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Pertussis Disease and Vaccine


Quick Facts

Pertussis (whooping cough)

  • Pertussis, commonly referred to as whooping cough, is a 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.1 Only a lab test will positively confirm the exact organism causing the whooping cough symptoms.2
  • Pertussis whooping cough is highly contagious. Whooping cough disease circulates all year long, however, in North America, more cases are diagnosed in the summer and fall.3
  • 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. 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.4
  • 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 mucous 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, 5 where large amounts of mucous are vomited up through the mouth and nose and interfere with breathing. The fatality rate for B. pertussis whooping cough disease is highest in infants under six months of age.6 Older children and adults can suffer rib fractures from violent coughing fits.7 Permanent health problems resulting from whooping cough disease can include brain inflammation,8 seizure disorders,9 mental retardation, learning disabilities, ADD/ADHD and other chronic illness.10
  • 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.11  
  • In 1922, there were 107,473 pertussis cases reported in the U.S. with 5,099 deaths.12 In the United States, deaths from pertussis infections dropped by more than 75% between 1922 and 1948, the year beforethe DPT vaccine was licensed. Mortality associated with pertussis declined dramatically in the 1940’s as living conditions improved.13

Pertussis 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). The ACIP also recommends that pregnant women receive a dose of Tdap vaccine during each pregnancy, between 27 and 36 weeks gestation, regardless of a previous history of Tdap vaccine.14 However, this recommendation contradicts the information provided by the vaccine manufacturers statement that the safety and effectiveness of vaccination has “not been established in pregnant women”.15 16
  • There are currently 8 different pertussis vaccines licensed in United States.17 DTaP/Tdap vaccines packaged in single dose vials contain reduced bioactive pertussis toxin, less endotoxin than the DTP vaccine, and may contain trace amounts of mercury, along with an aluminum adjuvant. Depending upon the vaccine manufacturer, vaccines containing pertussis 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).18
  • IMPORTANT: Parents should monitor their children carefully day and night for at least 72 hours after vaccination.19 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).20
  • According to the CDC, in 2017, out of a U.S. population of 326 million people, there were 15,808 reported cases of pertussis including 13 deaths, with 4 deaths occurring in infants under age one year.21 Out of 3,663 cases occurring in children from six months of age through six years of age, 44 percent of cases occurred in children who had completed the primary DTaP series22 and there are reported increases in whooping cough disease in the U.S. and other countries, no matter how high the vaccination rate.23
  • As of August 8, 2018, there had been 5,369 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following pertussis-containing vaccination, including 862 deaths and 4507 serious injuries.
  • Using the MedAlerts search engine, as of June 30, 2018 there had been 150,043 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with pertussis-containing vaccines since 1990. Half of those serious pertussis vaccine-related adverse events occurring in children under the age of three. Of these pertussis-vaccine related adverse event reports to VAERS, 2,745 were deaths, with over 90% of the deaths occurring in children under three years of age.

IMPORTANT NOTE: NVIC "Quick Facts" is not a substitute for becoming fully informed about Pertussis and the Pertussis vaccine. NVIC recommends consumers read all topics in the Table of Contents, as well as the vaccine manufacturer product information inserts, and speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

Food & Drug Administration (FDA)

Centers for Disease Control (CDC)

National Institute of Allergy & Infectious Diseases (NIAID)

Search for Vaccine Reactions

NVIC hosts MedAlerts, a powerful VAERS database search engine. MedAlerts examines symptoms, reactions, vaccines, dates, places, and more.

Reporting a Vaccine Reaction

Since 1982, the NVIC has operated a Vaccine Reaction Registry, which has served as a watchdog on VAERS. Reporting vaccine reactions to VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS.

Vaccine Reaction Symptoms & Ingredients

Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more. Calculate vaccine ingredients for potential toxic exposures & print a vaccination plan with the Vaccine Ingredients Calculator.   

IMPORTANT NOTE: NVIC encourages you to become fully informed about Pertussis and the Pertussis vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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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.24 The major symptom of B. pertussis whooping cough disease is uncontrollable coughing.25

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.26

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, pneumothorax, hernias, subdural hematomas and death.27

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.28 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.29 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.30 Sometimes babies must have the mucous suctioned from their throats so they can breathe.31

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.32

Symptoms of pertussis are sometimes milder in those who have had one or more doses of pertussis containing vaccines (DPT, DTaP, Tdap)33 and doctors or nurses may not suspect B. pertussis whooping cough in vaccinated children, adolescents and adults, who present with a bad cough.34 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.

The only sure way to find out if you or your child have B. pertussis or Bordetella 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.35 Bordetella parapertussis, another pertussis disease, can look identical to B, pertussis whooping cough, however symptoms are generally milder.36 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.37 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. 38 Pertussis vaccines widely used around the world do not protect against B. parapertussis. There is no vaccine for B. parapertussis.39

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.40 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.

Is pertussis contagious?

Pertussis whooping cough is highly contagious. 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.41 Whooping cough disease circulates in all months but, in North America, more cases are diagnosed in the summer and fall.42

The incubation period for B. pertussis after contact with an infected person and before symptoms begin is between 4 and 21 days, but typically in the range of 7 to 10 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.43 Antibiotics are usually prescribed to help prevent transmission to others and lower the risk of complications, such as pneumonia.44

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 mild or serious case of B. pertussis whooping cough. However, according to the CDC, 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. 45

What is the history of pertussis in America and other countries?

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.46 In the United States, deaths from pertussis infections dropped by more than 75% between 1922 and 1948, the year before the DPT vaccine was licensed. In 1948, the mortality rate was less than 1 pertussis death per 100,000 persons and would never be higher than that again.47 48 Mortality associated with pertussis declined dramatically in the 1940’s as living conditions improved, including sanitation and hygiene and access to health care.49 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.50 In 2013, there were about 29,000 reported pertussis cases and 13 pertussis-related deaths in America, with nine of those deaths in infants under age one.51 

According to the CDC, in 2017, out of a U.S. population of 326 million people, there were 15,808 reported cases of pertussis including 13 deaths, with 4 deaths occurring in infants under age one year.52 Out of 3,663 cases occurring in children from six months of age through six years of age, 44 percent of cases occurred in children who had completed the primary DTaP series.53

However, many cases of whooping cough are never diagnosed or reported. Every three 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.54

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.55 The World Health Organization estimates that globally 85 percent of children have gotten three pertussis shots. However each year, approximately 160,000 children under age five die from pertussis complications such as pneumonia, with over 60 percent of these children live in Africa.56 57 Mortality rates from infectious diseases are always higher where people live in poverty, with crowding and poor sanitation, industrial pollution, substandard nutrition, and lack of access to health care facilities.58 In 2015, the World Health Organization reported 142,512 cases of pertussis globally.59

In the U.S., Canada, Australia, Europe and other developed countries, 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.

Can pertussis cause injury and/or death?

Yes, according to the CDC, during 2017, out of the 15,808 reported cases of pertussis there were 13 deaths, with 4 deaths occurring in children less than one year of age. 60  

However, 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.61 The most serious complication of both whooping cough disease (and pertussis vaccine) is brain inflammation leading to varying degrees of permanent brain dysfunction.62

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.63

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.64

Another toxin produced by B. pertussis bacteria during natural infection is endotoxin, which is also present in pertussis vaccines in varying amounts. 65 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.66

The fatality rate for B. pertussis whooping cough disease is highest in infants under six months of age.67 Older children and adults can suffer rib fractures from violent coughing fits.68 Permanent health problems resulting from whooping cough disease (and the pertussis vaccine can include continuing seizure disorders,69 mental retardation, learning disabilities, ADD/ADHD and other chronic illness.70

Who is at highest risk for getting pertussis?

