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Pertussis (Whooping Cough) & Pertussis Vaccine

The following information is provided to help you understand the disease pertussis (whooping cough) and the pertussis vaccine so you can make an informed decision regarding use of this vaccine. Information on this website with links to other websites and resources will help you become educated about many infectious diseases and vaccines so you can take control of and responsibility for your health choices. This information is not intended to serve as medical advice but as background information that you can use to educate yourself.

Whenever making a major health care decision for yourself or your child, especially one that involves use of a pharmaceutical product such as a vaccine, obtaining information from many different sources and consulting health care professionals you trust is important. NVIC encourages you to become fully informed about whooping cough disease and pertussis vaccine and speak with one or more trusted health care professionals before making a decision about vaccination.

If your doctor does not support your informed health choices, consider consulting another doctor, who will work as a partner with you and respect whatever decision you make.

Keep Written Records

The pertussis (whooping cough) vaccine is included as a component in “combination” shots that may include tetanus and diphtheria (DPT, DTaP, Tdap) or polio, hepatitis B, and/or Haemophilus Influenza B (Hib). Check with the person who will give the shot containing pertussis vaccine to make sure which vaccine(s) you or your child are being given.

Always keep a written record of exactly which shots/vaccines you or your child have received, including the manufacturer’s name and vaccine lot number. Write down and describe in detail any serious health problems that develop after vaccination and keep vaccination records in a file you can access easily.

What is Pertussis Whooping Cough?

Pertussis, commonly referred to as whooping cough, is a highly contagious respiratory disease caused by the Bordetella (B.) pertussis bacterium. B. pertussis bacteria attach themselves to the mucus membranes of the respiratory tract and cause inflammation in the body.

The major symptom of B. pertussis whooping cough disease is uncontrollable coughing.

In advanced stages, thick mucous develops in the lungs and clogs air passages, triggering violent episodes of coughing, choking and vomiting up of mucus followed by a high-pitched intake of breath that sounds like "whoop." With whooping cough disease, it is possible to have such violent coughing spells, especially at night, that large amounts of mucous are vomited up through the mouth and nose and interfere with breathing.

The B. pertussis bacteria release several toxins, including pertussis toxin (PT) and endotoxin. In severe cases of whooping cough disease, complications include high fever, brain inflammation, convulsions, pneumonia and death.

Symptoms of B. pertussis at its onset are similar to the common cold, or an allergy attack with stuffy or runny nose, dry cough, loss of appetite, fatigue and, sometimes, a low fever. After one to two weeks, the disease usually progresses to bursts of spasmodic coughing (paroxysms) with large amounts of mucous, gagging and vomiting with or without a whoop that becomes worse at night.

During the day, the child or adult may look and feel fine with the exception of frequent coughing spasms. A final recovery stage with only occasional coughing fits may last for weeks or even months. Click here to hear what whooping cough can sound like.

Sometimes infants or older children and adults don’t cough with a whoop. Small babies and very young children, who are gasping for air, may have a red face, bulging eyes, blue lips and may stop breathing for a few seconds or longer because the thick mucus clogs their small airways. Sometimes babies must have the mucous suctioned from their throats so they can breathe.

Adults and adolescents with whooping cough may have milder symptoms, such as a persistent, mucous-producing cough that goes on for 4-8 weeks. Often older children and adults do not make the whooping cough when they cough.

Symptoms of pertussis are sometimes milder in those who have had one or more doses of pertussis containing vaccines (DPT, DTaP, Tdap) and doctors or nurses may not suspect B. pertussis whooping cough in vaccinated children, adolescents and adults, who present with a bad cough. Many cases of pertussis go undetected because they are mistakenly diagnosed by medical personnel as an allergy attack, bronchitis, influenza or other upper respiratory infection.

What is Parapertussis Whooping Cough?

There is another Bordetella pertussis whooping cough disease called B. parapertussis. Symptoms of B. parapertussis whooping cough can look identical to B, pertussis whooping cough but they are usually milder. B, parapertussis is increasing in the U.S. and other countries, which have had high pertussis vaccination rates for few decades. There are estimates that perhaps 30 percent or more of whooping cough disease in highly vaccinated populations is caused by B. parapertussis organisms.

It is possible to have both B. pertussis and B. parapertussis infections at the same time. Parapertussis is often milder than B. pertussis but can also involve serious complications which lead to pneumonia and death.

Pertussis vaccines widely used around the world do not protect against parapertussis. There is no vaccine for parapertussis.

Lab Confirmation Needed for Accurate Diagnosis

The only sure way to find out if you or your child have B. pertussis or B. parapertussis (or another respiratory disease caused by other viruses or bacteria), is to have a lab test  that will positively confirm the exact organism causing the whooping cough symptoms.

How Do You Get Pertussis Whooping Cough?

Whooping cough disease is transmitted from person to person through coughing, sneezing and by coming into direct contact with nasal secretions and mucus from the respiratory tract of a person who is actively contagious.

The incubation period for B. pertussis after contact with an infected person and before symptoms begin is usually give to 14 days but it can be as long as 21 days. People are most contagious in the early stages when symptoms may be mild and include only a stuffy or runny nose and nagging, dry cough. They can remain contagious for several weeks after the spasmodic coughing fits (with or without whooping) begins. Antibiotics are usually prescribed to help prevent transmission to others and lower the risk of complications, such as pneumonia.

Children and adults, who have gotten one or more doses of pertussis-containing vaccines (DPT, DtaP, Tdap), as well as those who have never been vaccinated at all, can experience a mlld or serious case of B, pertussis whooping cough.

However, those who have already had B. pertussis whooping cough once or have had one or more pertussis vaccinations often have a milder case, even though they can still transmit the disease to others.

How Contagious Is Pertussis Whooping Cough?

B. Pertussis whooping cough is highly contagious. Whooping cough disease circulates in all months but, in North America, more cases are diagnosed in the summer and fall.

How Do You Treat Pertussis Whooping Cough?

There are no prescription drugs that cure pertussis but many doctors routinely prescribe antibiotics to try to reduce a person’s ability to transmit the disease to others. Antibiotics are also given to help prevent secondary infections such as bronchitis, pneumonia, and otitis media (inner ear infection). In the past, these complications caused many of the deaths following whooping cough.

 

In past decades, the antibiotic of choice to treat B. pertussis whooping cough has been erythromycin but newer antibiotics, such as clarithromycin and azithromycin, are often used today. Antibiotics do not eliminate the symptoms of B. pertussis whooping cough, such as the severity or length of paroxysmal coughing.

Holistic health care approaches to help manage the symptoms of whooping cough disease include chiropractic, homeopathy, naturopathy, acupuncture, diet and vitamin therapy, including supplemental vitamin D and C.

It is very important to keep those sick with whooping cough properly hydrated with plenty of fluids. Fever, vomiting up of mucous and, sometimes, diarrhea, can cause severe dehydration. Untreated, severe dehydration can lead to shock/collapse, unconsciousness and even death.

Once You Have Had Pertussis Can You Get It Again?

Many people gain permanent immunity after experiencing B. pertussis whooping cough disease. However, it is possible to have more than one bout with whooping cough in life, although subsequent cases are generally milder or may even be experienced without many symptoms.

All vaccines only give temporary immunity, which is why booster doses are often given. Pertussis vaccine (DPT, DTaP, TdaP) does not give long lasting, permanent immunity. That is why, even after children get 3 to 6 doses of pertussis vaccine, they can still get B. pertussis whooping cough as children, teenagers or adults.

Can Pertussis Whooping Cough Cause Injury and/or Death?

There is a gap in medical knowledge in terms of predicting who will have a mild case of B. pertussis whooping cough and who will have a serious or even fatal case of this disease.

Pertussis can be quite serious, especially for young infants, whose tiny air passages can become clogged with thick mucous. Babies and very young children are at highest risk for apnea, pneumonia, seizures, encephalopathy, and death. The most serious complication of both whooping cough disease (and pertussis vaccine) is brain inflammation leading to varying degrees of permanent brain dysfunction.

Pertussis toxin (PT) is one of the most lethal toxins in nature. The toxin induces lymphocytosis, leukocytosis, stimulates insulin secreton and sensitizes histamine, which is involved in the immune system’s inflammatory response.

Pertussis toxin is thought to be the main component of B pertussis bacteria responsible for stimulating the production of protective antibodies during natural whooping cough infection and after pertussis vaccination.

Pertussis toxin is also thought to be the main toxin responsible for causing brain inflammation during B. pertussis whooping cough or after injection of pertussis-containing vaccines. (B. parapertussis bacteria do not secrete pertussis toxin and that is one reason why parapertussis is usually associated with milder symptoms). Because pertussis toxin can cross the blood brain barrier when conditions are right, brain inflammation (encephalitis) with convulsions that causes permanent brain damage has always been the most dreaded complication of both whooping cough and pertussis vaccination.

Another toxin produced by B. pertussis bacteria during natural infection is endotoxin, which is also present in pertussis vaccines in varying amounts. When the immune system detects the presence of endotoxins, it produces a defensive inflammatory immune response, including the release of large amounts of histamine that can lead to high fever, swelling, diarrhea, collapse, shock and death.

The fatality rate for B. pertussis whooping cough disease is highest in infants under six months of age. Older children and adults can suffer rib fractures from violent coughing fits. Permanent health problems resulting from whooping cough disease (and the pertussis vaccine] can include continuing seizure disorders, mental retardation, learning disabilities, ADD/ADHD and other chronic illness.

