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Vaccination Schedule There are various types and combinations of pertussis vaccine, but the schedule recommended remains the same. Three doses of DTwP or DTaP should be given in the first year. The vaccination should be started at the age of six weeks, and there should be an interval of at least 4 weeks between doses. A fourth dose (a booster) is recommended in the second year. It is usually given at 15-18 months. At least 6 months should have elapsed since the last of the three first year doses. These 4 doses provide protection for 5-10 years. To avoid whooping cough in older children and adolescents, another dose should be given. DTaP or DTwP can be used up to the age of 7 years; beyond this age, the side effects are severe. For older children and adolescents, Tdap is used (see Pertussis Vaccines, below).
Pertussis Vaccines Pertussis vaccine is available as various combinations, to reduce the number of injections children need to take. Children need a higher dose of this vaccine than adolescents and adults, who have unacceptable side effects with the pediatric formulations. DTwP or DTP: is well known as the triple vaaccine, and has been in use for several decades. It protects children against diphtheria, tetanus, and whooping cough (pertussis). It contains the children's dose (higher than adult's) of the diphtheria and pertussis components. The pertussis vaccine is the whole cell vaccine that has been in use for a long time. This vaccine should not be used beyond the age of 7 years. DTaP: is the newer version of the triple vaaccine. The whole cell pertussis component is responsible for side effects like local pain and fever, and the acellular pertussis vaccine avoids those to a large extent. Like DTwP, DTaP protects children against diphtheria, tetanus, and whooping cough (pertussis). It is not better than the older vaccine in efficacy, but has less side effects. Tdap: has a lower dose of diptheria toxoid and the acellular pertussis vaccine components, and is suitable for use in adolescents and children. Hexavalent vaccines: combine DTaP with hepatitis B, hemophilus influenzae type b, and injectable polio vaccines, to reduce the number of injections babies need to take.

Pertussis (Whooping
Cough) Vaccination

See also: Whooping Cough

Whooping cough is a troublesome, long lasting, dangerous disease of children. In spite of a vaccine being in use for many decases, it continues to occur all over the world, though the occurrence has gone down significantly in countries with a high vaccination coverage. About three hundred thousand children die of this preventable disease each year.

The disease is highly infectious - ninety percent of unvaccinated children coming into contact with a case of whooping cough are likely to get the disease. A child with whooping cough is infectious to others for several weeks. Whooping cough is a bacterial disease.

Whooping cough is most commonly seen in children one to 5 years old. However, in countries with a high vaccination rate, pertussis is now being increasingly seen in older children. This is because the vaccine induced immunity does not stay protective beyond a few years.

Vaccination

Unlike many other diseases, babies are born without antibodies to whooping cough. This is because whooping cough antibodies do not cross the placenta, and the mother's antibodies do not come into the child's blood. Because of this, there are no maternal antibodies to interfere with the vaccine. It also means that babies are born susceptible to whooping cough, and the vaccination must be started soon.

The WHO (World Health Organisaiton) recommends that pertussis immunisation be started at 6 weeks, and three doses be given in the first year, at intervals of 4 weeks each. A booster is recommended 1-4 years later. This will provide protection for 6-12 years after tha last dose. Since severe pertussis with complications and deaths occur mostly in babies and young children, this was thought to be satisfactory.

However, the rising incidence of whooping cough in older children and teens is cause for concern, and further doses of pertussis vaccine are being recommended.

Pertussis vaccine is not available as a solo vaccine. It is available as various combinations (see sidebar) with diphtheria, tetanus, poliomyelitis, hepatitis B, and Hemophilus influenzae type b vaccines.

Whole Cell Pertussis Vaccine

This is the traditional vaccine that has been available for decades. It is a suspension of killed whooping cough bacteria. The bacteria are usually killed by formalin. The DTP vaccine contains the whole cell pertussis vaccine, and is now being called the DTwP or DTPw.

The whole cell pertussis vaccine is an effective vaccine, and has the same incidence of serious side effects as the acellular pertussis vaccine. However, it has a high incidence of local pain, fever, and irritability.

Acellular Pertussis Vaccine

The acellular pertussis vaccine consists of some of the parts of the whooping cough bacteria. Using this vaccine also provides immunity to whooping cough, but there is less fever, pain, redness, and irritability. This is the advantage of the acellular pertussis vaccimes; they do not provide better immunity. Acellular pertussis vaccines are of various types, contaning one, two, three or more components.

Combinations of acellular pertussis vaccines have "a" in them -- DTaP, Tdap, etc. These combinations are more expensive than combinations containing whole cell pertussis vaccine.
 

Whole cell pertussis vaccines have a protective efficacy of about 85%. The best acellular pertussis vaccines are also as good.

Last revision: July 01, 2008

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