{"id":487,"date":"2023-07-23T10:27:49","date_gmt":"2023-07-23T09:27:49","guid":{"rendered":"https:\/\/microregistrar.com\/?p=487"},"modified":"2023-09-16T22:08:58","modified_gmt":"2023-09-16T21:08:58","slug":"greenbook-notes-pertussis-whooping-cough-vaccine","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=487","title":{"rendered":"Greenbook notes: Pertussis (Whooping cough) vaccine"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\" id=\"h.x1s9xvlkka34_l\">Pertussis vaccine<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The pertussis vaccine is thiomersal-free &amp; not a live vaccine.<\/li>\n\n\n\n<li>It is an <strong>acellular vaccine<\/strong> prepared from <strong>purified components of B pertussis<\/strong>, <strong>treated with formaldehyde\/glutaraldehyde<\/strong> and <strong>adsorbed onto adjuvants<\/strong> (aluminium hydroxide\/aluminium phosphate) to improve immunogenicity.<\/li>\n\n\n\n<li>Components of B pertussis vary from vaccine to vaccine \u2013 usual components are \u2013 pertussis toxoid, filamentous haemagglutinin, pertactin, fimbrial agglutinogens etc.<\/li>\n<\/ul>\n\n\n\n<p>Pertussis vaccine is only given as a part of a combined vaccine. Monovalent pertussis vaccines are not available.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>DTaP\/IPV\/Hib\/HepB (6 in 1) \u2013 for primary immunisation<\/li>\n\n\n\n<li>dTaP\/IPV or DTaP\/IPV (4 in 1) \u2013 preschool booster<\/li>\n\n\n\n<li>dTaP\/IPV \u2013 for pregnant women<\/li>\n<\/ul>\n\n\n\n<p>Vaccines are stored at +2\u02daC to +8\u02daC, protected from light.<\/p>\n\n\n\n<p>Excess heat \u2013 reduces potency and shelf-life.<br>Excess cold\/freezing \u2013 increases reactogenicity and loss of potency; it may also cause hairline cracks on the ampoule leading to contamination.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.9hbyz5b09xw8_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.9hbyz5b09xw8\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.9hbyz5b09xw8\"><\/a>Contraindication<\/h4>\n\n\n\n<p>Confirmed anaphylactic reaction to a previous dose of pertussis-containing vaccine or to any component of the vaccine, including neomycin or polymyxin.<\/p>\n\n\n\n<p>These adverse effects, if they occurred after a vaccine dose, are NOT a contraindication for further vaccination (as they may not recur):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>fever, irrespective of its severity<\/li>\n\n\n\n<li>hypotonic-hyporesponsive episodes (HHE)<\/li>\n\n\n\n<li>persistent crying or screaming for more than three hours<\/li>\n\n\n\n<li>severe local reaction, irrespective of the extent<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.zgbrf2yvjntu_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.zgbrf2yvjntu\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.zgbrf2yvjntu\"><\/a>Adverse effects<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Local reaction \u2013 Pain, swelling or redness at the injection.<\/li>\n\n\n\n<li>Fever, convulsions, high-pitched screaming and episodes of pallor, cyanosis and limpness (HHE).<\/li>\n\n\n\n<li>Anaphylaxis<\/li>\n<\/ul>\n\n\n\n<p>Other adverse effects \u2013 Whole-cell pertussis vaccine (not currently used acellular vaccine) was reported to have a rare adverse effect \u2013 severe acute neurological illness in children.<\/p>\n\n\n\n<p>Other adverse effects that were previously associated with the pertussis vaccine but no causal relationship was found in studies \u2013 infantile spasms, hypsarrhythmia, Reye\u2019s syndrome and sudden infant death syndrome.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.1dpfwuen6mct_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.1dpfwuen6mct\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.1dpfwuen6mct\"><\/a>Immunisation in children<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Primary immunisation \u2013 3 doses, 1 month apart, between 2 months and 10 years.<\/li>\n\n\n\n<li>As per the national immunisation schedule \u2013 it is given @ 8 weeks, 12 weeks and 16 weeks.<\/li>\n<\/ul>\n\n\n\n<p>A reinforcement\/booster dose \u2013 should be given 3 years after the primary immunisation, which is @ 3 years and 4 months of age. This is the preschool booster.<\/p>\n\n\n\n<p>If a child presents with a history of vaccine before the booster due to another indication, e.g.tetanus, prone injury, try to establish the vaccine type. If it was given at appropriate intervals and the vaccine is the same type as the booster vaccine, the preschool booster is not needed.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.3i0wvx88z3vs_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.3i0wvx88z3vs\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.3i0wvx88z3vs\"><\/a>Variations<\/h4>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/lh4.googleusercontent.com\/c_nXsx_ZJzQmfu1xuOLdyUW0MNUQVAuOxsumQhJHhtBy6fKMIvh_ojk-fr9R5oWwaZRr_phmppK2RuB2ZTKCtVRWlaqdPGcVVJWSTVTA4pqrMR1rj0fOjE-fS5-7leaXHA=w1280\" alt=\"\"\/><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.offd93tudfm0_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.offd93tudfm0\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.offd93tudfm0\"><\/a>Premature infants<\/h4>\n\n\n\n<p>Premature infants born \u2264 28 weeks of gestation should have their first vaccination in the hospital and be monitored for apnoea, bradycardia or desaturations. If any such event occurs, 2nd vaccination should be given in the hospital as well.