What Is the Incidence of Pertussis in the US?

In 1922, there were 107,473 pertussis cases reported in the U.S. with 5,099 deaths. Mortality associated with pertussis declined dramatically in the 1940’s as living conditions improved, including sanitation and hygiene and access to health care.  During the past quarter century, reports of whooping cough cases have increased among babies less than six months old and among teenagers and adults but mortality has remained low.

In 2010, out of a U.S. population of 308 million people, there were about 27,500 reported cases of pertussis including 27 deaths, with 25 deaths occurring in infants under age one year. However, many cases of whooping cough are never diagnosed or reported. Every four to five years, there are reported increases in whooping cough disease in the U.S. and other countries, no matter how high the vaccination rate.

What Is the Incidence of Pertussis in Other Countries?

In underdeveloped countries with poor sanitation, nutrition and limited access to health care, whooping cough disease still causes significant complications and death, especially in infants and small children. However, in the U.S., Canada, Australia, Europe and other countries, today whooping cough disease is much more manageable due to:

  • raised standards of living and availability of antibiotics to control secondary infections like pneumonia;
  • the use of suction to clear mucous from the throats and airways of babies and resuscitate those, who choke on mucus and stop breathing;
  • rehydration techniques to control the loss of body fluids from high fever, vomiting, or diarrhea.

In 1977, Britain had more than 99,000 reported pertussis cases with 23 deaths and no cases of encephalitis, which resulted in a case fatality ratio of approximately 1 in 4,300 cases. A 1985 British report placed the risk of death for infants under 1 year from pertussis at 1 in 69,000.

According to the World Health Organization (WHO), in 2010 there were about 91,600 reported cases of pertussis worldwide.

What Is the Pertussis (DPT, DTaP, Tdap) Vaccine?

In the U.S. today, pertussis vaccine is administered only in a combination shot (DTaP, Tdap) that contains vaccines for diphtheria (D), tetanus (T), and pertussis (whooping cough) (P). A pertussis vaccine containing shot is routinely given in the U.S. six times: at two, four, and six months old; between 15 and 18 months old; and between four and six years old. Another booster dose is given at 12-13 years of age (Tdap).

There are various combination shots that bundle diphtheria, tetanus and pertussis vaccines with vaccines for polio, haemophilus influenza B (HIB, and hepatitis B (see below for descriptions).

In the U.S., the older whole cell pertussis vaccine (DPT), which was created in 1912, was replaced with a purified, less reactive acellular DTaP vaccine in 1996. (DPT was available in some doctor’s offices in the U.S. until about 1999). DPT is still used in many other countries.

Pertussis Vaccine Ingredients

The whole cell pertussis vaccine (DPT), which is not used in the U.S. anymore but is still used in other countries, contains whole B. pertussis bacteria that have been inactivated with heat and chemicals, as well as an aluminum adjuvant and mercury preservative (thimerosal). The purified DTaP/Tdap vaccines packaged in single dose vials given to American babies since the late 1990’s, contain reduced bioactive pertussis toxin, less endotoxin and either no or reduced (trace amounts) of mercury, along with an aluminum adjuvant.

Depending upon the vaccine manufacturer, shots containing pertussis vaccine may contain varying amounts of inactivated pertussis toxin, filamentous hemagglutinin (FDA), pertactin, fimbriae, formaldehyde, polysorbate 80 (Tween 80), gluteraldehyde, 2-phenoxoyethanol, aluminum and thimerosal (mercury).

Other ingredients are included in larger combination shots that bundle pertussis, tetanus and diphtheria vaccines with polio, hepatitis B and/or HIB vaccines. See each manufacturer product insert for a list of vaccine ingredients.

Read the Product Information Insert

NVIC strongly recommends reading the vaccine manufacturer product information insert before you or your child receive any vaccine, including a shot containing pertussis vaccine. Product inserts are published by drug companies making vaccines and list important information about vaccine ingredients, reported health problems (adverse events) associated with the vaccine, and directions for who should and should not get the vaccine.

Links to pertussis-containing product inserts are available below or you can ask your doctor to give you a copy of the vaccine product insert to read before you or your child is vaccinated. It is best to ask your doctor for a copy of the product inserts of vaccines you or your child are scheduled to receive well in advance of the vaccination appointment.

Pertussis Vaccines Licensed for Use in the U.S.

The U.S. Food and Drug Administration and U.S.Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) have approved nine different combination shots that include acelullar pertussis vaccine. There are different rules for use of these vaccines by different ages groups.

Following is a list of currently available vaccine combination shots that contain pertussis vaccine with links to the manufacturer product inserts (click on the name of the product):

  • Tripedia, a 3 in 1 combination shot containing diphtheria and tetanus toxoids and acellular pertussis vaccine for children under 7 years of age. It is manufactured by Sanofi Pasteur, Inc.
  • Infanrix, a 3 in 1 combination shot containing diphtheria, tetanus toxoids, and acellular pertussis vaccine for children under 7 years of age. It is manufactured by GlaxoSmithKline.
  • Daptacel, a 3 in 1 combination shot containing diphtheria and tetanus toxoids and acellular pertussis vaccine for children under 7 years of age. It is manufactured by Sanofi Pasteur Ltd.
  • Pediatrix, a 5 in 1 combination shot containing diphtheria and tetanus toxoids and accelluar pertussis, hepatitis B recombinant and inactivated poliovirus vaccines for children under 7 years of age. It is manufactured by GlaxoSmithKline.
  • Kinrix, a 4 in 1 combination vaccine containing diphtheria and tetanus toxoids, acellular pertussis and inactivated poliovirus vaccines for children 4 to 6 years old. It is manufactured by GlaxoSmithKline.
  • Pentacel, a 5 in 1 combination shot containing diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus and Haemophilus b conjugate (tetanus toxoid conjugate) vaccines for children under four years old. It is manufactured by Sanofi Pasteur Ltd.
  • Adacel, a 3 in 1 combination booster shot containing tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine for those 11 years or older. It is manufactured by Sanofi Pasteur Ltd.
  • Boostrix, a 3 in 1 combination booster shot containing tetanus toxoid, reduced dipththeria toxoid and acellular pertussis vaccine for those 10 years or older. It is manufactured by GlaxoSmithKline.
  • ActHIB, a Haemophilus influenza b vaccine that can be reconstituted in the doctor’s office to become a 4 in 1 combination shot for children 15 -18 months that contains Tripedia (diphtheria and tetanus toxoids and acellular pertussis vaccine) and Haemophilus Influenza b vaccine. It is manufactured by Sanofi Pasteur.

Combination Vaccines

There are some doctors who limit the numbers of vaccines given simultaneously on the same day and will work as partners with parents to choose certain vaccine products and develop individualized schedules for vaccination. If you want your child to receive pertussis vaccine but would prefer a 3 in 1 combination shot (diphtheria, tetanus, pertussis) rather than a 4 in 1 or 5 in 1 combination shot, talk with your doctor.

If your doctor or the nurse administering vaccines refuses to have a discussion with you about vaccine products or schedules, you may want to consider consulting one or more other trusted health care professionals before making a vaccine decision.

Not all pertussis vaccine containing shots have been studied in clinical trials to prove the safety and effectiveness of giving the shot simultaneously with other licensed vaccines. Check the product inserts for more information about administering vaccines at the same time with other vaccines.

About TRIPEDIA Vaccine in Brief

  • Ages: Tripedia is a 3 in 1 shot (diptheria, tetanus and acellular pertussis vaccines) administered to children under age 7. (See Sanofi Pasteur product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. pertussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. In clinical trials, the acellular pertussis vaccine component of Tripedia was found to have a post-trial efficacy after two doses of 77 percent and 80 percent after three doses.
  • Use With Other Vaccines: In clinical trials, Tripedia was given simultaneously with HIB, hepatitis B, oral polio or MMR vaccines. “Data on the concomitant [simultaneous] administration of Tripedia vaccine or TriHIBit vaccine (ActHIB vaccine reconstituted with Tripedia vaccine) with varicella vaccine, inactivated poliovirus vaccine (IPV) or pneumococcal conjugate vaccine are not available.” There is no information in the product insert about the safey or effectiveness of giving Tripedia simultaneously with inactivated or live influenza, rotavirus, or hepatitis A vaccines.
  • Commonly Reported Adverse Events: Fever, irritability, fussiness, drowsiness, anorexia, vomiting, and swelling/tenderness at the injection site.
  • Other Serious Reported Adverse Events: Hypotonic/hyporesponsive (collapse) episode; persistent crying for 3 or more hours; febrile and afebrile convulsions (seizures); deaths attributed to SIDS; enteritis; Leigh Syndrome; adrenogenital syndrome; nodule/formation of abscess at site of injection; anaphylactic reaction that can include hives, swelling of mouth, difficulty breathing, and hypotension or shock; arthus-type hypersensitivity reaction; peripheral mononeuropathy and cranial mononeuropathy; brachial neuritis; Guillain-Barre syndrome and demyelinating disease. After licensure (post-marketing), adverse event reports include idiopathic thrombocytopenic purpura; SIDS, anaphylactic reaction; cellulitis; autism; convulsion/grand mal convulsion; encephalopathy; hypotonia; neuropathy; somnolence and apnea.
  • Contraindications (Some reasons Tripedia may not be given to a child – See Sanofi Pasteur product insert for complete list):
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination
    • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccinaton
    • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination
    • Serious allergic reaction to a pervious pertussis vaccination
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause
    • Children who have a progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, or progressive encephalopathy
    • Children with blood coagulation disorders (thombocytopania)