Young infants with developing immune systems, as well as older children, adolescents, and adults may be at risk for developing pertussis.71 Studies have indicated that infants do not appear to receive substantial benefits from maternal antibodies, which may put them at a higher risk of developing pertussis.72 For many individuals, the pertussis vaccine (DPT, DTaP, TDaP) does not give long lasting protection against the disease and some individuals will never develop temporary immunity despite receiving all recommended boosters.73, 74, 75 Over time, the temporary immunity individuals may acquire through vaccination wanes, which often results in outbreaks of B pertussis in fully vaccinated children, teenagers and adults.76, 77, 78, 79

Other populations who may be at risk for developing pertussis include healthcare personnel or persons with weakened immune systems.80

Who is at highest risk for suffering complications from pertussis?

Young infants are at highest risk for developing complications from pertussis. Complications of pertussis in infants include apnea, pneumonia, convulsions, encephalopathy (brain inflammation), and death. The CDC estimates that half of all babies under the age of one who develop pertussis will require hospitalization. Older children, teens, and adults may also be at risk for suffering complications from pertussis. Complications in older children and adults may include rib fractures from severe coughing, loss of bladder control, weight loss, abdominal hernias, otitis media, and fainting.81 82 Pregnant women and persons with diabetes may also be at higher risk of developing pertussis complications.83

Can pertussis be prevented and are there treatment options?

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. An additional treatment option may also include the use of Trimethoprim-sulfamethoxasole (Bactrim). However, antibiotics do not eliminate the symptoms of B. pertussis whooping cough, such as the severity or length of paroxysmal coughing.84

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.85 86

It is very important to keep those sick with whooping cough properly hydrated with plenty of fluids, as fever, vomiting up of mucous and, sometimes, diarrhea that occurs during a pertussis infection can cause severe dehydration. If untreated, severe dehydration can lead to shock/collapse, unconsciousness and even death.87

Once You Have Had Pertussis Can You Get It Again?

Some people gain 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.88 After recovering from a pertussis infection, natural immunity is thought to last between seven and 20 years89

All vaccines only give temporary protection/immunity from disease, which is why booster doses are often recommended. For many individuals, the pertussis vaccine (DPT, DTaP, TDaP) does not give long lasting protection against the disease and some individuals will never develop temporary immunity despite receiving all recommended boosters.90, 91, 92 Over time, the temporary immunity individuals may acquire through vaccination wanes, which often results in outbreaks of B pertussis in fully vaccinated children, teenagers and adults.93, 94, 95, 96 Further, it is possible for fully vaccinated individuals to be asymptomatic (infected, but having no symptoms) and spread B pertussis to others.97

What is pertussis vaccine?

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). The CDC’s Advisory Committee on Immunization Practices (ACIP) currently recommends administration of a pertussis containing vaccine (DTaP) at two, four, and six months old; between 15 and 18 months old; and between four and six years old. Another booster dose is recommended at 12-13 years of age (Tdap).98 While the ACIP also recommends that pregnant women receive a dose of Tdap vaccine during each pregnancy, between 27 and 36 weeks gestation, regardless of a previous history of Tdap vaccine,99 this recommendation contradicts the information provided by the vaccine manufacturers. The product insert of both Boostrix and Adacel, the two available Tdap vaccines in the U.S., state that the safety and effectiveness of vaccination has “not been established in pregnant women”.100 101

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).

The whole cell pertussis vaccine was created in 1912 and licensed in 1914. In the 1940’s, the pertussis vaccine was combined with diphtheria and tetanus to become the DPT vaccine and licensed for routine use.102 This vaccine was replaced with a purified, less reactive acellular DTaP vaccine in 1996.103 (DPT was available in some doctor’s offices in the U.S. until about 1999). DPT is still given to infants and children in many developing countries because it costs only pennies to manufacture a dose.104

Pertussis Vaccine Ingredients

The whole cell pertussis vaccine (DPT)is not currently used in the U.S., but remains in use in many developing countries. The whole DPT vaccine contains whole B. pertussis bacteria that is heated and washed with formaldehyde,105 and contains neurotoxic aluminum106 and mercury107 along with shock-inducing endotoxin,108 109 and brain damaging bioactive pertussis toxin.110 111 112

The purified DTaP/Tdap vaccines are packaged in single dose vials and have been given to American babies since the late 1990’s. These vaccines contain reduced bioactive pertussis toxin, less endotoxin, and either no or reduced (trace amounts) of mercury, along with an aluminum adjuvant.113

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).114

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.115

Read the Product Information Insert

NVIC strongly recommends reading the vaccine manufacturer product information insert before you or your child receives 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 for the vaccines you or your child is 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 eight different combination shots that include acellular pertussis vaccine. There are different rules for use of these vaccines by different aged 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):

  • 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.
  • Pediarix, a 5 in 1 combination shot containing diphtheria and tetanus toxoids and acellular 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.
  • Quadracel, a 4 in 1 combination vaccine containing diphtheria and tetanus toxoid, acellular pertussis and inactivated poliovirus vaccine for children 4 to 6 years old. It is manufactured by Sanofi Pasteur
  • 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 diphtheria toxoid and acellular pertussis vaccine for those 10 years or older. It is manufactured by GlaxoSmithKline.

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-containing vaccines 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 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. pertussis 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 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, pruritus, 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 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, 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. pertussis 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, and 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. Daptacel has been noted to reduce meningococcal antibody responses to Menactra when administered one month after Menactra. In cases where Daptacel and Menactra are to be administered, the vaccines were recommended to be given at the same time or else one month apart, with Menactra administered first.
  • 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, cellulitis, and 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: Pediarix 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 conjugate vaccine (no longer licensed in the U.S.) 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
    • 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)
    • 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. 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 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 or MMR and Varicella vaccine. There is no information in the product insert about the safety or effectiveness of giving Kinrix simultaneously 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, and cellulitis. 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; pruritus (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 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)
    • 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 Quadracel Vaccine in Brief

  • Ages: Quadracel is a 4 in 1 shot (diphtheria, tetanus, acellular pertussis, inactivated polio vaccines) given to children 4 to 6 years old (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. The efficacy of the acellular pertussis vaccine component of Quadracel is estimated to be equal to that of DAPTACEL.
  • Use with Other Vaccines: In clinical trials, Quadracel was administered simultaneously with the MMR and varicella. There is no information in the product insert about the safety or effectiveness of giving Quadracel simultaneously 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; malaise; muscle pain; headache.
  • Other Serious Reported Adverse Events: After licensure (post-marketing) reported adverse event reports have also included cyanosis; convulsions (with or without fever); injection site abscess; injection site cellulitis; pallor; screaming; allergic reactions, including anaphylaxis; urticarial, and dyspnea
  • Contraindications and precautions (Some reasons why Quadracel should not be given to a child – See Sanofi Pasteur product insert for complete list):
    • Serious allergic reaction following administration of a pertussis, tetanus, diphtheria, or polio containing vaccine or any ingredient of Quadracel vaccine
    • 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)
    • Seizures within 3 days of a previous pertussis vaccination
    • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause
    • If Guillain-BarrĂ© syndrome (GBS) occurred within 6 weeks of receiving a tetanus containing vaccine, assessment of the possible risks and potential benefits of receiving Quadracel should be carefully considered. 

