussis vaccine (DTaP) in 1997.

The Tdap vaccine, which could be given to older kids, was approved in 2006.

It has reduced amounts of pertussis antigens as compared to the pediatric DTaP vaccines.

Whooping-Cough Vaccines

The current whooping-cough vaccines that are in use today include:

  • DTaP - (three-dose primary series) - routinely given to infants when they are two, four, six months
  • DTaP - (two booster doses) - routinely given to kids when they are 15 to 18 months old and four to six years
  • Tdap - (booster dose) - routinely given to kids when they are 11 to 12 years old, but can be given as early as age seven years to kids who have not previously had a full set of whooping-cough vaccines

Infants are typically thought to be unprotected until they get their third dose in the whooping-cough vaccine series when they are six months old when the vaccine is 80 to 85% effective in preventing cases with severe whooping-cough symptoms. Unfortunately, immunity wears off after five to ten years, which is why kids need multiple booster doses.

Whooping-Cough Vaccine Brand Names

Surprisingly to many parents, there are a large number of brands for whooping-cough vaccines. That doesn't necessarily matter as to how well your child will be protected against whooping cough, but it can sometimes make it confusing to try to figure out if your child is up to date on his whooping-cough vaccines if your pediatrician only recorded brand names on your shot record.

Whooping-cough vaccine brand names include:

  • Tripedia - DTaP
  • Daptacel - DTaP
  • Infanrix - DTaP
  • Kinrix - a combination vaccine with DTaP and IPV (polio) in one shot that can be given to kids for their four- to six-year-old booster shots
  • Pediarix - a combination vaccine with DTaP (Infanrix), HepB (hepatitis B), and IPV in one shot
  • Pentacel - a combination vaccine with DTaP, Hib (Haemophilus influenzae type B), and IPV (polio) in one shot
  • TriHIBit - a combination vaccine that combines DTaP (Tripedia) and Hib in one shot and which can be used for the fourth dose of the primary whooping-cough vaccine series
  • Adacel - Tdap
  • Boostrix - Tdap

Although not absolutely necessary, the same brand of DTaP vaccine should be used to complete a whooping-cough vaccine schedule.

Whooping-Cough Vaccine Protection

With the wide availability of whooping-cough vaccines, many parents likely wonder why this vaccine-preventable infection is still such a problem.

There were 32,971 reported whooping cases in the United States in 2014, a number that continues to rise in recent years and is way above the historically low rates of about 3,000 cases a year in the early 1980s.

In 2010, there were 27,550 whooping cough cases and 25 deaths from whooping coughs in infants.

One reason for the high number of whooping cough outbreaks is parents who don't vaccinate their kids, refusing both whooping-cough vaccines and other vaccines, or choosing alternative vaccine schedules. One study found that 'vaccine refusers had a 23-fold increased risk for pertussis when compared with vaccine acceptors.'

Another reason is the low number of teens and adults who are immunized with the Tdap vaccine. It is estimated that just over half of teens and less than six percent of adults are immunized against whooping cough, even though the Tdap vaccine has been recommended since 2005 and there continue to be high rates of infection at these ages.

Although the absolute reason for the rise in whooping cough still isn't known, these are likely big factors.

Even as we continue to talk about whooping cough outbreaks and the rising rates of whooping cough, it is important to keep in mind that we are still way below the whooping cough rates, more than 200,000 cases a year, that we used to see before the whooping-cough vaccines were routinely used.

And unfortunately, the protection from the whooping-cough vaccine does seem to wear off much more quickly than we would like it too. That certainly isn't a reason to not get vaccinated, though.

Whooping-Cough Vaccine Recommendations

In addition to the whooping-cough vaccine recommendations that are a part of the childhood immunization schedule, other things to know about the whooping-cough vaccines include:

  • Teens between the ages of who 13 and 18 who haven't had a Tdap vaccine yet should get one.
  • All adults between the ages of 19 and 64 should get one dose of the Tdap vaccine if they have never had it before.
  • Adults who will have contact with infants less than 12 months old, including parents, grandparents (even if they are over 65 years old), child-care providers, and health care workers, should get a Tdap vaccine if they have not had one yet, even if it has been less than ten years since their last tetanus booster.
  • If the fourth dose of the primary series of DTaP was given on or after a child's fourth birthday, then they don't need necessarily need a booster dose when they are four to six years old.
  • The five-year waiting period between doses of Td and Tdap is no longer recommended. Teens and adults who haven't had a Tdap vaccine should get one as soon as they can, even if they recently had a Td booster.
  • Children and adults with a history of whooping cough should still get vaccinated against whooping cough, since natural immunity against whooping cough is not thought to be permanent.
  • Contraindications to getting a whooping-cough vaccine include having a severe allergic reaction to a previous dose or other vaccine component or an unexplained history of encephalopathy within seven days of a previous dose.
  • Side effects of the whooping-cough vaccines are usually mild, and can include local reactions, such as pain, redness, and swelling, which are more common after the fourth and fifth dose of DTaP, and fever. More moderate or severe side effects, such as high fever, persistent crying, or febrile seizures, etc., occur less commonly and occur less frequently with DTaP than they used to with DTP.

To provide protection for newborns and young infants, it is also now recommended that pregnant women get a dose of Tdap between 27 and 36 weeks gestation during each pregnancy.

Sources:

AAP. Prevention of Pertussis Among Adolescents: Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine. Pediatrics, Mar 2006; 117: 965 - 978.

CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR. January 14, 2011 / 60(01);13-15.

CDC. Pink Book. Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2013

Glanz, Jason M. Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children. Pediatrics, Jun 2009; 123: 1446 - 1451.

Kliegman: Nelson Textbook of Pediatrics, 18th ed.

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