NVIC NOTE: Some doctors only vaccinate children who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you do not want your acutely ill baby vaccinated and your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Tripedia. It is also not known whether Tripedia can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Tripedia has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About INFANRIX Vaccine in Brief

  • Ages: Infanrix is a 3 in 1 shot (diphtheria, tetanus, acellular pertussis vaccines) given to children under age 7 (see GlaxoSmithKline product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. petussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. In clinical trails the efficacy of the acellular pertussis vaccine component was 86 to 89 percent.
  • Use With Other Vaccines: In clinical trials, Infanrix was given with HIB, pneumococcal, hepatitis B, inactivated polio or MMR vaccines. There is no information in the product insert about the safety or effectiveness of giving Infanrix simultaneously with inactivated or live influenza, rotavirus, varicella or hepatitis A vaccines.
  • Commonly Reported Adverse Events: Pain, redness, and swelling at the site of the injection; drowsiness; irritability/fussiness; loss of appetite.
  • Other Serious Reported Adverse Events: Hypotonic-hyporesponsive (collapse) episode; persistent cry for 3 or more hours; high fever, and convulsions (seizures). After licensure (post-marketing), reported adverse events included bronchitis, cellulitis, respiratory tract infection, lymphadenopathy, thrombocytopenia, anaphylactic reaction, encephalopathy, headache, hypotonia, ear pain, apnea, cough, angiodema, pruritis, rash, fatigue and Sudden Infant Death Syndrome (SIDS).
  • Contraindications (Some reasons Infanrix may not be given to a child – See GlaxoSmithKline product insert for complete list):
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination
    • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccinaton
    • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination
    • Serious allergic reaction to a pervious pertussis vaccination
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause
    • Children with a progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, or progressive encephalopathy
    • Apnea following intramuscular vaccination has been observed in some infants born prematurely. “Decisions about when to administer Infanrix to infants born prematurely should be based on the individual infant’s medical status and the potential risks and benefits of the vaccine.”

NVIC NOTE: Some doctors only vaccinate children who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you do not want your acutely ill baby vaccinated and your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Infanrix. It is also not known whether Infanrix can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Infanrix has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About DAPTACEL Vaccine in Brief

  • Ages: Daptacel is a 3 in 1 shot (diphtheria, tetanus, acellular pertussis vaccines) given to children under age 7 (see Sanofi Pasteur product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. petussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. In clinical trials the efficacy of the acellular pertussis vaccine component was 78 to 85 percent.
  • Use With Other Vaccines: In clinical trials, Daptacel was given with HIB, inactivated polio (IPV), hepatitis B, pneumococcal, MMR or varicella vaccines. There is no information in the product insert about the safety or effectiveness of giving Daptacel simultaneously with inactivated or live influenza, rotavirus, or hepatitis A vaccines.
  • Commonly Reported Adverse Events: injection site soreness, tenderness, redness, and increase in arm circumference; fussiness/irritability; inconsolable crying; decreased activity/lethargy.
  • Other Serious Reported Adverse Events: Convulsions (seizures), including infantile spasms; bronchiolitis; pneumonia; meningitis; sepsis; irritability; unresponsiveness. After licensure (post-marketing), reported adverse events have also included cyanosis, nausea, diarrhea, cellulits; allergic reaction.
  • Contraindications (Some reasons Daptacel may not be given to a child – See Sanofi Pasteur product insert for complete list):
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination
    • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccination
    • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination
    • Serious allergic reaction to a pervious pertussis vaccination
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause
    • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy)

NVIC NOTE: Some doctors only vaccinate children who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you do not want your acutely ill baby vaccinated and your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Daptacel. It is not known whether Daptacel can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Daptacel has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About Pediarix Vaccine in Brief

  • Ages: Pediatrix is a 5 in 1 shot (diphtheria, tetanus, acellular pertussis, inactivated polio and recombinant hepatitis B vaccines) given to children under age 7 (see GlaxoSmithKline product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. pertussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. The efficacy of the acellular pertussis vaccine component of Pediarix is estimated to be 71 to 89 percent.
  • Use with Other Vaccines: In clinical trials, Pediarix was given with HIB or pneumococcal vaccines. There is no information in the product insert about the safety or effectiveness of giving Pediarix simultaneously with inactivated or live influenza, rotavirus, or hepatitis A vaccines.
  • Commonly Reported Adverse Events: Local injection site reactions (pain, redness, or swelling); fussiness, high fever (Pediarix is associated with higher rates of fever relative to separately administered vaccines. The prevalence of fever was highest on the day of vaccination and the day following vaccination.)
  • Other Serious Reported Adverse Events: High fever that requires medical attention (In a safety study that evaluated medically attended fever after Pediarix or separately administered vaccines when co-administered with 7-valent pneumococcal and Hib conjugate vaccines, infants who received Pediarix had a higher rate of medical encounters for fever within the first 4 days following the first vaccination); febrile and afebrile convulsions (seizures); gastroenteritis, bronchiolitis; asthma, diabetes mellitus, and chronic neutropenia; anaphylactic reactions (hives, swelling, difficulty breathing, hypotension or shock), demyelinating diseases.
  • Contraindications (Some reasons why Pediarix may not be given to a child – See GlaxoSmithKline product insert for complete list):
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination
    • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccination
    • Convulsionswith or without fever, occurring within 3 days of a previous pertussis vaccination
    • Serious allergic reaction to a pervious pertussis vaccination
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause
    • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy)
    • Sensitivity to any component of Pediarix, including yeast or neomycin and polymixin B (antibiotics).
    • Apnea following intramuscular vaccination has been observed in some infants born prematurely. “Decisions about when to administer an intramuscular vaccine, including Pediarix, to infants born prematurely should be based on consideration of the individual infant’s medical status, and the potential benefits and possible risks of vaccination.”
    • Children with a bleeding disorder (thrombocytopenia)

NVIC NOTE: Some doctors only vaccinate children who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you do not want your acutely ill baby vaccinated and your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Pediarix. It is not known whether Pediarix can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Pediarix has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About Kinrix Vaccine in Brief

  • Ages: Kinrix is a 4 in 1 shot (diphtheria, tetanus, acellular pertussis, inactivated polio vaccines) given to children 4 to 6 years old (see GlaxoSmithKline product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. petussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. The efficacy of the acellular pertussis vaccine component of Kinrix is estimated to be equal to that of Infanrix (86 to 89 percent).
  • Use with Other Vaccines: In clinical trials, Kinrix was administered simultaneously with the second dose of MMR. “Data are not available on concomitant use of Kinrix and varicella vaccine.” There is no information in the product insert about the safety or effectiveness of giving Kinrix simuntaneously with inactivated or live influenza, hepatitis B, or hepatitis A vaccines.
  • Commonly Reported Adverse Events: Injection site pain, including redness, swelling and increase in arm circumference; drowsiness; fever; loss of appetite.
  • Other Serious Reported Adverse Events: Gastroenteritis, dehydration, cellulits. After licensure (post-marketing) reported adverse event reports have also included apnea, collapse or shock-like state (hypotonic-hyporesponsive episode), convulsions (with or without fever), injection site vesicles; pruritis (intense itching); allergic reactions, including anaphylaxis; urticaria; angioedema; lympadenopathy, and thrombocytopenia.
  • Contraindications (Some reasons why Kinrix should not be given to a child – See GlaxoSmithKline product insert for complete list):
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination
    • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccinaton
    • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination
    • Serious allergic reaction to a pervious pertussis vaccination
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause.
    • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy)
    • Severe allergic reaction to any component of Kinrix, including neomycin and polymixin B (antibiotics).

NVIC NOTE: Some doctors only vaccinate children who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you do not want your acutely ill baby vaccinated and your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Kinrix. It is not known whether Kinrix can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Kinrix has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About Pentacel Vaccine in Brief

  • Ages: Pentacel is a 5 in 1 shot (diphtheria, tetanus, acellular pertussis, inactivated polio and haemophilus influenza b conjugate vaccines) for children under age 5 (see Sanofi Pasteur product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. petussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. The efficacy of the acellular pertussis vaccine component of Pentacel is estimated to be the same as for Daptacel (78-85 percent) except evidence in pre-licensure clinical trials raises questions about whether Pentacel has a lower long term efficacy compared to Daptacel. (While Pentacel and Daptacel (vaccines contain the same pertussis antigens, manufactured by the same process, Pentacel vaccine contains twice the amount of detoxified pertussis toxin (PT) and four times the amount of filamentous hemagglutinin (FHA) as Daptacel vaccine.)
  • Use with Other Vaccines: In clinical trials, Pentacel was given with hepatitis B, pneumococcal, MMR or varicella vaccines. There is no information in the product insert about the safety or effectiveness of giving Pentacel simultaneously with inactivated or live influenza, rotavirus, or hepatitis A vaccines
  • Commonly Reported Adverse Events: Systemic reactions that occurred in clinical trials in more than 50 percent of participants following any dose included fussiness/irritability and inconsolable crying; fever; injection site reactions, including tenderness, abcess and increase in arm circumference. Cases of encephalopathy and death occurred in clinical trials but were not causally attributed to Pentacel vaccine by investigators.
  • Other Serious Reported Adverse Events: After licensure (post marketing), there have been reports of febrile and afebrile convulsions (seizures); bronchiolitis, gastroenteritis, dehydration, pneumonia, lethargy/somnolence; hypotonic/hyporesponsive epidsode (collapse); apnea, cyanosis, asthma,
  • Contraindications (Some reasons why Pentacel may not be given to a child – See Sanofi Pasteur product insert for complete list):
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination
    • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccinaton
    • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination
    • Serious allergic reaction to a pervious pertussis vaccination
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause
    • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy)
    • Severe allergic reaction to any component of Pentacel, including neomycin and polymixin B (antibiotics).

