Pertussis Vaccination

Pertussis vaccination is a standard vaccination (regular vaccination) given by means of an inactivated vaccine. It is an acellular vaccine. The toxoid vaccine may contain up to four other antigens (such as pertacin, among others) in addition to pertussis toxin. Pertussis (whooping cough) is a respiratory infection caused by the bacterium Bordetella pertussis. A combination vaccine is usually used for pertussis vaccination: Tdap combination vaccine (tetanus–diphtheria-pertussis combination vaccine), and if indicated, Tdap-IPV combination vaccine (for booster vaccination against diphtheria–tetanus-pertussis-poliomyelitis). The duration of immunity by vaccination is limited to about ten years. If the disease has been passed through, to about 20 years. The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute on pertussis vaccination:

Tdap combination vaccine, Tdap-IPV combination vaccine if indicated.

Indications (areas of application)

  • S/A: Adults should receive the next due Td vaccination once as a Tdap combination vaccine.
  • I: Pregnant women at the beginning of the 3rd trimester (from the 28th week of pregnancy). If there is an increased likelihood of preterm birth, vaccination should be brought forward to the 2nd trimester (third trimester).Provided that there has been no pertussis vaccination in the last 10 years, the following should receive 1 dose of pertussis vaccine:
    • Women of childbearing age,
    • Close household contacts (parents, siblings) and caregivers (eg, childminders, babysitters, grandparents, if applicable) of a newborn at least 4 weeks before the birth of the child.

    If the vaccination was not successful before conception, the mother should be vaccinated preferably in the first days after the birth of the child* .New: vaccination against pertussis for pregnant women with a Tdap combination vaccine at the beginning of the 3rd trimester (pregnancy third). If there is an increased likelihood of preterm delivery, vaccination should be brought forward to the 2nd trimester. Vaccination should be carried out regardless of the distance from previously administered pertussis vaccinations and in any pregnancy.

  • B: Provided that no pertussis vaccination has taken place in the last 10 years, personnel in the health service as well as in community facilities should receive 1 dose of pertussis vaccine

A general vaccination of adults does not have to be carried out. The goal of the STIKO is an early immunization of children. * The Centers for Disease Control and Prevention (U.S. federal agency of the U.S. Department of Health and Human Services) recommend TdaP vaccination between the 27th and 36th week of pregnancy, because the placenta allows the greatest antibody transfer only from the 32nd to 34th week. This approach has led to a decrease in pertussis cases in infants.The most optimal timing according to a cohort study may be 30 weeks of gestation. Legend

  • S: Standard immunizations with general application.
  • A: booster vaccinations
  • I: Indication vaccinations for risk groups with individual (not occupational) increased risk of exposure, disease or complications and for the protection of third parties.
  • B: Vaccinations due to an increased occupational risk, e.g., after risk assessment in accordance with the Occupational Safety and Health Act / Biological Substances Ordinance / Ordinance on Occupational Medical Precautions (ArbMedVV) and / or for the protection of third parties in the context of occupational activities.

Contraindications

  • Persons with acute diseases requiring treatment.
  • Pregnant women (should be avoided)

Implementation

  • Basic immunization: the first four vaccinations take place in the first year of life (first vaccination at 2 months of age, followed by two more at 3 and 4 months of age, and the fourth vaccination at 11-14 months of age)
    • Today there is the possibility of carrying out combination vaccinations, so that children are effectively protected against infectious diseases with relatively few vaccinations. The six-vaccination schedule protects against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B. The current reduced “2+1 schedule” for the six-vaccination schedule is as follows: At 8 weeks of age, the vaccination series is started and subsequent vaccinations are given at the recommended times at 4 and 11 months of age. Between the 2nd and 3rd vaccination doses, a minimum interval of 6 months must be observed.
  • Repeat vaccination: age 15-23 months and 2-4 years.
  • The first booster vaccination is administered at the age of 5-6 years. Another booster vaccination is recommended at 9-17 years of age.
  • Vaccination gaps in adolescents and adults should be closed. At the next due tetanus vaccination should be vaccinated against pertussis with if necessary (Tdap combination vaccination).
  • Instructions for vaccination of pregnant women: Use of a Tdap combination vaccine (Covaxis, Boostrix), if indicated as Tdap-IPV combination vaccine (Repevax, Boostrix-Polio). Vaccination regardless of the distance from a previously administered pertussis vaccine and in any pregnancy.

Important note!From the age of 5-6 years should be used for vaccinations against diphtheria and pertussis vaccines with reduced amount of antigen (d instead of D and ap instead of aP). While the Td vaccines (Td-vaccine Mérieux, Td-pur, Td-Rix, with the exception of Td-Immun) and the monovalent IPV vaccine (IPV-Mérieux) are licensed for basic immunization according to the technical information, the corresponding combination vaccines with pertussis component (Tdap: (Boostrix, Covaxis, TdaP-Immun), Tdap-IPV: (Boostrix-Polio, Repevax)) are primarily intended for booster vaccination.

Efficacy

  • Reliable efficacy
  • Vaccine protection wears off after years. In a study of 1,246 fully vaccinated control subjects, overall vaccine protection was just under 64 percent. In the first year after vaccination, protection was 73 percent. After two to four years, protection dropped to 34 percent.

Possible side effects / vaccination reactions

  • In the vaccine for children (acellular pertussis vaccine – without shares of the pathogens) very rare.
  • With the vaccine for adults (dead vaccine with killed pertussis pathogens), local pain and reactions such as redness of the skin and swelling may occur; fever may also occur