WHOOPING COUGH (PERTUSSIS) VACCINE

When you are pregnant, it is strongly recommended that you get vaccinated against whooping cough (also known as ‘pertussis’). Women should have a whooping cough vaccination in each of their pregnancies, ideally between 20 and 32 weeks. The whooping cough vaccine will protect both your baby and you from this serious infectious disease. The vaccine is free for all pregnant women in Australia.


What is whooping cough?

Whooping cough is a serious bacterial infection of the nose, throat and lungs (also known as the ‘respiratory tract’). It’s also called ‘pertussis’ and it can affect people of all ages. In Australia, children aged between five and nine years are most commonly infected, but it is infants under three months that are most at risk of severe disease and death due to whooping cough.

 Whooping cough irritates your airways causing thick mucus and long, severe coughing fits that usually end with a gasping breath that can sound like a ‘whoop’. In addition to coughing, young babies may experience pauses in their breathing, called ‘apnoea’, which can make them turn blue, or they may develop more severe illness that can lead to hospitalisation and death. After one or two weeks of illness in children and adults, the coughing fits may become more severe and can lead to broken ribs, vomiting after coughing and exhaustion. It can take as long as three months to recover from whooping cough.

How do you catch whooping cough?

Whooping cough spreads very easily from one person to another through the air, like a cold. When someone who already has the disease coughs or sneezes, the whooping cough germs pass through the air on tiny droplets. If you breathe in those droplets, you can catch whooping cough, too. For young babies, the source of the infection is most often a family member, usually a parent or a young sibling (often aged between 2 and 3 years old)1, 2.

How will whooping cough affect my baby?

Whooping cough can be severe or life threatening for small babies. 

  • Babies under three months of age who develop severe whooping cough infection have the highest risk of death, despite advances in modern intensive care units3-7.
  • Babies under three months who develop a severe, potentially fatal whooping cough infection usually develop pneumonia, which can be complicated by low blood pressure, organ failure and death7.
  • Coughing fits and pauses in breathing can cause lack of oxygen to the brain, which may result in seizures and permanent brain damage8.
How does whooping cough affect adults, including pregnant women?

Pregnant women and other adults can get whooping cough but in most cases the disease is less severe. Adults with whooping cough are likely to experience prolonged coughing fits, sometimes resulting in vomiting, cracked ribs, disturbed sleep, incontinence and fainting9.

Is whooping cough common in Australia?

Yes. Despite being included on the National Immunisation Program since the mid 1950s, whooping cough is still common in Australia. Epidemics or outbreaks occur every three to four years11 or slightly longer. In 2019, over 12,000 people were diagnosed with whooping cough. During the 2011 epidemic in Australia, more than 38,000 cases were reported12

In Australia, whooping cough is most common in children aged between newborn and 14 years old. However, the disease is most serious among babies younger than six months old, particularly among those less than three months old who are at the highest risk of death from whooping cough infection.  

  • About nine in ten young babies who get whooping cough will have to go to hospital for treatment. 
  • Babies under six months old who catch whooping cough are most at risk: one in 200 will die13.

The majority of whooping cough-related deaths reported in Australia and New Zealand since 2002 have occurred in infants <2 months of age12, 14.

The protection the whooping cough vaccine provides wears off over time which is why regular boosters are recommended for both children and adults, as outlined in the Australian Immunisation Handbook13, 15.

How can I protect my baby from whooping cough?

The most effective way to protect your baby against whooping cough during the first few months of their life is to be vaccinated against whooping cough while you are pregnant. 

The whooping cough vaccine trains your body to produce antibodies that can recognise and fight a whooping cough infection. When you have the vaccine during pregnancy, those antibodies are transferred to your baby via the placenta, giving your baby protection against whooping cough  for several months after birth which is when the most severe disease occurs. Studies indicate that nine out of ten babies under three months of age are protected against whooping cough if their mothers received the whooping cough vaccine during pregnancy16, 17.

For the best protection at birth, mothers should have the vaccine at least seven days before delivery so that enough antibodies can be produced by the mother and passed to the baby via the placenta16.

Babies receive their first whooping cough vaccine at six weeks, with further doses at four months and six months. Other doses of whooping cough vaccine are given as boosters at different time points in childhood and adolescence, as outlined in the Australian Immunisation Handbook13.