NVIC NOTE: Some doctors only vaccinate children, who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you do not want your acutely ill baby vaccinated and your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Kinrix. It is not known whether Kinrix can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Kinrix has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About Adacel in Brief:

  • Ages: Adacel is a 3 in 1 shot (diphtheria, tetanus, acellular pertussis) used as a booster dose (Tdap) for children and adults 11 years and older (see Sanofi Pasteur product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. petussis disease is not well understood. A serologic correlate of protection for pertussis has not been established. The estimated efficacy of the acellular pertussis vaccine component of Adacel is difficult to determine from available data. See product insert for more information.
  • Use with Other Vaccines: In clinical trials, Adacel was given with hepatitis B or inactivated influenza vaccine. “The safety and effectiveness of concomitant administration of Adacel with other vaccines has not been evaluated.” There is no information in the product insert about the safety or effectiveness of giving Adacel simultaneously with live influenza, meningococcal, HPV, MMR, varicella, hepatitis A, inactivated polio or other vaccines.
  • Commonly Reported Adverse Events: In clinical trials, most common reactions were pain at the injection site, including swelling; fever (especially in adolescents); headache; body aches/muscle weakness; fatigue; chills, sore and swollen joints; nausea, lymph node swelling.
  • Other Serious Adverse Events: After licensure (post-marketing), adverse event reports include severe injection site swelling, bruising, sterile abscess; facial palsy; convulsion; syncope (fainting); parasthesia; Guillain-Barre syndrome; myelitis; anaphylactic reaction; hypersensitivity reaction (angioedema, rash, hypotension); urticaria; muscle spasm; myocarditis.
  • Contraindications (Some reasons why Adacel may not be given to a child or adult – See Sanofi Pasteur product insert for complete list):
    • Moderate or severe acute illness (with or without fever) until the illness resolves;
    • Serious allergic or hypsensitivity reaction to a pervious shot;
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause;
    • In adolescents, a progressive neurologic disorder, including progressive encephalopathy or uncontrolled epilepsy (convulsions);
    • In adults, an unstabled neurologic condition, such as cerebrovascular events and acute encephalopathic conditions;
    • Severe allergic reaction to any component of Adacel.

Animal reproduction studies have not been conducted with Adacel. It is not known whether Adacel can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Adacel has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About Boostrix Vaccine in Brief

  • Ages: Boosterix is a 3 in 1 shot (diphtheria, tetanus, acellular pertussis) used as a booster dose (Tdap) for children and adults 10 years and older (see GlaxoSmithKline product insert for recommended schedule and other indications).
  • Estimated Efficacy: The mechanism of protection from B. pertussis disease is not well established. A serologic correlate for protection from pertussis has not been established. The estimated efficacy of the acellular pertussis vaccine component of Boosterix is difficult to state from available data. See product insert for more information.
  • Use With Other Vaccines: In clinical trials, Boostrix was given with inactivated influenza vaccine (Fluarix) and the efficacy for the pertussis component was lowered. There is no information in the product insert about the safety or effectiveness of giving Boostrix simultaneously with live influenza, MMR, varicella, meningococcal, HPV, hepatitis B, hepatitis A, inactivated polio or other vaccines.
  • Commonly Reported Adverse Events: In pre-licensure clinical trials, pain, redness, and swelling at the injection site, increase in arm circumference of injected arm; headache; fatigue; gastrointestinal symptoms.
  • Other Serious Adverse Events: There was one case of diabetes that developed after Boostrix in clinical trials. After licensure (post marketing) adverse event reports have included extensive inflammation, swelling of injected limb, nodule, itching; encephalitis (brain inflammation); convulsion; facial palsy; lymphadenitis; lymphadenopathy; myocarditis; arthralgia; back pain; myalgia; urticaria; Henoch-Schonlein purpura.
  • Contraindications (Some reasons why Boostrix may not be given to a child or adult – See Sanofi Pasteur product insert for complete list):
    • Serious allergic or hypersensitivity reaction to a previous shot
    • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause
    • In adolescents and adults, a progressive neurologic disorder, including progressive encephalopathy or uncontrolled epilepsy (convulsions).

NVIC NOTE: Some doctors only vaccinate children and adults, who are healthy and are not sick with a coinciding viral or bacterial infection at the time of vaccination. If you or your child are sick and do not want to get vaccinated but your doctor disagrees with you, you may want to consider consulting one or more other trusted health care professionals before vaccinating.

Animal reproduction studies have not been conducted with Boostrix. It is not known whether Boostrix can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Boostrix has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

About ActHIB Vaccine in Brief

ActHIB is a Haemophilus influenza b vaccine that can be reconstituted in the doctor’s office and combined with Tripedia (diphtheria, tetanus, acellular pertussis) to become a 4 in 1 shot (TriHIBit) given to children between 15 and 18 months old. (ActHIB is sold in countries that still use whole cell pertussis (DPT) vaccine, where it is reconstituted with DPT and given to children 2 to 18 months old). See Sanofi Pasteur product insert for recommended schedule and other indications.

Is the Pertussis Vaccine Mandated?

Federal health officials make recommendations for vaccine use and states enact laws that require vaccine use. Currently, there are mandates in every state that children receive of 3 to 6 doses of pertussis vaccine to attend school. Medical exemptions to vaccination are allowed in every state but few medical conditions qualify for a medical exemption, which must be written by a medical doctor (M.D.) or Doctor of Osteopathy (D.O.).

Depending upon which state you live in, you may be legally allowed to exercise a religious or philosophical/conscientious belief exemption to vaccination, including pertussis vaccination. For more information about which vaccines your state requires and exemptions, go here on NVIC’s website.

If you are a health care worker, you may be required to get pertussis vaccine as a condition of employment.

How Effective Is Pertussis Vaccine?

Most public health officials maintain that when pertussis vaccine is used on a widespread basis in a population, it appears to lessen the overall incidence of the disease and that vaccinated children have less severe cases of pertussis whooping cough. When pertussis vaccination rates fell to about 30 percent in Sweden, West Germany, England, and Japan in the 1970’s, these countries saw major increases in reported cases of the disease within three years of that drop in widespread use.

However, in 1984, Swedish epidemiologist B. Trollfors concluded that whole cell B. pertussis vaccines are only effective for 2 to 5 years. He pointed out that even countries with a 90-95 percent vaccination rate (such as the U.S.) could not completely prevent the disease.

According to a 2005 study in the journal, Pediatrics, pertussis containing DTP and DTaP vaccines were estimated to be from 83.6 percent to as much as 97.7 percent effective, depending on the number of doses administered, the combinations of vaccine used in the shot containing pertussis vaccine, and age of the child at which it was administered,

In 2010, an analysis of a California whooping cough outbreak published in the medical literature revealed that more than 80% were fully vaccinated and pertussis vaccine effectiveness was only between 24% and 41% in children two to 18 years old after three years from the date of vaccination.

In 2012, the CDC acknowledged that pertussis vaccine immunity has waned in older children, that DTaP/Tdap immunity begins to wane within five years of vaccination and that unvaccinated individuals and children with vaccine exemptions are not to blame for current whooping cough outbreaks.

There is another Bordetella pertussis whooping cough disease called B. parapertussis. Symptoms of B. parapertussis whooping cough can look identical to B, pertussis whooping cough but they are usually milder. B, parapertussis is increasing in the U.S. and other countries, which have had high pertussis vaccination rates for few decades. There are estimates that perhaps up to 30 percent of whooping cough disease in highly vaccinated populations may be  caused by B. parapertussis organisms.

It is possible to have both B. pertussis and B. parapertussis infections at the same time. Parapertussis is often milder than B. pertussis but can also involve serious complications which lead to pneumonia and death.

Pertussis vaccines widely used around the world do not protect against parapertussis. There is no vaccine for parapertussis.

There is also some evidence that B. pertussis bacteria may have evolved to become vaccine resistant.

Other evidence points to emerging pertussis strains that are not covered in the current DTaP/Tdap and DTP pertussis containing vaccines used in the U.S. and globally.

Can Pertussis Vaccine Cause Brain Damage or Death?

Vaccines are pharmaceutical products and, like all pharmaceutical products, carry a risk of injury or death that can be greater for some than others. The risk for injury or death from vaccination depends upon the vaccine or vaccines given; the individual’s health at time of vaccination; vaccine reaction history; personal or family medical history and whether the child or adult are exposed to other environmental toxins or factors that may affect immune responses to vaccination.

