Pertussis Vaccine for Clinicians

Tdap is a vaccine that helps protect teens from acquiring Tetanus, Diptheria, and Pertussis. Pertussis, otherwise known as “whooping cough,” is caused by bacteria called Bordetella pertussis and spreads easily from person to person. It is a disease that remains common among adolescents and adults, and one that has serious complications.

How is Pertussis transmitted?

A person becomes infected with the pertussis bacteria if they come in close contact with another person who has the disease. The transmission is via respiratory droplets.

Clinical presentation: Pertussis typically starts with cold-like symptoms; a runny nose, a mild fever, and a minor cough. After 1 to 2 weeks, the cough begins to get worse and lasts for many weeks. Those infected often complain of a disruption in sleep and vomiting with severe coughing episodes. The classic symptom for this disease is a “whoop-like” sound that an infected person makes when air is breathed into the lungs, thus the name, “whooping cough.” Other complications that can result from violent coughing episodes include rib fractures, urinary incontinence, and weight loss. Symptoms generally last from 2-6 weeks however coughing can last for over 2 months or more. A person who is infected with pertussis is most contagious during the first 2 weeks after the cough begins. Because the symptoms of pertussis in its early stage mimic a common cold, it is often not diagnosed or treated until more severe symptoms occur, putting many people at a high risk of infection.

Who is at risk for getting pertussis?

Anyone can get pertussis. Babies are at greatest risk since they are not completely protected from pertussis until they get all their pertussis shots. It is recommended that pregnant women get the vaccine between the 27th and 36th week (of pregnancy) so they can pass antibodies against pertussis to their babies. By 15 to 18 months, a child should have received four pertussis shots (DTaP) with a fifth one just before starting school. Teens and college students living or spending time in close quarters such as dormitories, camp, or in classrooms, are considered at high risk for getting pertussis. School nurses and other health care providers who work directly with students and patients are also at higher risk of pertussis exposure and therefore should get a dose of Tdap.

How many people get pertussis each year?

In the early 1940s, before the vaccine was available, about 200,000 people in the United States acquired pertussis each year. After people started getting vaccinated, the numbers decreased. Since then, however, the number of teenagers and adults getting pertussis has increased. This is likely due to the fact that the vaccine from childhood becomes less effective over time. According to the CDC, in 2012 there were approximately 16 million cases of pertussis reported worldwide. More than 48,000 cases were reported in the United States alone, yet many more cases go undiagnosed and hence, untreated.

How can teens and adults protect themselves from getting pertussis?

According to the CDC, “The most effective way to prevent pertussis is through vaccination with DTaP for infants and children and with Tdap for preteens, teens and adults—protection from the childhood vaccine fades over time.” The FDA approved the Tdap (Tetanus, diphtheria, acellular pertussis) vaccine in 2005. It is a vaccine created for teenagers and adults to prevent three different bacterial infections: tetanus, diphtheria, and pertussis. Tdap is a booster shot, that will protect teens against infection only if they have received the first series of pertussis shots, called DTaP (Diphtheria, Tetanus, acellular Pertussis), when they were younger.

If someone gets pertussis do they acquire lifelong immunity?

Having a pertussis infection does not necessarily give a person lifelong immunity. It is still very important that a person receives the Tdap vaccine. Even an individual with a history of pertussis should be treated if they come in contact with an infected person.

What is DTaP?

DTaP is the pertussis vaccine most teens received as an infant and young child. Unlike the Tdap booster shot, DTaP is stronger and given in five different shots at 2 months, 4 months, 6 months, 15-18 months of age, and just before starting school (age 4-6 years). It is necessary to get the DTaP vaccines as a child to help make antibodies that target pertussis.

How does the vaccine work?

The DTaP vaccine is composed of “inactive” pertussis bacteria. When a person gets the vaccine injection, the body begins making antibodies to fight the inactive bacteria.

At what age should the Tdap booster vaccine be given?

It is recommended that teens receive the vaccine at the 11-12 year old checkup with their healthcare provider. However, a teen can receive the vaccine anytime between 11-18 years of age.

How many Tdap shots does a teen need?

Most teens only need a single booster shot if they already had the first series of DTaP vaccines as a baby and young child. Before giving the Tdap booster shot, the health care provider should review the teen’s immunization record if possible to be sure that the first five DTaP vaccinations were given.

How long is the pertussis vaccine effective?