Infographic whooping cough vaccine

 

What is the whooping cough vaccine and how effective is it?

In Australia, the whooping cough vaccine is combined with the diphtheria and tetanus vaccines in a combination vaccine called the ‘diphtheria-tetanus-pertussis vaccine’ or ‘dTpa’ vaccine. It is given in one needle in your arm.

How does the vaccine work?

The whooping cough vaccine works by training your body’s immune system to recognise and get rid of the pertussis bacteria that cause infection.

The vaccine contains ‘antigens’ which are small parts of the pertussis bacteria that cannot reproduce themselves or cause disease. When your immune system detects the antigens, it produces antibodies to fight them and get rid of them.

Your body usually starts producing antibodies around one or two weeks after you have the vaccine. When you’re pregnant it can take a bit longer. Once the antibodies are circulating in your blood stream, your immune system is ready to start fighting the disease as soon as it encounters it.

Whooping cough vaccine is only available in Australia in combination with diphtheria and tetanus. So, when people talk about the whooping cough or ‘pertussis’ vaccine, these other antigens, diphtheria and tetanus are also included. This is also true of the many studies that consider the safety of the vaccine. The vaccine that adults have for whooping cough is a ‘booster’ formulation. It contains a lower concentration of the diphtheria and pertussis antigens than the whooping cough vaccines that babies receive.

How will the vaccine protect my baby?

When you have a vaccine during pregnancy, the antibodies that your immune system produces will cross the placenta to give your baby protection against the disease, too. Having the  whooping cough vaccine between 20 and 32 weeks of pregnancy ensures the antibody transfer occurs at the right time for your baby to be best protected at birth. After birth, antibodies will also be passed on through your breastmilk.

Infographic vaccines protect my baby

How effective is it?

The whooping cough vaccine in pregnancy is extremely effective in preventing whooping cough in young babies. When women receive the whooping cough vaccine as recommended during pregnancy, it provides protection against whooping cough infection for nine out of ten babies under three months of age16, 17.

  • The USA and UK were the first to introduce programs providing whooping cough vaccines for pregnant women. Several studies from these countries have shown that 91 to 93 per cent of babies whose mothers were vaccinated during pregnancy are effectively protected against whooping cough for the first two to three months of life 16-18.
  • Research also shows that babies born to mothers who were vaccinated against whooping cough during pregnancy have a lower risk of being admitted to hospital. Those that are admitted to hospital are less likely to be admitted to intensive care and tend to have shorter hospital stays19.
  • In Australia, studies have shown that 69 per cent of babies whose mothers were vaccinated during pregnancy are effectively protected against whooping cough for the first two to three months of life and 94 per cent avoid hospitalisation20.

Infographic whooping cough vaccine

 

Is it safe to get the vaccine when you’re pregnant?

Yes. The recommended whooping cough vaccine is safe for pregnant women and for their babies.

Does the vaccine increase the risk of complications during pregnancy?

No. Research tells us that being vaccinated against whooping cough during pregnancy does not increase the risk of adverse pregnancy outcomes20. Specifically, a review of many studies20 confirmed that for mothers vaccinated against whooping cough during pregnancy there was:

  • no increase in the risk of preterm birth (birth under 37 weeks of gestation)
  • no increase in the risk of stillbirth or neonatal death (death during the first 28 days of life)
  • no increase in the risk of babies that were small for gestational age
  • no increase in the risk of low birth weight (less than 2.5kg)
  • and no increase in the risk of birth defects.
Is there a risk my baby and I will catch whooping cough from the vaccine?

No. There is no risk that either you or your baby could catch the disease from the vaccine because it does not contain any live bacteria. The whooping cough vaccine recommended during pregnancy contains small parts of the whooping cough (pertussis) bacteria that cannot reproduce themselves or cause disease.

Vaccines that contain ‘live’ viruses or bacteria, such as the measles or chicken pox vaccines, are not given to women during pregnancy.

Does the vaccine have any serious side effects, even if they are rare?

A very small number of people have a severe allergic reaction to vaccines called ‘anaphylaxis’, where they can develop swelling, hives, breathing difficulties, lowered blood pressure and in severe cases, shock. Anaphylactic reactions are very rare – they occur in about one in a million people who have a vaccination21. Midwives, nurses and GPs are trained to respond to an anaphylactic reaction with quick delivery of adrenaline.