There is a gap in medical knowledge in terms of doctors being able to predict who will have an adverse reaction to pertussis vaccination, and who will not.

B. pertussis bacteria, which cause pertussis whooping cough disease, and lab altered to make pertussis vaccine, contain several toxins that can cause inflammation in the body. Pertussis toxin (PT) is one of the most lethal toxins in nature. The toxin induces lymphocytosis, leukocytosis, stimulates insulin secretion and sensitizes histamine, which is involved in the immune system’s inflammatory response.

Pertussis toxin is thought to be the main component of B pertussis bacteria responsible for stimulating the production of protective antibodies during natural whooping cough infection and after pertussis vaccination. But pertussis toxin is also thought to be the main component responsible for causing brain inflammation during B. pertussis whooping cough or after injection of pertussis-containing vaccines.

Since the 1950’s, scientists have injected pertussis toxin into lab animals whenever they want to deliberately induce histamine, serontonin and endotoxin sensitivity or experimental autoimmune encephalomyelitis. Because pertussis toxin can cross the blood brain barrier when conditions are right, brain inflammation (encephalitis) that causes permanent brain damage has always been the most dreaded serious complication of both whooping cough and pertussis vaccination.

The acellular pertussis vaccine (DTaP/Tdap) vaccines still contain chemically inactivated pertussis toxin (10-25 mcg per dose) that retain varying amounts of bioactivity, which may induce brain inflammation in some individuals. A company producing a genetically engineered DTaP vaccine in the early 1990’s, Chiron, explained one reason why chemically inactivated pertussis toxin will be a problem for some: “Genetic detoxification ensures than no active form of the pertussis toxin is present, while chemically detoxified pertussis toxins may revert to toxicity.”

Another toxin produced by B. pertussis bacteria during natural infection is endotoxin, which is also present in pertussis vaccines in varying amounts. When the immune system detects the presence of endotoxins, it produces a defensive inflammatory immune response, including the release of large amounts of histamine that can, under certain circumstances, lead to high fever, swelling, diarrhea, collapse, shock and death.

The authors of the 1981 British National Childhood Encephalopathy Study (NCES) noted in 1993, and the Institute of Medicine confirmed in 1994, that brain inflammation and encephalopathy is associated with a broad range of long term brain dysfunction that affects the physical, social, behavioral and educational outcomes for children. Signs of brain inflammation in infants or very young children can include high fever; irritability; vomiting; high pitched screaming (encephalitic cry) with or without arching of back; prolonged, uncontrollable crying; collapse and unresponsiveness with pale skin and blue lips; crossing or wandering eyes; drowsiness/lethargy; convulsions (seizures) with or without fever; regression and loss of developmental milestones and negative changes in mental, emotional and physical health. Death or a diagnosis of mental retardation, medication resistant seizure disorders, learning disabilities, attention deficit disorder, autism and other chronic neurological and health problems may follow an acute brain inflammation.

In 1991, the Institute of Medicine (IOM), National Academy of Sciences, published the first of four reports of expert committees, which reviewed the medical literature for evidence that vaccines can cause injury and death. The literature review was mandated under the National Childhood Vaccine Injury Act of 1986. The 1991 IOM report on Adverse Effects of Pertussis and Rubella Vaccines concluded that “evidence is consistent with a causal relation between DPT vaccine and acute encephalopathy (brain inflammation) and “unusual shock-like state” (hypotonic/hyporesponsive episode): and that “evidence indicates a causal relation between DPT vaccine and shock (anaphylaxis) and protracted, inconsolable crying.”

In 1994, the IOM published the report DPT Vaccine and Chronic Nervous System Dysfunction after reviewing the 10-year follow up the British NCES study and concluded that “NCES data are consistent with the possibility that some children without underlying brain or metabolic abnormalities might experience serious acute neurologic illness within 7 days after receiving DPT and that acute illness could have chronic nervous system sequelae. The NCES data also are consistent with the possibility that some children with underlying brain or metabolic abnormalities (which foster a “triggering” by DPT of an acute neurologic illness) might go on to develop chronic nervous system dysfunction due to a DPT-triggered acute illness. Therefore the committee concludes that the balance of evidence is consistent with a causal relation between DPT and the forms of chronic nervous system dysfunction described in NCES in those children who experience a serious acute neurologic illness within 7 days after receiving DPT vaccine.. This serious neurologic risk is a rare event. The estimated excess risk ranged from 0 to 10.5 per million immunizations.”

As of August 2012,  about half of the 2,982 awards for vaccine injury and death totaling nearly $2.5 billion dollars made under the U.S. 1986 National Childhood Vaccine Injury Act involve pertussis containing vaccines.

Most pediatric neurologists acknowledge that vaccination, including use of vaccines for smallpox, rabies, influenza, mumps, measles, tetanus, polio and pertussis, can and does occasionally cause neurological complications that can lead to permanent brain dysfunction.

What Does the CDC Advise About Precautions?

The vaccine manufacturer product information inserts contain the most complete information about contraindications and precautions for use of pertussis vaccine. However, federal health officials at the CDC also publish information about what they consider to be contraindications and precautions for use of pertussis containing vaccines, including DTaP and Tdap.

The CDC lists the following CONTRAINDICATIONS to getting pertussis containing (DTP, DTaP, Tdap) vaccines:

  • Those who have had a life-threatening allergic reaction after a previous dose of DPT, DTaP or TdaP should not get another dose.
  • Those who have suffered a brain or nervous system disease (brain inflammation, coma, convulsions, encephalopathy) within 7 days after a dose of DPT or DTaP should not another dose of pertussis containing vaccine.
  • The CDC lists the following PRECAUTIONS to getting a pertussis containing vaccine (DTP, DtaP/Tdap):
  • Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stablized.
  • Temperature of ≥105° F (≥40.5° C or higher) within 48 hours after vaccination with a previous dose of DTP or DTaP
  • Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
  • Seizure ≤3 days after receiving a previous dose of DTP/DTaP
  • Persistent, inconsolable crying lasting ≥3 hours within 48 hours after receiving a previous dose of DTP/DTaP
  • GBS <6 weeks after a previous dose of tetanus toxoid-containing vaccine
  • History of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria-toxoid containing vaccines (including MCV4); defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine
  • Moderate or severe acute illness with or without fever

Children, who  should not get another dose of pertussis vaccine, often are able to  get a vaccine without pertussis, called DT (diphtheria-tetanus).

Are There Other High Risk Factors for Pertussis Vaccine?

For the first 40 years of use of whole cell pertussis (DPT) vaccine, ABSOLUTE CONTRAINDICATIONS to pertussis vaccination included:

  • Temperature of 103 F. or higher within 48 hours after getting a DPT shot;
  • Seizure within 3 days after getting a DPT shot;
  • Collapse or shock-like state (hypotonic hyporesponsive episode) with 48 hours of getting a DPT shot;
  • High pitched screaming or inconsolable crying within 48 hours of getting a DPT shot;
  • Acute illness with fever

After the 1986 National Childhood Vaccine Injury Act was passed by Congress creating a federal vaccine injury compensation program and shielding vaccine manufacturers and doctors giving vaccines from civil vaccine injury lawsuits, by  1991, these absolute CONTRAINDICATIONS to receipt of pertussis containing vaccines were re-categorized as “PRECAUTIONS” and parents were told to speak with their doctor about further vaccinations.

In general, the same high risk factors and contraindications for whole cell pertussis vaccine (DPT) are also considered high risk factors and contraindications for DTaP, Tdap or other combination shots containing acellular pertussis vaccine. There may be other circumstances, which could place a child or adult at higher risk for reacting to pertussis vaccine that are not officially recognized by the CDC’s Advisory Committee on Immunization Practices (ACIP), the vaccine manufacturers or the American Academy of Pediatrics. You may want to do your own research and access medical studies on the internet or visit a medical library at a community hospital or university to gain access to the medical literature.

Since 1982, the co-founders of NVIC have been concerned about the lack of scientific studies investigating the biological mechanisms and high risk factors for pertussis vaccine, which has long been associated with reports of injury and death in more than 60 years of medical literature. Acknowledgement of biodiversity and genetic variation between individuals argues for a national scientific research agenda, which responsibly examines the biological factors that predispose some individuals to responding adversely to vaccination, including pertussis vaccination, and suffering brain and immune system damage or death.

In 1946, Werne and Garrow reported the deaths of identical twins within 24 hours of their second diphtheria-pertussis shot. The same outcome in identical twins following receipt of a pertussis vaccine-containing vaccine suggested genetic predisposition. The possibility of genetic predisposition to adverse responses to vaccination has been cited in the scientific literature. Additionally, there have been reports of two, three and four children in the same family, who have experienced serious reactions to pertussis-containing vaccines and suffered permanent brain damage.

Following is a list of potential high risk factors for pertussis vaccine reactions, which are not acknowledged by public health officials, vaccine manufacturers or medical organizations, but which deserve serious scientific investigation.

Family History of Convulsions or Neurological Disease For most of the time that pertussis vaccine has been used, a personal history of convulsions or neurological disease has been listed as an absolute contraindication or serious precaution. In the past, some European countries have exercised caution and contraindicated pertussis vaccination if a member of the child’s immediate family (brother, sister, mother or father) has a history of convulsions or neurological disease.

The product information circular accompanying DPT vaccine manufactured by Lederle Laboratories in 1985 stated, "Routine immunization with this product should not be attempted if the child has a personal or family history of central nervous system disease or convulsions."