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 Quadracel. It is not known whether Quadracel can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Quadracel 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. 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 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, abscess 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 episode (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 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)
    • 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 Pentacel. It is not known whether Pentacel can cause fetal harm when administered to a pregnant woman, or can affect reproductive capacity. Pentacel 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. pertussis 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. 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 hypersensitivity 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 unstable 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: Boostrix 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 Boostrix 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 meningococcal vaccine (Menactra). In both clinical trials the antibody level for the pertussis component was determined to be lowered. There is no information in the product insert about the safety or effectiveness of giving Boostrix simultaneously with live influenza, MMR, varicella, 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.

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 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.

What is the history of pertussis vaccine use in America?

In 1906, Octave Gengou and Jules Bordet of the Pasteur Institute of Brussels, were successful in growing pertussis bacterium using an artificial media.116 As a result of the breakthrough, the pertussis bacterium was renamed Bordetella pertussis in honor of Jules Bordet. Following publication of research on the Bordet-Gengou technique, several scientists began development of a pertussis vaccine using whole cell killed pertussis. The first crude whole cell pertussis vaccine was licensed in 1914117 but was not routinely used until after 1949, when it was combined with diphtheria and tetanus vaccines to become the DPT vaccine.118 Prior to 1949, the crude whole cell pertussis vaccine was in limited use and reports of serious side effects, including deaths, following vaccination appeared in published medical research.119 120 121

A 1974 published study122 reporting serious side effects following DPT vaccination received widespread publicity in Great Britain and DPT vaccination rates drop from 80 to 30 percent.123 In 1975, Japan suspended the use of pertussis vaccine for several months in response to concerns over vaccine safety. The vaccine was reinstated for use but recommended for children ages 2 years and older only.124 It was Japan that introduced the first acellular pertussis vaccine, the less reactive DTaP vaccine, in 1981, replacing the highly reactive whole cell pertussis vaccine.125

In 1982, the damaging effects of the highly reactive DPT vaccine was profiled in an award-winning television documentary DPT: Vaccine Roulette. This documentary led to the founding the organization known today as the National Vaccine Information Center and the publishing of the book DPT: A Shot in the Dark in 1985.126 During the 1980’s, parents of DPT vaccine injured children worked tirelessly for over a decade to get the less reactive DTaP vaccine licensed in the United States. Since 1981, Japan had used the DTaP vaccine with far fewer serious reactions and no reported whooping cough outbreaks. 127

It was the highly reactive whole cell DPT vaccine that caused many children to suffer permanent brain damage or death, which prompted vaccine makers in the United States to push Congress into giving pharmaceutical companies a partial product liability shield in 1986.128 Parents of children who were severely injured or who died as a result of the whole cell DPT vaccine were suing vaccine manufacturers for damages, and as a result of the growing number of lawsuits, vaccine manufacturers were threatening to stop the sale of vaccines in the United States.129 130 As a result, the National Childhood Vaccine Injury Act was passed by the 99th Congress in 1986.131 The goal of the National Childhood Vaccine Injury Act was to restrict vaccine lawsuits against vaccine manufacturers and negligent doctors when vaccines such as the highly reactive DPT vaccine injure or kill to Americans. NVIC’s co-founders worked with Congress on the historic law and as a result, Congress acknowledged the reality of vaccine injuries and deaths, that safety reforms are needed, and that those who are harmed by vaccines should be financially compensated.132 The National Vaccine Injury Compensation Program, set up in response to the passage of the National Childhood Vaccine Injury Act, was promised by Congress to be “a non-adversarial, expedited, less traumatic and less expensive administrative alternative to a lawsuit - not an exclusive legal remedy that prohibited all product liability lawsuits against vaccine manufacturers.”133

Between 1988 and 1995, following the passage of the National Childhood Vaccine Injury Act of 1986, DPT vaccine injured children were receiving awards through an administrative procedure.134 However, in 1995, Health and Human Services Secretary Donna Shalala, officials at the CDC, and attorneys in the U.S. Department of Justice actively worked to substantially weaken the compensation and safety provisions of the National Childhood Vaccine Injury Act of 1986. Beginning in March of 1995, only anaphylaxis occurring within four hours and encephalopathy/encephalitis occurring within 72 hours of a DPT vaccination (or resulting in hospitalization) would be presumed to be associated with DPT vaccination. This rule change meant that any child who suffered classic pertussis vaccine reaction symptom such as collapse or shock, high pitched screaming, bulging fontanelle, or seizures within 72 hours of a DPT vaccination, and suffered permanent neurological damage (including residual seizure disorder), would no longer be presumed to have suffered a vaccine injury and be eligible for “no fault” compensation in the federal program. As a result of this change, attorneys representing children suffering these classic DPT vaccine reaction symptoms followed by permanent injury or death would have to prove causation in the U.S. Court of Claims whenever the Secretary of Health and the Justice Department refused to award compensation.135 Since this change in 1995, it has become extremely rare for any vaccine injured child to qualify for uncontested compensation, and currently, most vaccine injury claims take many years to adjudicate because the Departments of Health and Justice fight against awarding compensation for the majority of children and adults who apply.136

In February 2011, the U.S. Supreme Court chose to inaccurately interpret the National Childhood Vaccine Injury Act of 1986, and removed the right of vaccine injured Americans to sue a vaccine maker, even when evidence existed that injuries could have been prevented if a pharmaceutical company had chosen to make a safer vaccine.137 When the National Childhood Vaccine Injury Act passed in 1986, the Act protected a citizen’s right to sue drug companies when federal compensation was denied, or in the case that evidence existed that the company had the technological ability to make a vaccine safer but refused to do so. The February 2011 Supreme Court decision to remove this provision completely shielded pharmaceutical companies from all liability for harm caused by any vaccine.138

The Supreme Court decision was a result of a lawsuit filed by the attorneys and parents of Hannah Bruesewitz, a young woman who suffered from seizures within hours of her six month whole cell DPT vaccination that resulted in lifelong developmental delays. In 1995, one month prior to the hearing of her case in the federal compensation program, the injuries that Hannah suffered were removed from the vaccine injury table and Hannah was denied compensation by an administrative judge.139 As a result of this denial, her parents filed a lawsuit against Wyeth, the company that had acquired the vaccine’s manufacturer, Lederle Laboratories, and provided evidence that Wyeth-Lederle had the technology to produce a less reactive, purified pertussis vaccine but declined to do so.140 The case went all the way to the Supreme Court and in a 6-2 split decision, the Court ruled in favor of the pharmaceutical companies, protecting them against any lawsuits as a result of injuries and deaths resulting from the vaccines they design, manufacture and market. Only Justices Sotomayor and Ginsburg stood up for the American public by dissenting.141

Although the FDA approved the first acellular DTaP vaccines for use in the United States in 1991,142 it took until 1996 for this less reactive vaccine to be granted approval for use in infants and children for all five of the recommended doses of pertussis, diphtheria, and tetanus vaccination.143 Between 1991 and 1996, the DTaP vaccine was approved only for use in children ages 15 months to 6 years of age, following administration of three doses of the whole cell DPT vaccine.144 In 1997, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended the DTaP vaccine for use instead of the highly reactive whole cell DPT vaccine.145