It is not known exactly how long the Tdap booster shot will protect a teen or adult from pertussis. Although the vaccine does not prevent pertussis 100% of the time, it will greatly decrease the chance of getting a pertussis infection.

It is recommended that anyone who comes in close contact with someone with pertussis (regardless if they received the Tdap vaccine or not), they should contact their health care provider to determine if antibiotic treatment is necessary.

Are there any side-effects?

Most of the discomforts following the administration of the Tdap vaccine are considered mild and temporary. Sometimes, however, the discomforts can interfere with activities, thus requiring medical attention, such as a fever over 102°. Severe allergic reactions such as hives, difficulty breathing, wheezing, or dizziness requires immediate medical attention.

Possible side-effects of the Tdap vaccine:

• Redness and/or swelling at the site of the injection
• Soreness at the site of the injection (usually arm)
• Mild fever
• Headache
• Fatigue
• GI disturbances- nausea, diarrhea, stomach cramps

The U.S. Department of Health and Human Services has set up a Vaccine Adverse Event Reporting System (VAERS). For more information contact: 1-800-822-7967 or vaers.hhs.gov.

Is there anything I can do to help an adolescent who may have had a serious complication from a vaccine?

Serious adverse events to vaccines occur in approximately 1 out of every 1 million people (who have received the vaccine). A person is much more likely to have life- threatening complications from pertussis and other diseases than they are to have a severe reaction from the vaccine. The Federal government has established a program to help pay for the medical expenses for children who have had a serious reaction to a vaccine. For details, contact the National Vaccine Injury Compensation Program online or call: 1-800-338-2382.

Is there any reason for a teen to wait or not get the Tdap vaccine?

Most teens can get the Tdap with no problems.

The following circumstances suggest when a teen should wait or not get the vaccine:

• If a teen ever had a serious allergic reaction, such as anaphylaxis, when he/she got a vaccine.
• If a teen ever had prolonged seizures or another neurologic condition after receiving a pertussis-containing vaccine.
• If a teen has a condition or is taking any medications that suppress the immune system. Studies suggest that immunosuppressed teens may not get as much protection from the vaccine.
• If the teen is feeling ill with a fever on the day the shot is scheduled, it may be best to postpone giving the vaccine until they are feeling better. They should speak to their primary care provider to determine if they are healthy enough to get the vaccine.
• If a teen is pregnant, vaccination is recommended preferably during the third trimester between the 27th and 36th week. The vaccine is recommended with each subsequent pregnancy.

Is there anything I can do to encourage teens to be involved with their immunization and well visits?

Yes, you can teach teens to be actively involved in their health! One way of doing this is by encouraging them to ask about their immunization record, especially if they will be going to college soon and managing their health.

Sample questions they can ask their health care provider include:

• Did I receive the first group of DTaP vaccines as a baby and young child?
• Are there any medical reasons why I shouldn’t get the Tdap vaccine?
• Who should I call if I don’t feel well (after getting the vaccine)?
• Should I expect any side effects?
• What if I come in contact with someone who has whooping cough?

What are the types of pertussis vaccines and how are they administered?

Boostrix®

• Boostrix® has been approved for children 10 years of age and over. The ideal age to receive the Tdap vaccine is between 11-12 years of age.
• Tdap can be given at the same time as other vaccines but at separate sites.
• Boostrix® comes in a pre-filled single dose (0.5 ml) and disposable Tip-Lok syringe.
• Follow packaging instructions: Shake the syringe vigorously until the suspension appears cloudy and white. If the liquid does not mix with shaking, do not use the product.
• After the skin has been cleaned with a germicide such as alcohol, administer the vaccine intramuscularly (IM) into the deltoid region of the upper arm using a 22-25 gauge, 1-1 ¼ inch needle. DO NOT administer this product SC or intravenously.
• Record the date, lot number, and the manufacturer of the vaccine in the student’s health record.

Adacel®

• Adacel® is indicated as a single-dose booster immunization for people who are 11 to 64 years of age.
• Adacel® comes in a single (0.5 ml) dose vial.
• It is given intramuscularly (IM) in the deltoid area after the skin has been cleansed with a germicide. Adacel® should not be administered into the buttocks, or by the intradermal route.
• Record the date, lot number and the manufacturer of the vaccine in the student’s health record.

Before administering any vaccine ask about the adolescent’s immunization history, medical history, current health issues and specifically ask if they have ever experienced any “type of reaction” or adverse event with vaccines in the past.

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