The product information circular accompanying DPT vaccine manufactured by Connaught Laboratories in 1989 stated, "Use of this product is also contraindicated if the child has a personal or family history of a seizure disorder.”

In 1975, a World Health Organization-sponsored international meeting of pertussis vaccine experts recommended that "children from families with a history of neurological disorders should not be vaccinated."

In 1977, the Department of Health and Social Security in England stated that children should not be given pertussis vaccine if they have a "family history of epilepsy or other diseases of the central nervous system.”

In a 1987 recommendation published in the Morbidity and Mortality Weekly Report, the CDC stated "recent studies suggest that infants and children with a history of convulsions in the first degree family members (i.e. siblings and parents have a 3.2 fold increase risk for neurologic events compared with those without such histories (CDC, unpublished data)." The CDC went on to recommend, however, that these children should still receive pertussis vaccine.

Premature Birth or Low Birth Weight – Babies who are born prematurely may have neurological, respiratory, and immunological systems that are not as fully developed as those who are full-term. Premature and low weight babies are at high risk for dying from pertussis whooping cough disease but may also be at higher risk for adverse responses to pertussis vaccination.

A 1994 study of 2-month old babies in a special care nursery for premature/low birth weight babies in Dallas showed 19 percent had either new or increased episodes of apnea (stopped breathing) in the 24 to 48 hours after being vaccinated with DPT and HIB vaccines, and some required oxygen and other support to begin breathing again.

Several pertussis containing vaccines on the market today, list apnea as a reported adverse event and also advise caution when vaccinating premature babies with some pertussis containing vaccines.

Cerebral Irritation in the Neonatal Period – Newborn babies can exhibit cerebral irritation following birth, including high pitched screaming (encephalitic cry) with arching of the back, depressed consciousness and other neurological signs. A difficult labor and birth can cause cerebral irritation as can inflammation of the brain from meningitis or other infection. An infant with symptoms of cerebral irritation after birth may be manifesting evidence of a weakened or damaged neurological system that may be especially vulnerable to the inflammatory effects of the pertussis vaccine.

In years past, the British department of Health and Social Security stated that pertussis vaccination "should not be carried out in children who have … a history of cerebral irritation or damage in the neonatal period."

A Personal or Family History of Severe Allergies and Autoimmune Disorders – A healthy, mature immune system requires an equal balance of cellular (Th1 - innate) and humoral (Th2 - learned) immune system responses to prevent inflammatory responses from remaining unresolved and causing chronic illness. A disruption in immune function can lead to chronic inflammation and development of allergy or autoimmune disorders.

Vaccination does not exactly mimic the natural infection process and often by-passes cellular immunity in favor of humoral immunity (measured by antibodies in the blood). There have been persistent reports that some individuals may be at risk for developing autoimmune disorders after vaccination.

In than 60 years of scientific literature reporting complications of pertussis vaccine, there have been reports by some researchers that a history of severe allergies or autoimmune disorders in a child or his family (eczema, asthma, hay fever, milk allergy) may predispose a child to reacting to the pertussis vaccine. In England in past decades, a personal or family history of allergies was considered a contraindication.

Dow Chemical Company’s DPT product insert in the 1960s stated "fractional doses are recommended in infants with cerebral injury, asthma, a strong family history of allergy …"

In 1961, Hopper found that in a group of babies who reacted strongly to the pertussis vaccine, there was twice as much eczema, asthma, hay fever, and allergic skin rashes in the child, his brothers and sisters, parents, and grandparents as there was in a control group of the same size.

In 1969, Hannik found a positive family history of allergies in a significant proportion of infants who reacted with high-pitched screaming, shock and convulsions.

In 2000, a study comparing the health of vaccinated and unvaccinated children between 1988 and 1994 found that a child who received DPT or tetanus vaccination was 50 percent more likely to experience severe allergic reactions, more than 80 percent more likely to experience sinusitis, and twice as likely to experience asthma as those who were not vaccinated. The conclusion of the authors was that “asthma and other allergic hypersensitivity reactions and related symptoms may be causes, in part, by the delayed effects of DTP or tetanus vaccination.”

A healthy, mature immune system requires an equal balance of cellular (inate) and humoral (learned) immune system responses so that inflammatory responses do not remain unresolved and cause chronic illness. A disruption in immune function can lead to development of allergy and autoimmune disorders. Vaccination does not exactly mimic the natural infection process and often by-passes cellular immunity in favor of humoral immunity. There have been persistent reports of development of autoimmune disorders and allergy after vaccination, including pertussis vaccination.

Milk Allergy (Casein Intolerance) – 1982 and 1985, studies identified genetic susceptibility to pertussis vaccine induces encephalopathy involving genes of the major histocompatibility complex correlating to genetic regulation of antibody responses to bovine serum albumin (a cow’s milk protein).

A personal or family history of allergies, particularly milk (casein) allergy, may be one high risk factor for reacting to pertussis vaccine. There were many cases of pertussis vaccine injury documented in the 1985 book DPT: A Shot in the Dark of children, who had milk allergy before or developed milk allergy after suffering a serious DPT vaccine reaction. Casein is a protein in milk and symptoms of milk allergy include frequent spitting up of milk after bottle or breast feeding; projectile vomiting of milk; frequent diarrhea; constipation; gas and abdominal pain; persistent crying after feedings (colic); eczema or recurrent skin rashes.

Children with casein allergy are often also allergic to foods containing gluten, which is a protein in wheat and other kinds of grains. The genes for both casein and gluten intolerance are inherited and symptoms can be mild or severe. Severe gluten intolerance is diagnosed as celiac disease, which can cause loss of weight and failure to thrive; gas and stomach pain; diarrhea/constipation; anemia; mouth ulcers; extreme fatigue (especially after eating gluten containing foods); and behavior disorders. If left undiagnosed without dietary elimination of foods containing gluten, celiac disease can lead to malnourishment and retarded growth in children; irritability; depression; seizures; permanent brain and immune system disorders or even death.

Sickness at Time of Vaccination – When a person has a coinciding viral or bacterial infection at the time of vaccination, the body may not mount an antibody response and fail to provide any protection. In addition, when a child or adult is sick at the time of vaccination and an even more serious health problem develops following vaccination, there may be confusion about whether the new health problem is related to the vaccination, to the infection present at the time of vaccination, or a combination of the two.

One article in the medical literature suggests that as long as "a four week interval between illness and vaccination may be advisable" and warns that while "it is a matter of clinical judgment how long the vaccine should be deferred….in administering the vaccines of any kind care should be taken to exclude the likelihood of infection in the child, his family, or other close contacts."

In order to ensure that your child is healthy at the time of vaccination, make sure a doctor gives your child a careful physical exam before giving shots. This should include taking a temperature and a thorough exam of your child’s throat and ears. Be sure to mention any illness, however slight, that your child has had in the previous months or if you or a member of your family may have an infection to which your child has been exposed.

How to Recognize a Pertussis Vaccine Reaction

It cannot be emphasized enough that parents should monitor their children carefully day and night for at least 72 hours after vaccination. The first 24-hour post-vaccination is an especially important time to be alert. Although identifying a severe vaccine reaction is the shared responsibility of parents and doctors, only parents can be with a child 24 hours a day.

Many children react to pertussis containing vaccines and recover without any apparent effects while others are left with chronic health problems. It is important to know how to recognize a potential vaccine reaction and to seek medical attention immediately if you suspect your child is suffering a severe vaccine reaction, such as unresponsiveness, convulsion (seizure), high pitched screaming (encephalitic cry) or other signs of brain inflammation.

It is important for parents to know what constitutes a severe reaction to a petussis vaccine containing shot because it is generally agreed by vaccine policy makers that those who react severely should not receive the "P" or pertussis portion of the DPT, DTap or Tdap shot again. For subsequent boosters, only the "D" (diphtheria) and "T" (tetanus) portion of the shot is given.

Pertussis vaccine has been documented to cause high fever; severe local reactions at the site of the injection; high pitched screaming and uncontrollable crying; collapse/shock (hypotonic/hyporesponsive episode); lethargy (excessive sleepiness); convulsions with or without fever; and brain inflammation (encephalopathy).