In 2005, the FDA approved two additional pertussis-containing vaccines, Tdap, targeting adolescents and adults. Boostrix, initially approved for persons ages 10 through 18 years of age, and Adacel, approved for persons ages 11 through 64 years of age. Following FDA approval, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended all adolescents receive a dose of Tdap vaccine between the age of 11 and 12. This recommendation was made in response to high rates of pertussis outbreaks in adolescents as a result of waning vaccine-induced pertussis immunity.146

In 2006, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended Tdap vaccination for all persons between the ages of 19 and 65 years, especially encouraging individuals to be vaccinated if they anticipate close contact with infants under one year of age. This recommendation was made without any scientific evidence to support the theory that vaccinating adults with Tdap would reduce the risk of pertussis in infants.147 In fact, a 2013 published study found that baboons that were recently vaccinated carried the pertussis infection in their throats and spread the illness to others despite being asymptomatic themselves.148 149 Recommendations also included women of childbearing age, recommending vaccine with Tdap vaccine prior to pregnancy or immediately postpartum if Tdap was not administered prior to pregnancy. Breastfeeding women who did not receive the Tdap prior to pregnancy were also included in this recommendation150 despite a lack of information on whether Tdap is excreted in human milk and what implications this may have on the nursing infant.151 The ACIP also recommended that health care personnel working in ambulatory care and hospital settings receive a Tdap vaccine as soon as possible, especially if their practice places them in direct contact with infants under the age of one year.152

In October 2011, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended that health-care personnel implement a Tdap vaccine program for pregnant women after 20 weeks gestation, who had not been previously vaccinated with Tdap. The ACIP also continued to recommend vaccination all adolescents and adults, especially those who may come into close contact with infants.153  One year later, in October of 2012, the CDC’s Advisory Committee on Immunization Practices (ACIP) updated its Tdap vaccination recommendations for pregnant women, recommending the vaccine be administered between 27 and 36 weeks gestation during each pregnancy.154 This recommendation was made despite the fact that both available Tdap vaccines are FDA approved to be administered as a single dose, and the CDC’s recommendation that every pregnant woman receive a Tdap vaccination during every pregnancy - regardless of whether a woman has already received a dose of Tdap- is an off-label use of the vaccine.155 In fact, product inserts for both Adacel and Boostrix, the two available Tdap vaccines for children and adults, including pregnant women, both state that safety and effectiveness have not been established in pregnant women.156 157 Drug companies did not test the safety and effectiveness of giving Tdap vaccine to pregnant women before the vaccines were licensed in the U.S.158 159 and almost no data exists on inflammatory or other biological responses to these vaccines that may have an effect on pregnancy and birth outcomes.160  Further, a 2017 review of 15 published articles, including 2 randomized controlled trials and 13 observational studies determined that while Tdap vaccination boosted maternal antibodies, evidence was lacking on whether or not this had any impact on reducing the incidence of pertussis, serious complications from pertussis, or death in infants.161

Currently, the CDC recommends infants and children receive 5 doses of DTaP vaccination followed by a booster dose of Tdap vaccination in adolescence (age 11-12). Adults who have not received a Tdap vaccine are also recommended to receive a single dose. Pregnant women are recommended to receive Tdap vaccination with each pregnancy regardless of a previous history of Tdap vaccine.162

How effective is pertussis vaccine?  

After a century of pertussis vaccination programs, vaccinologists are still unsure how pertussis infections - or many other infections - stimulate long lasting cell mediated and humoral immunity in the body. 163 This lack of basic scientific knowledge relates directly to the inability of vaccine makers to develop and manufacture vaccines that provide long lasting artificial immunity and to the lack of correlates for immunity to accurately measure the kind of immunity vaccines do or do not provide. 164 165

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.

However, studies published in the 1980’s reported that the highly reactive whole cell DPT vaccine licensed in 1949 did not prevent infection or transmission,166 and provided only two to five years of temporary immunity at best.167 168 The efficacy of whole cell pertussis vaccine in the DPT shot was measured to be between 30 and 85 percent, depending upon the type of DPT and vaccine manufacturer.169 170 171 172 173

The less toxic acellular DTaP vaccine, licensed in the U.S. in 1991, and currently in use in the United States and other developed countries, has also failed to prevent infection or transmission of pertussis.174 175 176 Studies have also demonstrated that DTaP vaccine provides only between two and five years of temporary immunity from pertussis.177 178 179 Acellular pertussis vaccine efficacy in clinical trials has been measured to be between 40 and 89 percent, depending upon the DTaP vaccine manufacturer.180 181 182

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.183 However, a 2010 analysis of a California whooping cough outbreak published in the medical literature revealed that more than 80% of those affected were fully vaccinated and the pertussis vaccine was found to be between 24 and 41 percent effective in children two to 18 years of age three years post-vaccination.184 In 2010, the Tdap vaccine, recommended in 2006 for adolescents as a booster dose of acellular pertussis vaccine, 185 was found to be only about 66 percent effective.186

By 2012, the CDC acknowledged that pertussis vaccine immunity had 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 were not to blame for the ongoing whooping cough outbreaks.187

In fact, child pertussis vaccination rates in the U.S. have remained very high since 1961188 and consistently more than 94 percent of kindergarten children have had four to five pertussis-containing vaccines.189 As well, nearly 94 percent of all children have received at least three doses of DTaP vaccine,190 and 88 percent of teenagers attending high school have received a sixth pertussis booster shot.191

However, reported numbers of pertussis cases differ substantially from the total number of actual cases of pertussis in the United States, as most pertussis cases are not being diagnosed or reported by doctors to the government.192 Public health officials do not have reliable lab tests to measure pertussis immunity and are unable to agree about how to diagnose pertussis when infected people, especially vaccinated people, are seen in doctor’s offices with mild symptoms.193 194 195 Further, there is evidence that millions of vaccinated children and adults living in the U.S. become infected with pertussis whooping cough but are never identified as doctors are not diagnosing or reporting them.196 197 198 199 In fact, a person, vaccinated or unvaccinated, can develop a silent asymptomatic pertussis infection and transmit it to another person without even knowing it.200 201 202 Both natural and vaccine acquired immunity is temporary203 and while vaccination may prevent clinical symptoms, it does not block infection, carriage or transmission.204 205

In fact, a review of the medical literature has revealed that the experts are unhappy with their lack of knowledge of the B. pertussis microbe206 and are disagreeing with each other about if, when, how and why pertussis vaccines have consistently failed to achieve herd immunity and prevent B. pertussis whooping cough from circulating in highly vaccinated populations around the world.207 208 209

In 1976, after only approximately 1,000 cases of pertussis were reported in the U.S.210, pertussis rates began to climb. In the 1980’s and 1990’s, researchers became aware that the whole cell pertussis vaccine found in DPT was not capable of preventing infection and transmission of the disease.211 212 213 214 215 Just like before the introduction of widespread DPT vaccination programs, pertussis increases continued to be reported in cycles of three to five years, 216 217 218 219 220 221 including in the U.S. where over 94 percent of children had gotten three to five DPT shots. 222 223

In 1988, researchers began warning that the B. pertussis microbe had begun to evolve in order to evade the whole cell pertussis vaccine.224 225 226 227 The evolving of the B. pertussis microbe had begun following the mass introduction of the DPT vaccine in 1950’s.228 229 230