Are there any medical reasons why someone should NOT be vaccinated during pregnancy?

The only medical reason for a pregnant woman not to have the whooping cough vaccine is if she has previously had an anaphylactic reaction to a component of the whooping cough vaccine.

Will I have a reaction to the vaccine?

Most people who have the whooping cough vaccine have no reaction at all. Some people have mild reactions that last between 12 and 24 hours and are easily treated at home. These are described below.

If your symptoms last longer than a couple of days, or if you are worried about how you feel after your vaccination, you can get help from your doctor, or your nearest emergency department, or by calling Health Direct on 1800 022 222.

Redness or soreness at the spot where the needle went in

Up to seven in every 100 women get some redness or soreness at the spot where the needle went in22 (this is called a ‘local reaction’). Women who have had a whooping cough vaccine before are slightly more likely to have a local reaction than women who are having the vaccine for the first time. The redness and soreness will get better in a day or two, but in the meantime you can put a cool, damp cloth on the spot to soothe it, or take an over-the-counter pain medication, such as paracetamol, if you feel you need to. Check with your doctor before taking any other pain medications.

Headache

Around three in every 100 women experience a headache after vaccination22.The headache will get better by itself, but you can take over-the-counter pain medication, such as paracetamol, if you feel you need to.

Mild fever

Around two in every 100 women develop a fever of around 38.5°C or more22. If you have a fever after your vaccination, drink plenty of water and consider using some paracetamol to help bring the temperature down.

Other reactions

Very few women (around three in every 1,000) experience a reaction serious enough to require them to attend a hospital emergency department22. Follow-up with those women indicated that all symptoms resolved and that both mother and baby remained healthy.

Where do I go to get vaccinated?

The midwife or trained immunisation nurse at your antenatal clinic may be able to give you a whooping cough vaccination. If not, then you can go to your GP or your local council clinic. Most GPs will need you to make an appointment if you require a vaccine

When should I have the vaccination?

The best time to have the vaccination is between 20 and 32 weeks of pregnancy. This is when the transfer of protective antibodies from you to your baby is most effective and will provide the best protection for your baby after birth. However, the vaccine can be delivered anytime from 20 weeks of pregnancy up to delivery.13

I have been vaccinated for whooping cough before - do I need another vaccination?

It is recommended that women are vaccinated against whooping cough each time they are pregnant. The protective effect of the antibodies decreases quite quickly over time so, even if you have been vaccinated in the past, you will need a new whooping cough vaccination in every pregnancy.

Can I wait until after my baby is born?

If you delay having the vaccine until after your baby is born, your baby will not be protected against whooping cough at birth. In fact, vaccination during pregnancy has been shown to be 85 per cent more effective than vaccination after pregnancy19

Having the vaccine during pregnancy means that your baby will have the best protection at birth. That’s because the antibodies your immune system produces after the vaccination will cross the placenta to give your baby protection, too. 

If you have the vaccine after your baby is born, some of the antibodies you produce will be passed on to your baby through your breastmilk. This will offer some protection, but it will not be as effective as the protection provided by the antibodies that cross the placenta during pregnancy. Also, your body won’t begin producing antibodies until a few weeks after you have had the vaccination which means your baby will be unprotected for at least the first few weeks after birth.   

Vaccination for babies begins at six weeks13. At their first vaccination they will get a dose of the whooping cough vaccine in a combination vaccine that also protects against diphtheria, tetanus, Hib, polio and hepatitis B. 

What else can I do to protect my baby against whooping cough?

Getting vaccinated against whooping cough during pregnancy is the best way to protect your baby against whooping cough.

Should anyone else in the family be vaccinated against whooping cough?

Of the babies who do catch whooping cough, about 80 percent get it from parents or siblings1 so it’s important that anyone likely to be in close contact with your baby, including other parents, siblings and grandparents, are also fully vaccinated. Brothers and sisters should have their vaccinations up to date, and any adults who have not had a whooping cough vaccination in the last ten years or longer should get a booster dose.

KEY FACTS

Pertussis is a serious bacterial infection of the nose, throat and lungs commonly called ‘whooping cough’.

Babies usually catch whooping cough from family members, especially parents and siblings.

It is most severe and life threatening for babies less than three months old.