Following are descriptions of more serious vaccine reactions symptoms in the words of parents:

  • Collapse/Shock: “She turned white with a blue tinge around her mouth and went completely limp.”
  • Convulsion: “Her eyes twitched, her chin trembled, her body went rigid and then would shake.”
  • Behavior Changes: “She won’t sleep or eat. She throws herself down and screams for no reason. She was sweet and happy and is now out of control. She changed into a totally different child.”
  • High Fever: “His temperature was 105 degrees. I had to put cool towels on him to bring the fever down.”
  • Injection Site: “There was a big, hot swollen lump at the site of the shot that stayed for weeks.”
  • High Pitched Screaming: “It was a pain cry, a shrill scream and lasted for hours and nothing would help.”
  • Excessive Sleepiness: “He passed out and we couldn’t wake him to feed or do anything for over 12 hours.”
  • Brain Inflammation: “He just laid in his crib with his eyes wide open, then would arch his back and scream and go unconscious. Now he has seizures.”
  • Regression: “My 18 month old son stopped talking and walking after those shots. He developed severe allergies, constant diarrhea, ear infections and was sick all the time.”
  • Other Descriptions of Complications:
    • Allergic hypersensitive reactions occur within minutes or hours of vaccination and may include hives, sudden swelling of the mouth or throat, difficulty breathing, hypertension and shock.
    • Thrombocytopenia and Hemolytic Anemia are two blood disorders which have been reported to rarely follow pertussis vaccine containing shots. Thrombocytopenia means a reduced number of platelets circulating in the blood and can cause "purpura" (blotchy red patches on the child’s body caused by the thinned blood seeping into the tissues beneath the skin).
    • Diabetes and Hypoglycemia – The body’s glucose (sugar) metabolism is regulated by insulin which is secreted by the pancreas. Researchers have detected increased insulin production in infants injected with pertussis vaccine.
    • In 1970, Pittman stated "the infant whose blood sugar level is influenced by food intake may be especially vulnerable to vaccine-induced hypoglycemia should a feeding be missed because of a feverish reaction following vaccinations."
    • Hannik and Cohen in 1978 concluded, "infants who show serious reactions following pertussis vaccination suffer from failure to maintain glucose homeostasis."
    • A 1982 study detailed the role the DPT vaccine played in causing diabetes in a 16-month old girl who was genetically predisposed to diabetes and who suffered from a viral infection that attacked her pancreas.

If your child exhibits one or more of these symptoms or other dramatic change in physical, mental or emotional health/behavior within hours, days or weeks after vaccination, you should immediately have your child examined by your physician or go to the emergency room of your local hospital.

Make sure the date and time of the vaccination and the symptoms your child is having are recorded in your child’s medical record and that you do not leave the office or hospital without a written medical record that your child has been examined.

You can request that medical personnel make a formal vaccine adverse event report to the federal Vaccine Adverse Event Reporting System (VAERS).

The Pertussis Vaccine, Death, and SIDS

Death was the first reaction to be associated with pertussis vaccine. In 1933, the Danish vaccine researcher Madsen described the deaths of two babies within a few hours after they had been vaccinated.

It is not known how many pertussis vaccine-related deaths occur in the US each year because sometimes the deaths of babies, who die after experiencing symptoms of reactions to DTaP, are misclassified as SIDS. Sudden Infant Death Syndrome (SIDS). SIDS usually involves the sudden, unexplained death of an infant, where there are no symptoms of any health problems before the baby is found lifeless.

Babies, who die after exhibiting pertussis vaccine reaction symptoms (such as high pitched screaming, collapse, extreme lethargy, convulsions) do not fit the general criteria of SIDS but are rarely reported as vaccine-related deaths.

The National Childhood Vaccine Injury Act of 1986

The safety provisions of the National Childhood Vaccine Injury Act of 1986 mandated that parents be given written information about vaccine benefits and risks before children are vaccinated; that written records be kept of all serious health problems that occur following vaccination as well as the manufacturer’s name and lot number; and that vaccine providers report adverse events that occur within 30 days of vaccination to the federal Vaccine Adverse Events Reporting System (VAERS).

After your child receives a vaccination, you may request a written record of:

  • the date and time of day the vaccine was given;
  • the type of vaccine and the dose number;
  • the name and title of the person who gave the shot;
  • the vaccine manufacturer’s name;
  • the vaccine lot number

All reports of serious health problems following vaccination should be made to the Vaccine Adverse Events Reporting System (VAERS). If your doctor or nurse refuses to make a vaccine adverse event report, you have the right to report yourself by calling 800-822-7967. NVIC can provide you with the forms and assist you in reporting the reaction.

Conclusion

It is important to be equally concerned and knowledgeable about the risks of pertussis disease as we are about the risks of pertussis vaccine. Both B, pertussis whooping cough and the pertussis vaccine carry risks. Pertussis disease has the potential to cause seizures, brain damage, and even death, just as the vaccine can.

Most of America’s medical community believes that the risk of serious injury or death from pertussis is greater than the risk of injury or death which can be caused by pertussis vaccine. However, recognition of and concern about the risks of pertussis disease does not diminish our need and responsibility to acknowledge the need to minimize pertussis vaccine risks.

The challenge today is for parents, physicians, scientists, manufacturers and health officials to recognize the risks of both the disease and the vaccine and work to protect the health and well being of every child.

References & Links to More Information

Manufacturer Product Information Inserts:

  • Sanofi Pasteur Tripedia (Diphtheria, Tetanus and Pertussis combined)
  • GlaxoSmithKline Infanrix (Diphtheria, Tetanus, Pertussis combined)
  • Sanofi Pasteur DAPTACEL (Diphtheria, Tetanus, Pertussis combined)
  • GlaxoSmithKline Pediarix (Diphtheria, Tetanus, Pertussis, Hepatitis B, Inactivated Polio combined)
  • GlaxoSmithKline KINRIX (Diphtheria, Tetanus, Pertussis, Inactivated Polio combined)
  • Sanofi Pasteur Pentacel (Diphtheria, Tetanus, Pertussis, Inactivated Polio, Haemophilus B combined)
  • Sanofi Pasteur Adacel Tdap (Tetanus, Diphtheria, Pertussis combined)
  • GlaxoSmithKline Boostrix (Tetanus, Diptheria, Pertussis combined)
  • Sanofi Pasteur ActHIB (Diphtheria, Tetanus, Pertussis, Haemophilus Influenza B combined)
  • GlaxoSmithKline Pediarix (Pertussis, Tetanus, Diphtheria, Hepatitis B and Inactivated Polio)

Centers for Disease Control

Food & Drug Administration

Report a Pertussis Vaccine Reaction to the Government Vaccine Adverse Events Reporting System (VAERS)

Search VAERS Vaccine Adverse Event Reports on MedAlerts Database

Report a Pertussis Vaccine Reaction to NVIC

Report Harassment to NVIC

Has your doctor or a vaccine provider refused to report a serious health problem after vaccination to the federal Vaccine Adverse Event Reporting System (VAERS), or discouraged you from reporting a vaccine reaction you or your child experienced?

Have you been threatened or harassed for making vaccine decisions which does not conform with your doctor’s opinion?

NVIC supports your right to make informed, voluntary health care decisions. To make a report of harassment for making informed vaccination choices to NVIC, click here.

NVIC Reports & Referenced Video Commentaries

Fisher BL. Whooping Cough Outbreaks and Vaccine Failures. NVIC Vaccine E-news July 8, 2010.

Fisher BL. Using Fear and Prejudice to Attack Vaccine Exemptions. NVIC Vaccine E-news Aug. 4, 2010.

Fisher BL. Find a Compassionate Doctor to Help You Prevent Vaccine Injuries. NVIC Vaccine E-news. Aug. 28, 2012.

Books

  • DPT: A Shot in the Dark by Harris L. Coulter and Barbara Loe Fisher (Harcourt Brace Jovanovich, 1985; Warner, 1986; Avery 1991; Penguin Books)
  • Vaccines, Autism & Chronic Inflammation: The New Epidemic by Barbara Loe Fisher (2008)