In a fight to survive, the B. pertussis microbe has created new strains of pertussis that produce more toxin to suppress the human immune system and cause more serious disease. Today, the pertussis strains included in the vaccine no longer match the pertussis strains causing whooping cough disease.231 232 233 234 235 There is compelling scientific evidence that B. pertussis bacteria have evolved to survive vaccine pressure and as a result, there are more virulent pertussis strains that are more efficiently transmitted by vaccinated children and adults with waning immunity. In 2014, public health officials at the CDC and around the world admitted that “most mutations in genes encoding acellular vaccine components arose in the period in which the whole cell vaccine was used.” 236

Another Bordetella pertussis whooping cough disease, B. parapertussis is also circulating in the United States and elsewhere.237 B. parapertussis whooping cough can look identical to B. pertussis whooping cough,238 however symptoms 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.239 Pertussis vaccines widely used around the world do not protect against parapertussis and there is no vaccine for parapertussis.240

It is possible to have both B. pertussis and B. parapertussis infections at the same time. B. parapertussis is often milder than B. pertussis but can also involve serious complications, which lead to pneumonia and death.241

Can pertussis vaccine cause injury and death?

The Institute of Medicine has acknowledged that there is individual susceptibility to vaccine reactions for genetic, biological and environmental reasons, but that vaccine providers cannot accurately predict prior to a vaccine’s administration who will suffer complications, injury or death from vaccination.242 However, a person who has previously had a serious reaction to a vaccination or is acutely or chronically ill should become informed about all potential risks associated with vaccination and discuss any concerns with a trusted health care professional before receiving a DTaP/Tdap vaccine or any other vaccine.

  1. 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 and this toxin induces lymphocytosis, leukocytosis, stimulates insulin secretion and sensitizes histamine, which is involved in the immune system’s inflammatory response.243

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 component responsible for causing brain inflammation during B. pertussis whooping cough or after injection of pertussis-containing vaccines.244 245

Since the 1950’s, scientists have injected pertussis toxin into lab animals whenever they want to deliberately induce histamine, serotonin and endotoxin sensitivity or experimental autoimmune encephalomyelitis.246 247 248 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.

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.249

The whole cell pertussis component of the DPT vaccine, the original pertussis containing vaccine in widespread use from 1949 until the late 1990’s, was found to be highly reactive, causing brain inflammation and encephalopathy.250 251 252

The authors of the 1981 British National Childhood Encephalopathy Study (NCES)253 noted in 1993,254 and the Institute of Medicine confirmed in 1994,255 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.256

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.257 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 Vaccines258 concluded that “evidence is consistent with a causal relation between DPT vaccine and acute encephalopathy (brain inflammation) and “unusual shock-like state”259 (hypotonic/hyporesponsive episode): and that “evidence indicates a causal relation between DPT vaccine and shock (anaphylaxis) and protracted, inconsolable crying.”260

In 1994, the IOM published the report DPT Vaccine and Chronic Nervous System Dysfunction 261 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.”262

Between 50 and 80 percent of babies who received the whole cell DPT vaccine ran fevers, and experienced pain, redness and swelling at the site of the injection, and many of them were fussier or lost their appetite for a day or two. 263 Published research also concluded that the whole cell pertussis vaccine had the ability to cause far more serious reactions such as high-pitched screaming,264 hypotonic/hyporesponsive episodes, 265 febrile or afebrile convulsions, 266 267 and brain inflammation (also known as encephalitis, encephalomyelitis and encephalopathy). 268 269 270 Between 25 and 60 percent of children who develop acute encephalitis or encephalopathy or have convulsions, including febrile convulsions - for any reason - are left with personality changes, developmental delays, learning disabilities, ADHD, seizure disorders, lower IQ, speech, motor and behavior disorders and other disabilities. 271 272 273 274 275

A 1981 U.S. study funded by the FDA and conducted at UCLA found that convulsion or collapse/shock occurred as frequently as 1 in every 875 DPT shots.276 As well, some of the children who participated in this study were left with neurological problems and low IQs. The 1981 British National Childhood Encephalopathy Study (NCES) estimated that the risk of a previously healthy child developing a serious neurological problem within seven days of DPT vaccination was 1 in 110,000 DPT shots and the risk of chronic brain dysfunction was 1 in 310,000 DPT shots. 277 Again, some of the children involved in the study were left with brain damage manifested by “neurologic, motor, sensory, educational behavioral and self-care dysfunctions.” 278

While a “safer” acellular pertussis vaccine (DTaP) was available and in wide-spread use in Japan by 1981, the FDA did not approve this vaccine until 1991, and only as an option for young children over the ages of 15 months to 6 years of age following administration of three doses of the whole cell DPT vaccine.279 It was 1996 before the FDA approved the DTaP vaccine for administration in infants and children 6 weeks to 6 years of age280 and 1997 before the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended the DTaP vaccine in lieu of the highly reactive whole cell DPT vaccine.281

The current 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. Chiron, a company producing a genetically engineered DTaP vaccine in the early 1990’s, explained that 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.”282

In the comprehensive report evaluating scientific evidence, Adverse Effects of Vaccines: Evidence and Causality, published in 2012 by the Institute of Medicine, 26 reported vaccine adverse events following DTaP/Tdap vaccine were evaluated by a physician committee.283 These adverse events included encephalopathy, encephalitis, chronic urticarial, autism, serum sickness, SIDS, arthritis, Guillain Barre Syndrome, diabetes mellitus, immune thrombocytopenic purpura, transverse myelitis and more.

In 24 of the 26 DTaP/Tdap vaccine-related adverse events evaluated, the IOM committee concluded that there was inadequate evidence to support or reject a causal relationship between the DTaP/Tdap vaccine and the reported adverse event, primarily because there was either an absence of methodologically sound published studies or too few quality studies to make a determination.284 The IOM committee concluded that the scientific evidence “convincingly supports” a causal relationship between anaphylaxis and DTaP/Tdap vaccine.285 However, based on the evaluation of five epidemiological studies, the committee concluded that scientific evidence “favors rejection” of a relationship between Diabetes Type 1 and DTaP/Tdap vaccine.286

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.287

Additional Reported Complications:

  • Allergic hypersensitive reactions occurring within minutes or hours of vaccination. These may include hives, sudden swelling of the mouth or throat, difficulty breathing, hypertension and shock.288 289
  • Thrombocytopenia and Hemolytic Anemia are two blood disorders, which have been reported to rarely follow pertussis vaccine containing shots.290 291Thrombocytopenia 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).292
  • 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."293
      • Hannik and Cohen in 1978 concluded, "infants who show serious reactions following pertussis vaccination suffer from failure to maintain glucose homeostasis."294
      • 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.295

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.296

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. 297 298 299

Reported Pertussis vaccine reactions

Using the MedAlerts search engine, as of June 30, 2018 there had been 150,043 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with pertussis-containing vaccines since 1990. Half of those serious pertussis vaccine-related adverse events occurred in children under the age of three. Of these pertussis-vaccine related adverse event reports to VAERS, 2,745 were deaths, with over 90% of the deaths occurring in children under three years of age.

However, the numbers of vaccine-related injuries and deaths reported to VAERS may not reflect the true number of serious health problems that occur develop after pertussis vaccination.

Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to federal health agencies (VAERS), many doctors and other medical workers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. There is evidence that only between one and 10 percent of serious health problems that occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials, who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations. 300 301 302 303 304

As of August 8, 2018, there had been 5,369 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following pertussis-containing vaccination, including 862 deaths and 4507 serious injuries. The DPT vaccine is the vaccine with the most injury claims filed, including for death, and it is the second most compensated vaccine injury claim, with influenza vaccine now in first place. 305

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.306 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.307

Pertussis vaccine has been documented to cause high fever; severe local reactions at the site of the injection308 309; high pitched screaming and uncontrollable crying310 311; collapse/shock (hypotonic/hyporesponsive episode) 312; lethargy (excessive sleepiness); convulsions with or without fever 313 314 315 316 317; and brain inflammation (encephalopathy).318 319 320 321 322 323 324

It is important for parents to know what constitutes a severe reaction to a pertussis 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 should be administered.325

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.”

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).326 If a doctor or medical worker will not make a vaccine reaction report to the government, you can make a report yourself.327

Who is at highest risk for complications from pertussis vaccine?    

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.

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 70 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.328

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. In 1985, CDC officials reported that children who experienced a neurological problem after DPT vaccination had a 7 times greater risk if they had a personal history of convulsions and a 4.5 times greater risk if they had a family history of convulsions. 329

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." 330

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.” 331

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)."332 The CDC went on to recommend, however, that these children should still receive pertussis vaccine.333

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 2006 study of preterm infants (defined as newborns born before or at 32 weeks gestation) found an increase in adverse cardiorespiratory events such as desaturations, bradycardia, and apnea in the first 72 hours following the first dose of a combination Diphtheria, tetanus, pertussis, inactivated polio and HIB vaccine. The risk was determined to be similar for acellular pertussis vaccine versus whole cell pertussis vaccine.  Lower current weight was found to be a risk for adverse events and the study suggested that vaccination should occur at least 72 hours prior to discharge from the hospital. 334

A 2012 Dutch study found that nearly 25 percent of preterm infants born before 33 weeks gestation experiences bradycardia or a slight decrease in oxygen saturation following vaccination at 2 months. 7 percent, however, experienced a moderate cardiorespiratory event requiring stimulation. The study found that younger and lower birth weight infants experienced higher adverse events following vaccination.335

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.336

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.337

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.338

Vaccination does not exactly mimic the natural infection process and often bypasses 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.339

In more than 70 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. 340

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.341

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.” 342

A healthy, mature immune system requires an equal balance of cellular (innate) 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 bypasses cellular immunity in favor of humoral immunity. There have been persistent reports of development of autoimmune disorders and allergy after vaccination, including pertussis vaccination. 343

Milk Allergy (Casein Intolerance) – Studies have 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). 344

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 345of 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.346

Is Tdap vaccine safe during pregnancy?

For many years, pregnancy was also a contraindication to pertussis vaccine but, today, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) recommends pertussis vaccine for all pregnant women. Currently, the ACIP recommends that pregnant women receive a dose of Tdap vaccine between 27 and 36 weeks gestation, during each pregnancy, regardless of a previous history of Tdap vaccine.347 However both Tdap vaccines are FDA approved to be administered as a single dose, and the CDC’s recommendation that every pregnant woman receive a Tdap vaccination during every pregnancy - regardless of whether a woman has already received a dose of Tdap- is an off-label use of the vaccine.348

Drug companies did not test the safety and effectiveness of giving Tdap vaccine to pregnant women before the vaccines were licensed in the U.S.349 350 and there is almost no data on inflammatory or other biological responses to these vaccines that could affect pregnancy and birth outcomes.351 In fact, product inserts for both Adacel and Boostrix, the two available Tdap vaccines for children and adults, including pregnant women, both state that safety and effectiveness have not been established in pregnant women.352 353

Adacel vaccine is considered a Pregnancy Category C biological. According to the U.S. Department of Health and Human Services, Category C biologicals are products where ” Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.” 354 No animal reproduction studies have been completed on Adacel and it is unknown if this vaccine can cause fetal harm or impair reproduction.355 Sanofi Pasteur, the manufacturer of Adacel, warns that this vaccine should “be given to a pregnant woman only if clearly needed.”356

Boostrix vaccine is considered a Pregnancy Category B biological. According to the U.S. Department of Health and Human Services, Category B biologicals are products where “Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.”357 Toxicity studies performed on female rats found no evidence of fetal harm, however, no well-controlled and adequate studies have been completed on pregnant women.358 GlaxoSmithKline, the manufacturer of Boostrix, also warns that this vaccine should “be given to a pregnant woman only if clearly needed.”359

There are ingredients in the pertussis containing Tdap vaccines that have not been fully evaluated for potential genotoxic360 or other adverse effects on the human fetus developing in the womb that may negatively affect health after birth, including aluminum adjuvants and many more bioactive and potentially toxic ingredients.361 362 363 364 365 366 367 368 369 As well, there are no published biological mechanism studies that assess pre-vaccination health status and measure changes in brain and immune function and chromosomal integrity after vaccination of pregnant women or their babies developing in the womb.370

Since licensure of Tdap vaccines in the U.S., there have been no well-designed prospective case controlled studies comparing the health outcomes of large groups of women who get pertussis containing Tdap vaccines during pregnancy either separately or simultaneously with influenza vaccine, compared to those who do not get the vaccines, and no similar health outcome comparisons of their newborns at birth or in the first year of life have been conducted. Safety and effectiveness evaluations that have been conducted are either small,371 or have been performed by drug company or government health officials using unpublished data.372

A 2017 review of 15 published articles, including 2 randomized controlled trials and 13 observational studies determined that while vaccination boosted maternal antibodies, evidence was lacking on whether or not this had any impact on reducing the incidence of pertussis, serious complications from pertussis, or death in infants.373

Vaccine manufacturers, doctors, and other vaccine providers are shielded from vaccine injury lawsuits374, however, it is unclear whether injuries sustained by an unborn child in the womb will qualify for federal vaccine injury compensation.375 The Health Resources & Services Administration (HRSA) is seeking public comment until October 1st pertaining to “Adding the Category of Vaccines Recommended for Pregnant Women to the Vaccine Injury Table.”376

Who should not get Pertussis vaccine?

For the first 40 years of use of whole cell pertussis (DPT) vaccine, ABSOLUTE CONTRAINDICATIONS to pertussis vaccination included377:

  • 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. 378

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.

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: 379

  • Those who have had a life-threatening allergic reaction after a previous dose of DPT, DTaP or Tdap should not get another dose.
  • Persons who have a severe allergy to any vaccine component
  • 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): 380

  • Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized.
  • 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

It is important for parents to know what constitutes a severe reaction to a pertussis 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 may be given.381 While the CDC currently recognizes the capability of pertussis vaccination to cause serious reactions and has issued a list of contraindications and precautions to vaccination, the World Health Organization (WHO) has opted to eliminate nearly all contraindications to giving children any pertussis containing vaccine. In 2015, the World Health Organization published a new pertussis vaccine position and in doing so, global public health officials rejected nearly a century of scientific evidence documenting the toxicity and risks of whole cell pertussis vaccine, stating that except for anaphylaxis, no contraindications exist to giving children any type of pertussis-containing vaccine.382 Positions such as these ones make it even more important for individuals and parents to educate themselves to determine the personal risk that pertussis vaccination may have on themselves and their children.

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.

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.

What questions should I ask my doctor about the pertussis vaccine?    

