Vaccines: Pertussis

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccines: There are 4 vaccines currently authorized for use in adults in Canada, all of which are acellular preparations in a combination vaccine. These preparations contain a lower (reduced) Bordetella pertussis antigen concentration and are abbreviated as "ap" (as opposed to the higher concentration "aP" pediatric vaccines). Reduced acellular pertussis vaccines also contain tetanus toxoid and reduced diphtheria toxoid (Tdap); some formulations also include inactivated poliovirus (Tdap-IPV) (see Vaccines: Diphtheria and Tetanus; see Vaccines: Poliomyelitis).

2. Indications: Vaccination with Tdap is recommended as a booster dose at least once for all adults after having completed the primary vaccination in childhood. After receiving ≥1 Tdap booster in adulthood, adults may be offered either Td or Tdap every 10 years.

In addition, adults who have or are going to have close contact with infants aged <12 months and have not previously received Tdap or Tdap-IPV in adulthood (parents, grandparents, caretakers, health-care personnel, daycare personnel) should receive a dose of Tdap vaccine, ideally >2 weeks before contact with infants. Pregnant patients should be vaccinated in every pregnancy, regardless of prior immunizations or the length of interval between pregnancies, between 27 and 32 weeks of gestation.

3. Contraindications: As for tetanus and diphtheria vaccines; encephalopathy within 7 days after the previous vaccination against pertussis. Immunization should be postponed in severe acute illness.

4. Immunization schedule: A single IM dose of Tdap vaccine every 10 years in patients aged >18 years.

Pregnant patients should be vaccinated in every pregnancy, regardless of prior immunizations or the length of intervals between pregnancies, between 27 and 32 weeks of gestation. In cases where there is an increased risk of preterm delivery, earlier immunization between 13 and 26 weeks of gestation may be considered.

Adults with inadequate immunization records should be considered unimmunized and should be offered a 3-dose Tdap vaccine series, with the second dose given at 4 weeks and the third dose given at 6 to 12 months, followed by Tdap boosters every 10 years.

5. Adverse events: Local injection site reactions (10%-40%), limb swelling, fever (8%-29%), drowsiness (40%-52%), anaphylaxis (<0.1%), severe Arthus-type reactions (<0.1%).