World Health Organization

Selected Medical Literature

  • Pediatrics: Safety & Immunogenicity of Pentavalent (DTaP5-IPV-Hib) Vaccine. Vol 123, No. 1, Jan. 2009, pp 301-312.
  • Acute Myocarditis After DPT Vaccination – Asian Cardiovascular & Thoracic Annals 2006; 14:e111-e112. An infant develops acute myocarditis after the DPT vaccination, and dies while waiting for a heart transplant
  • Harrison’s Principles of Internal Medicine
  • Madge N. Diamond J, Miller D, Ross E, et al. The National Childhood Encephalopathy Study: A 10-Year Follow-Up. A report of the medical, social, behavioral, and educational outcomes after serious, acute neurological illness in early childhood. Dev Med Child Neurol 193;68:35:1-118
  • Pediatrics – August 2005 study on effectiveness of DPT vaccine
  • Gold, R. Pertussis: The Disease & the Vaccine. Canadian Family Physician. Vol 32, January 1986, pp. 79-83.
  • Legido A, Tenembaum SN, Katsetos CD, Menkes JH. Autoimmune & Postinfectious Diseases (Chapter 8). Child Neurology – 7th Edition. Lippencott Williams & Wilkins, 2006. Pages 631-634 (Neurologic Complications of Immunizations).
  • Grilc E, Pirnat N. Pertussis outbreak in recently vaccinated children in a kindergarten in Ljubljana during a resurgence in pertussis incidence. Eurosurveillance. Vol. 10, Issue 33. 18 August 2005.
  • Sidney M, Furman BL, Wardlaw AC. Effect of hyperreactivity to endotoxin on the toxicity of pertussis vaccine and pertussis toxin in mice. Vaccine. Vol. 7, Issue 3. June 1989. Pages 237-241.
  • World Health Organization (WHO). Requirements for Diphtheria, Tetanus, Pertussis 7 Combined Vaccines (Revised 1989). Technical Report Series, No) 500. 1990. Steinman L, Weiss A et al. Pertussis toxin is required for pertussis vaccine encephalopathy. Proc Natl Acad Sci, 1985. December; 82(24) 8733-8736.
  • Hofstetter HH, Shive CL, Forsthuber TC. Pertussis Toxin Modulates the Immune Response to Neuroantigens Injected in Incomplete Freund’s Adjuvant: Induction of Th1 Cells and Experimental Autoimmune Encephalomyelitis in the Presence of High Frequencies of Th2 Cells. The Journal of Immunology, 2002. 169: 117-125.
  • Gupta RK, Relyveid EH. Adverse reactions after injection of adsorbed diptheria – pertussis – tetanus (DPT) vaccine are not due only to pertussis organisms or pertussis components in the vaccine. Vaccine. Vol. 9, Issue 10. October 1991. Pages 699-702.
  • Bergfors E, Trollfors B, Inerot A. Unexpectedly high incidence of persistent itching nodules and delayed hypersensitivity to aluminum in children after the use of adsorbed vaccines from a single manufacturer. Vaccine. Vol. 22, Issue 1. December 8, 2003. Pages 64-69.
  • Rimaniol AC, Gras G et al. Aluminum hydroxide adjuvant induces macrophage differentiation towards a specialized antigen-presenting cell type. Vaccine. Vol. 22, Issues 23-24. 13 August 2004. Pages 3127-3135.
  • Mooi F R, van LooIHM, King A. Adaptation of Bordetella pertussis to Vaccination: A Cause for its Reemergence? Emerging Infectious Diseases. Vol. 7, No. 3 Supplement June 2001.
  • Srugo I, Benilevi D et al. Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel. Emerging Infectious Diseases. Vol. 6, No. 5 September-Oct. 2000.
  • Brooks DA, Clover R. Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults. Journal of the American Board of Family Medicine 19:603-611. 2006.
  • Kheief N, Danve B etal. Bordetella pertussis and Bordetella parapertussis: two immunologically distinct species. Infection & Immunity. 1993 February; 61(2): 486-490.
  • He Q, Vijanen MK et al. Whooping Cough Caused by Bordetella pertussis and Bordetella parapertussis in an Immunized Population. JAMA. 1998; 280: 635-637.
  • Liese JG, Renner C. Clinical and epidemiological picture of B pertussis and B parapertussis infections after introduction of acellular pertussis vaccines. Archives of Diseases in Childhood2003; 88: 684-687.
  • Magin K. Low vaccination rates cause worry over whooping cough. The Union (Nevada). June 15, 2010.
  • LabCorp. A Technical Review: Bordetella pertussis and Bordetella parapertussis Detection using Real-time PCR. 2007.
  • Preston A. Bordetella pertussis: the intersection of genomics and pathobiology. Canadian Medical Association Journal. July 5, 2005. 173 (1)
  • A Simple Chemically Defined Medium for the Production of Phase I Bordetella pertussis; D.W. Stainer and M.J. Scholte; 1971. Describes the Stainer-Scholte growth medium for pertussis; also explains how pertussis vaccine acts as an adjuvant (booster) to diphtheria and tetanus vaccines
  • Clinical & Experimental Medicine: The Current Epidemiology of Pertussis in the Developed World; 1988; 13 Suppl: 97-101
  • DPT Vaccine and Chronic Nervous Dysfunction: A New Analysis, Institutes of Medicine. Washington, DC:National Academy Press, 1994

Additional Bibliography:

  • Baraff, L.J., et al. 1983. Possible temporal association between diphtheria-tetanus toxoid-pertussis-vaccination and sudden infant death syndrome. Pediatric Infectious Disease 2(1):7-11.
  • Barkin, R.M., and Pichichero, M.E. 1979. Diphtheria-pertussis-tetanus vaccine: Reactogenicity of commercial products. Pediatrics 63(2):256-60.
  • Berg, J.M. 1958. Neurological complications of pertussis immunization. British Medical Journal (July 5), 24,-27.
  • Byers, R.K., and Moll, F.C. 1948. Encephalopathies following propylactic pertussis vaccination. Pediatrics 1(4):437-56.
  • Cavanaugh, N.P.C., et al. 1981. The possible adjuvant role of bordetella pertussis and pertussis vaccine in causing severe encephalopathic illness: A presentation of three case histories. Neuropediatrics 12 (4):374-81.
  • Champsaur, H., et al. 1982. Virologic, immunologic, and genetic factors in insulin dependent diabetes mellitus. Journal of Pediatrics 100(1):15-20.
  • Cockburn, W.C. 1951. Whooping cough immunization. Practitioner 167:232-36.
  • Cody, C.L., et al. 1981. Nature and rates of adverse reactions associated with DPT and DT immunizations in infants and children. Pediatrics 68(5):650-60.
  • Coulter, H.L., and Fisher, B.L. 1985. DPT: A Shot in the Dark, New York: Harcourt Brace Jovanovich.
  • Dick, G.W.A. 1967. Reactions to the pertussis component of quadruple and triple vaccines. International Symposium on Combined Vaccines, Masburg. Symposia Series in Immunobiological Standardization 7:21-28.
  • Basel and New York Karger.
  • Gerathy, K.C. 1984. DPT Immunization and SIDS. Journal of Pediatrics 105:169-170.
  • Globus, J.H., and Kohn, J.L. 1949. Encephalopathy following pertussis vaccine prophylaxis. Journal of the American Medical Association 141(8):507-9.
  • Halpern, S.R., and Halpern, D. 1955. Reactions from DPT immunization and its relationship to allergic children. Journal of Pediatrics 47:60-67.
  • Hanik, C.A. 1969. Major reactions after DPT-polio vaccination in the Netherlands. International Symposium of Pertussis, Bilthoven. Symposium Series on Immunobiological Standardization 13 161-70: Basel, Mughen, New York: Karger.
  • Hannik, C.A. and Cohen, H. 1978. Changes in plasma insulin concentration and temperature of infants after pertussis vaccination. International Symposium on Pertussis, 297-99.
  • Hennessen, W., and Quast, U. 1979. Adverse reactions after pertussis vaccination. International Symposium on Immunization: Benefits vs. Risk Factors, Brussels. Developments in Biological Standardization 43:95-100.
  • Basel: Karger.
  • Hinman, A.R., and Koplan, J. 1984. Pertussis and pertussis vaccine: Reanalysis of benefits, risks, and costs. Journal of the American Medical Association 251(23):3109-13.
  • Hopper, J.M. 1961. Illness after whooping cough vaccination. Medical Officer (October 20), 241-44.
  • Kalokerinos, A. 1981. Every Second Child. New Canaan, Conn.: Keats.
  • Koplan, J.P., et al. 1979. Pertussis vaccine –An analysis of benefits, risks, and costs. New England Journal of Medicine 301(17):906-11.
  • Kulenkampff, M., et al. 1974. Neurologic complications of pertussis inoculation of pertussis inoculation. Archives of Disease in Childhood. 49 46-49.
  • Linthicum, D.S., et al. 1982. Acute experimental autoimmune encephaloyelitis in mice. Cellular Immunology 73:229-310.
  • Low, N.L. 1955. Electroencephalographic studies following pertussis immunization. Journal of Pediatrics 47: 35-39.
  • Madsen, T. 1933. Vaccination against whooping cough. Journal of the American Medical Association 101(3):187-88.
  • Menkes JH, Kinsbourne M. Neuropediatr 1990;21:171-6
  • Mortimer, E.A., Jr. 1980. Pertussis immunization: Problems, perspectives, prospects. Hospital Practice (October), 103-18.
  • Pittman, M. 1970. Bordetella pertussis – Bacterial and host factors in the pathogenesis and prevention of whooping cough. In S. Mudd, ed. Infectious agents and host reactions: Philadelphia: W.B. Saunders, 239-70.
  • Pollack, T.M., et al. 1984. Severity of whooping cough in England before and after the decline in pertussis immunization. Archives of Disease in Childhood 59:162-165.
  • Robinson, D.A., et al. 1981. Whooping Cough – a study of severity in hospital cases. Archives of Disease in Childhood 56:687-91.
  • Steinman, L., et al. 1982. Murine model of pertussis vaccine encephalopathy: Linkage to H-2. Nature 299: 738-40.
  • Stewart, G.T. 1977. Vaccination against whooping cough: Efficacy vs. risks. Lancet (January 29) 234-37.
  • Stewart, G.T., et al. 1981. Pertussis vaccine and acute neurological disease in children. British Medical Journal (June 13), 1968-69.
  • Strom, J. 1960. Is universal vaccination against pertussis always justified: British Medical Journal (October 22) 1184-86.
  • Strom, J. 1967. Further experience of reactions, especially of a cerebral nature, in conjunction with triple vaccination: study based on vaccinations in Sweden, 1959-1965. British Medical Journal 4:320-23.
  • Taranger, J. 1982. Mild clinical course of pertussis in Sweden. Lancet (June 12), 1360.
  • Torch, W.C. 1982. Diptheria-pertussis-tetanus (DPT) immunization: A potential cause of sudden infant death syndrome (SIDS), American Academy of Neurology, 34th Annual Meeting, April25-May1. Neurology 32(4):pt. 2.
  • Trollfors, B., and Rabo, E. 1981. Whooping cough in adults. British Medical Journal (September 12), 696-97.
  • Trollfors, B., et al. 1984. Bordetella Pertussis Whole Cell Vaccines: Efficacy and Toxicity. Acta Pediatrica Scandinavica 73: 917-923.
  • Valman, H.B. 1980. Contraindications to immunization. British Medical Journal (May 3), 1138-39.
  • Werne, J., and Garrow, I. 1946. Fatal anaphylactic shock occurrence in identical twins following second injection of diptheria toxoid and pertussis antigen. Journal of the American Medical Association 131(9): 730-35.



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