NVIC’s If You Vaccinate, Ask 8! Webpage downloadable brochure suggests asking eight questions before you make a vaccination decision for yourself, or for your child. If you review these questions before your appointment, you will be better prepared to ask your doctor questions.  Also make sure that the nurse or doctor gives you the relevant Vaccine Information Statement (VIS) for the vaccine or vaccines you are considering well ahead of time to allow you to review it before you or your child gets vaccinated. Copies of VIS for each vaccine are also available on the CDC's website and there is a link to the VIS for DTaP, Tdap and Multi vaccines on NVIC's “Quick Facts” at the top of this page.

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.

It is also a good idea to read the vaccine manufacturer product insert that can be obtained from your doctor or public health clinic because federal law requires drug companies marketing vaccines to include certain kinds of vaccine benefit, risk and use information in product information inserts that may not be available in other published information. Vaccine product inserts are located on the Food and Drug Administration’s website. A review of the vaccine product insert to determine whether any contraindications and/or precautions to vaccination exists is also important. More information on contraindications and precautions to vaccination can be found here.

Other questions that may be useful to discuss with your doctor before getting the pertussis (DTaP/Tdap) vaccine are: 

  • If other vaccines in addition to DTaP/Tdap vaccine are scheduled for my child at this office visit, am I allowed to modify the schedule so fewer vaccines are given at once?
  • What should I do if my child has a high fever or appears very ill after vaccination?
  • What other kinds of reaction symptoms should I call to report after DTaP/Tdap vaccination?
  • If the DTaP/Tdap vaccine doesn’t protect my child, do I have any other options for preventing mumps infection?

Under the National Childhood Vaccine Injury Act of 1986, doctors and all vaccine providers are legally required to give you vaccine benefit and risk information before vaccination; record serious health problems following vaccination in the permanent medical record; keep a permanent record of all vaccines given, including the manufacturer’s name and lot number; and report serious health problems, injuries and deaths that follow vaccination to VAERS.

Remember, if you choose to vaccinate, 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.  

It also is important to be able to recognize a vaccine reaction and seek immediate medical attention if the reaction appears serious, as well as know how to make a vaccine reaction report to federal health officials at the Vaccine Adverse Reporting System (VAERS). NVIC’s Report Vaccine Reactions—It’s the Law webpage can help you file a vaccine reaction report yourself to VAERS if your doctor fails or refuses to make a report.

NVIC's Pertussis Commentaries and Video Collection

NVIC DPT Vaccine Video Playlist

View the collection of video resources within the player below for more information on the DPT vaccine (diphtheria, pertussis, and tetanus combination vaccine).

To view the entire video collection, click the hamburger menu in the upper left corner of the video player above. This will expand a full list of videos. You may also open the video player in full screen mode for optimal display.

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 that 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

Do You Know How to Recognize a Vaccine Reaction? (August 2018)

Back to the Future: Shalala Takes Away Compensation for DPT Injured Children (August 2017)

Pertussis Microbe Outsmarts the Vaccines As Experts Argue About Why (March 2016)

Vaccine Injury Compensation: Government’s Broken Social Contract with Parents (November 2015)

Vaccination During Pregnancy: Is it Safe? (November 2013)

Find a Compassionate Doctor to Help You Prevent Vaccine Injuries  (August 2012)

Video - Pertussis Vaccine Reaction Leads to Developmental Delays (October 2011)

Using Fear & Prejudice to Attack Vaccine Exemptions (August 2010)

Whooping Cough Outbreaks & Vaccine Failures (July 2010)

Harris Coulter Was a Brave Visionary (March 2010)

Workshop on Neurologic Complications of Pertussis and Pertussis Vaccination (Sept 29 – Oct 1, 1989)

Bibliography & Resource Links

Manufacturer Product Information Inserts:

  • 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 Quadracel (Diphtheria, Tetanus, Pertussis, Polio combined)
  • Sanofi Pasteur Adacel Tdap (Tetanus, Diphtheria, Pertussis combined)
  • GlaxoSmithKline Boostrix (Tetanus, Diphtheria, Pertussis combined)

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

« Return to Vaccines & Diseases Table of Contents

References

1 CDC Causes and Transmission. Aug 7, 2017

2 CDC Diagnostic Testing. Aug. 7, 2017

3 CDC. Pertussis - Epidemiology Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

4 CDC Pertussis Causes and Transmission. Aug. 7, 2017

5 Medline Plus. Whooping Cough. July 30, 2018

6 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan 31, 2018

7 CDC Complications. Aug. 7, 2017

8 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS. Aug. 24, 2018

9 Preidt R. Kids' Whooping Cough and Risk of Epilepsy. WebMD. Nov. 3, 2015

10 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan. 31, 2018

11 CDC Diagnosis and Treatment. Aug. 7, 2017

12 CDC Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998. MMWR. Apr. 02, 1999 48(12);243-248

13 Chow MYK, Khandaker G, McIntyre P. Global Childhood Deaths From Pertussis: A Historical Review. Clin Infect Dis. 2016 Dec 1; 63(Suppl 4): S134–S141.

14 CDC Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Apr. 27, 2018 / 67(2);1–44

15 FDA Boostrix Product Insert. Apr. 25, 2016

16 FDA Adacel Product Insert Sept. 29, 2017

17 FDA Vaccines Licensed for Use in the United States. Mar. 29. 2018

18 CDC. Vaccine Excipients & Media Summary (Vaccine Ingredients).Appendix B.The Pink Book, 13th Edition, June 2018

19 Institute of Medicine Committee to Study New Research on Vaccines. DPT Vaccine and Chronic Nervous System Dysfunction: A New Analysis. Executive Summary (pp.1-2) Washington, D.C. The National Academies Press 1994.

20 NVIC. Do You Know How to Recognize a Vaccine Reaction? Aug 27, 2018

21 CDC 2017 Provisional Pertussis Surveillance Report. Jan 5, 2018 66(52)

22 CDC 2017 Provisional Pertussis Surveillance Report. Jan 5, 2018 66(52)

23 CDC Pertussis Frequently Asked Questions Aug 7, 2017

24 CDC. Pertussis - Bordetella pertussis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

25 Medline Plus. Whooping Cough. July 30, 2018

26 CDC Pertussis – Signs and Symptoms. Aug. 7, 2017

27 CDC. Pertussis - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

28 CDC Pertussis – Signs and Symptoms. Aug. 7, 2017

29 Ibid

30 Mayo Clinic Whooping Cough. Feb. 10, 2018

31 CDC Diagnosis and Treatment. Aug. 7, 2017

32 Kids Health Infections – Whooping Cough (Pertussis). Feb. 2016

33 CDC Pertussis Complications. Aug. 7, 2017

34 Glick J Doctors Say Whooping Cough Often Misdiagnosed. CBS DC Oct. 1, 2015

35 CDC Pertussis Diagnosis Confirmation. Aug. 7, 2017

36 Bocka JJ. Pertussis Medscape. Oct. 20, 2017

37 He Q, Viljanen MK, et al Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population. JAMA.1998 Aug 19;280(7):635-7.

38 CDC Surveillance Manual Chapter 10: Pertussis – Disease Description. 6th Edition. 2013

39 Liese JG, Renner C, Stojanov S, et al Clinical and epidemiological picture of B pertussis and B parapertussis infections after introduction of acellular pertussis vaccines  Arch Dis Child 2003;88:684-687.