The most effective way to protect your baby against whooping cough is to get the whooping cough vaccination in each pregnancy.

Nine out of ten babies under three months of age are protected against whooping cough if their mothers had the whooping cough vaccine during pregnancy.

During pregnancy, the whooping cough vaccine works by producing antibodies that cross the placenta to give your baby much needed protection against whooping cough at birth.

Having the whooping cough vaccine in pregnancy is safe for both babies and mothers.

  1. Wiley, K.E., Zuo, Y., Macartney, K.K., and McIntyre, P.B., Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy. Vaccine, 2013. 31(4): p. 618-25.
  2. Bertilone, C., Wallace, T., and Selvey, L.A., Finding the 'who' in whooping cough: vaccinated siblings are important pertussis sources in infants 6 months of age and under. Commun Dis Intell Q Rep, 2014. 38(3): p. E195-200.
  3. Winter, K., Zipprich, J., Harriman, K., et al., Risk Factors Associated With Infant Deaths From Pertussis: A Case-Control Study. Clin Infect Dis, 2015. 61(7): p. 1099-106.
  4. Murray, E.L., Nieves, D., Bradley, J.S., et al., Characteristics of Severe Bordetella pertussis Infection Among Infants ≤90 Days of Age Admitted to Pediatric Intensive Care Units - Southern California, September 2009-June 2011. J Pediatric Infect Dis Soc, 2013. 2(1): p. 1-6.
  5. Pertussis--United States, 1997-2000. MMWR Morb Mortal Wkly Rep, 2002. 51(4): p. 73-6.
  6. Halperin, S.A., Wang, E.E., Law, B., et al., Epidemiological features of pertussis in hospitalized patients in Canada, 1991-1997: report of the Immunization Monitoring Program--Active (IMPACT). Clin Infect Dis, 1999. 28(6): p. 1238-43.
  7. Mikelova, L.K., Halperin, S.A., Scheifele, D., et al., Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in Canada. J Pediatr, 2003. 143(5): p. 576-81.
  8. Olsen, M., Thygesen, S.K., Østergaard, J.R., et al., Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy. Jama, 2015. 314(17): p. 1844-9.
  9. De Serres, G., Shadmani, R., Duval, B., et al., Morbidity of pertussis in adolescents and adults. J Infect Dis, 2000. 182(1): p. 174-9.
  10. Quinn, H.E. and McIntyre, P.B., Pertussis epidemiology in Australia over the decade 1995-2005--trends by region and age group. Commun Dis Intell Q Rep, 2007. 31(2): p. 205-15.
  11. Australian Government Department of Health. National Notifiable Diseases Surveillance System.  [cited 2020 August ]; Available from: http://www9.health.gov.au/cda/source/rpt_4.cfm.
  12. Pillsbury, A., Quinn, H.E., and McIntyre, P.B., Australian vaccine preventable disease epidemiological review series: pertussis, 2006-2012. Commun Dis Intell Q Rep, 2014. 38(3): p. E179-94.
  13. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook [Electronic book] 2018; Available from: https://immunisationhandbook.health.gov.au/.
  14. Straney, L., Schibler, A., Ganeshalingham, A., et al., Burden and Outcomes of Severe Pertussis Infection in Critically Ill Infants. Pediatr Crit Care Med, 2016. 17(8): p. 735-42.
  15. Schwartz, K.L., Kwong, J.C., Deeks, S.L., et al., Effectiveness of pertussis vaccination and duration of immunity. Cmaj, 2016. 188(16): p. E399-e406.
  16. Amirthalingam, G., Andrews, N., Campbell, H., et al., Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet, 2014. 384(9953): p. 1521-8.
  17. Baxter, R., Bartlett, J., Fireman, B., Lewis, E., and Klein, N.P., Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis. Pediatrics, 2017. 139(5).
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  19. Winter, K., Cherry, J.D., and Harriman, K., Effectiveness of Prenatal Tetanus, Diphtheria, and Acellular Pertussis Vaccination on Pertussis Severity in Infants. Clin Infect Dis, 2017. 64(1): p. 9-14.
  20. McMillan, M., Clarke, M., Parrella, A., et al., Safety of Tetanus, Diphtheria, and Pertussis Vaccination During Pregnancy: A Systematic Review. Obstet Gynecol, 2017. 129(3): p. 560-573.
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