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.oi1p14te3h0y_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.oi1p14te3h0y\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.oi1p14te3h0y\"><\/a>Neurological condition<\/h4>\n\n\n\n<p>It (spina bifida, epilepsy, congenital abnormality of the brain or perinatal hypoxic-ischaemic encephalopathy) is not a contraindication.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If the condition is stable, immunise as normal.<\/li>\n\n\n\n<li>If deteriorating\/not stable (including poorly controlled epilepsy), defer immunisation &amp; refer to paediatrics\/ paediatric neurologist. If the cause is identified, immunise. If not identified \u2013 defer.<\/li>\n\n\n\n<li>If the child recovers completely within 7 days \u2013 immunise. If not, defer and investigate.<\/li>\n\n\n\n<li>Immunise once the condition stabilises.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/lh6.googleusercontent.com\/cXSKYWiou_ZNKHbGnGKwyRY7XNUTNWS_hafQRrSp0ck3L1fCo9NS99u54HRKMUssMuu4kTEBuIAj4hkyFQ2jF9aFFB0IE5UKGpjVIXG79Oqz5pDJ0wJBuS-PkWU5Eohgew=w1280\" alt=\"\"\/><\/figure>\n\n\n\n<p>If a child develops encephalopathy within 7 days of immunisation, follow the above plan. If the cause is identified or recovers within 7 days, continue with vaccination; if not, defer and investigate.<\/p>\n\n\n\n<p>If a child develops a febrile seizure within 72 hours of immunisation, continue with immunisation if the cause is identified or recovers within 24 hours; if not, defer and investigate.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.rq2mbg7k1uc9_l\"><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.rq2mbg7k1uc9\"><\/a><a href=\"https:\/\/www.microregistrar.app\/vaccines\/greenbook-notes-pertussis-whooping-cough-vaccine#h.rq2mbg7k1uc9\"><\/a>Pertussis vaccination programme for pregnant women<\/h4>\n\n\n\n<p>This temporary immunisation programme for pregnant women was started in 2012 after a significant increase in the number of pertussis cases, mainly in adolescents and young adults. The highest risk of serious disease was still in infants &lt;3 Months old, hence this booster vaccination in pregnancy would help pass the antibody generated by the mother to the infants before they receive their first vaccine dose at 8 weeks of age. This booster dose should be given in each pregnancy, regardless of previous immunisation, booster during a previous pregnancy or a history of natural infection.<\/p>\n\n\n\n<p>Evaluation of pertussis vaccine in pregnant women found it safe.<\/p>\n\n\n\n<p>[<a href=\"https:\/\/www.google.com\/url?q=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F349%2Fbmj.g4219&amp;sa=D&amp;sntz=1&amp;usg=AOvVaw1hynWfo2QOsXn4WtA_Cv9Q\" target=\"_blank\" rel=\"noreferrer noopener\">Donegan, 2014<\/a>][<a href=\"https:\/\/www.google.com\/url?q=https%3A%2F%2Fbnf.nice.org.uk%2Ftreatment-summary%2Fpertussis-vaccine.html&amp;sa=D&amp;sntz=1&amp;usg=AOvVaw2LgpYsrnLXPZZ8C1CJD7C6\" target=\"_blank\" rel=\"noreferrer noopener\">BNF<\/a>][<a href=\"https:\/\/www.google.com\/url?q=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fvaccination-against-pertussis-whooping-cough-for-pregnant-women%2Fpertussis-whooping-cough-vaccination-programme-for-pregnant-women&amp;sa=D&amp;sntz=1&amp;usg=AOvVaw3D8K8ku6UnCFpLoSbAiM6T\" target=\"_blank\" rel=\"noreferrer noopener\">UKHSA, 2021<\/a>][<a href=\"https:\/\/www.google.com\/url?q=https%3A%2F%2Fmicroregistrar.com%2F2022%2F03%2F25%2Fwhooping-cough-vaccine%2Fthe%2520green%2520book%2C%2520chapter%252024&amp;sa=D&amp;sntz=1&amp;usg=AOvVaw2YmGRzhnnFv5GxA8eeMUfp\" target=\"_blank\" rel=\"noreferrer noopener\">Greenbook Ch 24<\/a>]<\/p>\n\n\n\n<p id=\"h.93lxwpf9q37w\"><strong>Regimen<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The optimal time for vaccination is between weeks 28 and 32 of pregnancy.<\/li>\n\n\n\n<li>It could be given from 16 weeks onwards as per a recent recommendation. PHE recommends it should be given after the <strong>first anomaly scan<\/strong> <strong>(18-20 weeks)<\/strong> to avoid any unnecessary association with complications.<\/li>\n\n\n\n<li>It takes 2 weeks to generate the optimum level of antibody.<\/li>\n\n\n\n<li>It can be given up to 38 weeks; however, at later stages, the response might not be optimum as the vaccine may fail to generate adequate antibodies before birth, especially in cases of premature birth.<\/li>\n\n\n\n<li>If a pregnant woman received a pertussis-containing vaccine just before 16 weeks for any reason (e.g. occupational), give a booster as per the programme. If she received it after 16 weeks \u2013 that can be counted as a booster.<\/li>\n<\/ul>\n\n\n\n<p><strong>Boostrix-IPV<\/strong> ((dTaP\/IPV) is the vaccine used for this programme.<\/p>\n\n\n\n<p>Those women who have not received their vaccine during pregnancy can have the booster in the first two months after childbirth (until the infant receives their first vaccine). It will protect the baby indirectly by protecting the mother.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Pertussis vaccine Pertussis vaccine is only given as a part of a combined vaccine. Monovalent pertussis vaccines are not available. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[11],"tags":[68,17,67],"class_list":["post-487","post","type-post","status-publish","format-standard","hentry","category-vaccine","tag-pertussis","tag-vaccine","tag-whooping-cough"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=487"}],"version-history":[{"count":4,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/487\/revisions"}],"predecessor-version":[{"id":491,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/487\/revisions\/491"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=487"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}