Pertussis

Whooping cough, also known as pertussis, is a highly infectious disease with symptoms that can last for weeks to months. It is caused by the Bordetella pertussis bacterium. Outbreaks of the disease occur every 3–5 years because whooping cough protection decreases with time after having either the disease or immunisation.

Infants too young to have been fully immunised, those who have had any one of their immunisations delayed or have only just completed their first three immunisations and not yet had time to develop protection, are at highest risk of catching whooping cough and developing serious complications. Unimmunised children, older children and adolescents who did not have their booster immunisation at four and 11 years of age, and adults also have a high risk of catching the disease. Infants  less than 12 months of age, particularly those less than six months of age, have the highest risk of hospitalisation and death. Prior to immunisation, whooping cough was a major cause of infant death.

Protection of infants less than 12 months of age is the most important strategy because they have the highest risk of developing serious complications.

  • A whooping cough booster immunisation is free for women between 28–38 weeks of every pregnancy. The immunisation is given to increase the woman’s circulating protection against whooping cough and maximise the amount of her protection that crosses over the placenta to the baby in the weeks before birth. The circulating protection in the newborn is likely to protect the new baby from severe whooping cough for at up to six weeks after birth. Comparison of infant pertussis cases in the United Kingdom before and after the introduction of a whooping cough booster vaccination for pregnant women between 28–38 weeks gestation showed that maternal vaccination was highly effective at reducing infant pertussis, with a vaccine effectiveness of 91% (95% CI 84–95) for infants up to 3 months of age.
  • Followed by on-time immunisation at six weeks, three months and five months of age.

Two tetanus, diphtheria and pertussis booster vaccines are available for adults in New Zealand. BOOSTRIX® and ADACEL®.

BOOSTRIX® is the free whooping cough booster vaccine on the 'special groups' Immunisation Schedule for pregnant women between 28–38 weeks of every pregnancy and adults with a medical condition listed on the Pharmaceutical Schedule. Health professionals may recommend a whooping cough booster immunisation for adults who do not have a condition listed on the Pharmaceutical Schedule, but the vaccine will not be free. BOOSTRIX® and ADACEL® can be purchased from Healthcare Logistics for ineligible individuals.

Vaccination during pregnancy

Influenza and whooping cough (pertussis) immunisations are recommended and funded for pregnant women who are eligible for publicly funded health and disability services in New Zealand. These types of vaccines are used internationally during pregnancy with no evidence of harm for the course of the pregnancy, unborn baby or newborn. They are not live vaccines.

For further information visit:

The Immunisation Advisory Centre

Chapter 14 in the Immunisation Handbook 2017

Medsafe

References

  • Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, Donegan K, et al. Effectiveness of maternal pertussis vaccination in England: An observational study. Lancet. 2014;384(9953):p. 1521-8.
  • Baxter R, Bartlett J, Fireman B, Lewis E, Klein NP. Effectiveness of vaccination during pregnancy to prevent infant pertussis. Pediatrics. 2017;139(5):e20164091.
  • Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vazquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clinical Infectious Diseases. 2010;51(12):1355-61.
  • Edwards KM, Decker MD. Pertussis vaccines. In: Plotkin S, Orenstein W, Offit P, editors. Vaccines. 7th ed. Philadelphia, PA: Elsevier; 2013. p. 711-61.
  • Ministry of Health. Immunisation handbook 2017. Wellington: Ministry of Health; 2017.
  • Sukumaran L, McCarthy NL, Kharbanda EO, Weintraub ES, Vazquez-Benitez G, McNeil MM, et al. Safety of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis and influenza vaccinations in pregnancy. Obstet Gynecol. 2015;126(5):1069-74.
  • Winter K, Cherry JD, Harriman K. Effectiveness of prenatal tetanus, diphtheria, and acellular pertussis vaccination on pertussis severity in infants. Clin Infect Dis. 2017;64(1):9-14.

BOOSTRIX® (diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine): Single-dose 0.5 mL pre-filled glass syringe. Indications: For booster vaccination against diphtheria, tetanus and pertussis of individuals aged 4 years and older. Contraindications: Known hypersensitivity to any component of the vaccine or signs of hypersensitivity after previous administration of diphtheria, tetanus or pertussis vaccines. Encephalopathy of unknown aetiology, occurring within 7 days of previous vaccination with pertussis-containing vaccine. Transient thrombocytopenia or neurological complications following an earlier diphtheria and/or tetanus vaccination. Administration of Boostrix should be postponed in individuals suffering from acute moderate or severe febrile illness. Precautions: If any of the following events have occurred in temporal relation to receipt of pertussis containing vaccines, the decision to give doses of pertussis containing vaccines, should be carefully considered: Temperature of ≥40.0°C within 48 hours of vaccination, not due to another identifiable cause; collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours of vaccination; persistent, inconsolable crying lasting ≥3 hours, occurring within 48 hours of vaccination; convulsions with or without fever, occurring within 3 days of vaccination. In children with progressive neurological disorders, including infantile spasms, uncontrolled epilepsy or progressive encephalopathy, it is better to defer pertussis immunisation until the condition is corrected or stable. However, the decision to give pertussis vaccine must be made on an individual basis after careful consideration of the risks and benefits. In patients with immunodeficiency or in patients receiving immunosuppressive therapy, an adequate immunologic response may not be achieved. Syncope (fainting) can occur following, or even before, any vaccination as a psychogenic response to the needle injection. Interactions: Boostrix can be administered simultaneously with other vaccines or immunoglobulins. If Boostrix is to be given at the same time as another injectable vaccine or immunoglobulin, the products should always be administered at different sites. Adverse reactions: Local reactions, headache, fatigue, malaise, fever, dizziness, nausea, gastrointestinal disorders. Dosage: Individuals aged 4 years and older: 0.5 mL. Administration: IM. Presentation: Single-dose 0.5 mL pre-filled glass syringe in packs of 1 or 10. Cold chain: Store between +2°C to +8°C. Sponsor: GlaxoSmithKline NZ Ltd.

ADACEL® (pertussis vaccine-acellular combined with diphtheria and tetanus toxoids): Single-dose 0.5 mL glass vial. Indications: For active immunisation against tetanus, diphtheria and pertussis in persons aged 10 years and over as a booster following primary immunisation. Contraindications: Previous hypersensitivity reaction to any vaccine containing diphtheria or tetanus toxoids or pertussis (acellular or whole cell). Hypersensitivity to any component of the vaccine. Encephalopathy of unknown aetiology, occurring within 7 days of previous vaccination with pertussis-containing vaccine. Neurological complications following an earlier diphtheria and/or tetanus and/or pertussis vaccination. Precautions: The use of Adacel as a primary series, or to complete the primary series, has not been studied. A booster response will only be elicited in individuals who have been previously primed by vaccination. There are currently no data upon which to base a recommendation for the optimal interval for administering subsequent booster doses with Adacel to maintain antibody levels against pertussis. There are no data on the duration of protection against pertussis following vaccination with Adacel. The immunogenicity of the vaccine could be reduced by immunosuppressive treatment or immunodeficiency. If Guillain-Barré syndrome or brachial neuritis has occurred following receipt of prior vaccine containing tetanus toxoid, the decision to give any vaccine containing tetanus toxoid should be based on careful consideration of the potential benefits and possible risks. Administration of Adacel should be postponed in individuals suffering from acute moderate or severe febrile illness. Interactions: Adacel can be administered concomitantly with hepatitis B vaccine, using a separate limb for the site of injection. Concomitant administration of other vaccines with Adacel has not been studied. Adverse reactions: Local reactions, headache, tiredness, chills, body ache, nausea, fever, diarrhoea, Dosage: Persons aged 10 years or older: 0.5 mL. Administration: IM. Presentation: Single-dose 0.5 mL glass vial in packs of 1. Cold chain: Store between +2°C to +8°C. Sponsor: Sanofi-Aventis New Zealand Pty. Ltd.