40 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS. Aug. 24, 2018

41 CDC Pertussis Causes and Transmission. Aug. 7, 2017

42 Ibid

43 CDC. Pertussis– Clinical Features  Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

44 CDC. Pertussis - Medical Management Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

45 Ibid

46 CDC Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998. MMWR. Apr. 02, 1999 48(12);243-248

47 National Center for Health Statistics. U.S. Vital Statistics Mortality Data 1940-1949. Table 2 – Death Rates for Selected Causes, Whooping Cough (All Races, Both Sexes) 1948 . Pg. 38.

48 Grove RD, Hetzel AM. Vital Statistics Rates in the United States 1940-1960. General Mortality (1921-1929), Section C, Table 65: Whooping Cough . Pg. 577. U.S. Public Health Service National Center for Health Statistics 1968.

49 Chow MYK, Khandaker G, McIntyre P. Global Childhood Deaths From Pertussis: A Historical Review. Clin Infect Dis. 2016 Dec 1; 63(Suppl 4): S134–S141.

50 Brooks DA, Clover R. Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults. J Am Board Fam Med November-December 2006 vol. 19 no. 6

51 CDC. 2013 Final Pertussis Surveillance Report. Aug. 15, 2014.

52 CDC 2017 Provisional Pertussis Surveillance Report. Jan 5, 2018 66(52)

53 CDC 2017 Provisional Pertussis Surveillance Report. Jan 5, 2018 66(52)

54 CDC Pertussis Frequently Asked Questions Aug 7, 2017

55 WHO Pertussis June 21, 2011

56 World Health Organization/UNICEF. A record 123 million children were immunized globally in 2017 but millions of children are still not reached by potential life saving vaccines. 2017.

57 Yeung KHT, Ducios P et al. An update of the global burden of pertussis in children younger than 5 years: a modeling study. Lancet Infect Dis 2017; 9: 974-980.

58 Korte R, Rehle T, Merkle A. Strategies to maintain health in the Third World. Trop Med Parasitol 1991; 42(4): 428-432.

59 CDC Pertussis in Other Countries. Aug. 7, 2017

60 CDC 2017 Provisional Pertussis Surveillance Report. Jan 5, 2018 66(52)

61 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan 31, 2018

62 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS. Aug. 24, 2018

63 Carbonetti NH. Contribution of pertussis toxin to the pathogenesis of pertussis disease. Pathog Dis. 2015 Nov; 73(8): ftv073.

64 Steinman L, Weiss A, et al Pertussis toxin is required for pertussis vaccine encephalopathy. Proc Natl Acad Sci U S A. 1985 Dec; 82(24): 8733–8736.

65 Geier DA, Geier MR. Clinical implications of endotoxin concentrations in vaccines. Ann Pharmacother. 2002 May;36(5):776-80.

66 Bannatyne RM, Cheung R. Reducing the endotoxic activity of pertussis vaccine. J Hyg (Lond). 1981 Dec; 87(3): 377–381.

67 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan 31, 2018

68 CDC Complications. Aug. 7, 2017

69 Preidt R. Kids' Whooping Cough and Risk of Epilepsy. WebMD. Nov. 3, 2015

70 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan. 31, 2018

71 Mayo Clinic Whooping Cough. Feb. 10, 2018

72 Finger H, von Koenig CHW. Chapter 31 Bordetella. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.

73 Cherry JD. Why Do Pertussis Vaccines Fail? Pediatrics 2012; 129(5).

74 Lavine J, Bjornstad O, de Blasio BF, Storsaeter J. Short-lived immunity against pertussis, age-specific routes of transmission, and the utility of a teenage booster vaccine. Vaccine 2012; 30(3): 544-551.

75 McGirr A, Fisman, DN, Duration of Pertussis Immunity After DTaP Immunization: A Meta-analysis.

Pediatrics Feb 2015, 135 (2)

76 Klein NP, Bartless S, Fireman B, Baxter R. Waning Tdap Effectiveness in Adolescents. Pediatrics Feb. 3, 2016.

77 Klein NP; Bartlett J; Rowhani-Rahbar A; Fireman B; Baxter R Waning protection after fifth dose of acellular pertussis vaccine in children N Engl J Med.  2012; 367(11):1012-9

78 Misegades LK, Winter K, Harriman K et al. Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010 JAMA 2012; 308(20): 2126-2132.

79 Matthias J, Pritchard S, Martin SW et al. Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA Emerg Infect Dis Jan. 15, 2016.

80 Mayo Clinic Whooping Cough. Feb. 10, 2018

81 Nordqvist C, Whooping cough: What you should know. MedicalNewsToday. May 19, 2017

82 CDC Pertussis Complications. Aug. 7, 2017

83 Nordqvist C, Whooping cough: What you should know. MedicalNewsToday. May 19, 2017

84 CDC Pertussis Treatment. Aug. 7, 2017

85 Mercola. Evolving Bacteria Outsmarts Vaccines. Jan 13, 2015

86 Ormerod, MJ, Unkauf BM. Ascorbic Acid (Vitamin C) Treatment of Whooping Cough. Can Med Assoc J. 1937 Aug; 37(2): 134–136.

87 Moore K. Whooping Cough (Pertussis). Healthline. May 21, 2018

88 Finger H, von Koenig CHW. Chapter 31 Bordetella. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.

89 Wendelboe AM, Van Rie A, et al. Duration of immunity against pertussis after natural infection or vaccination. Pediatr Infect Dis J 2005; 24(Suppl 5): S58-S61.

90 Cherry JD. Why Do Pertussis Vaccines Fail? Pediatrics 2012; 129(5).

91 Lavine J, Bjornstad O, de Blasio BF, Storsaeter J. Short-lived immunity against pertussis, age-specific routes of transmission, and the utility of a teenage booster vaccine. Vaccine 2012; 30(3): 544-551.

92 McGirr A, Fisman, DN, Duration of Pertussis Immunity After DTaP Immunization: A Meta-analysis.

Pediatrics Feb 2015, 135 (2)

93 Klein NP, Bartless S, Fireman B, Baxter R. Waning Tdap Effectiveness in Adolescents. Pediatrics Feb. 3, 2016.

94 Klein NP; Bartlett J; Rowhani-Rahbar A; Fireman B; Baxter R Waning protection after fifth dose of acellular pertussis vaccine in children N Engl J Med.  2012; 367(11):1012-9

95 Misegades LK, Winter K, Harriman K et al. Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010 JAMA 2012; 308(20): 2126-2132.

96 Matthias J, Pritchard S, Martin SW et al. Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA. Emerg Infect Dis Jan. 15, 2016.

97 Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci USA. 2014; 111(2): 787–792

98 CDC Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Apr. 27, 2018 / 67(2);1–44

99 Ibid

100 FDA Boostrix Product Insert. Apr. 25, 2016

101 FDA Adacel Product Insert Sept. 29, 2017

102 Institute of Medicine. Pertussis and Rubella Vaccines: A Brief Chronology (Appendix B, pp. 320) In: Adverse Effects of Pertussis and Rubella Vaccines. The National Academies Press 1991.

103 CDC Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Mar. 28, 1997  46(RR-7);1-25

104 Patel MK, Patel TK, Tripathi CB. Diphtheria, pertussis (whooping cough) and tetanus vaccine induced recurrent seizures and acute encephalopathy in a pediatric patients: Possibly due to pertussis fraction. J Pharmacol Pharmacother 2012; 3(1): 71-73.

105 US National Library of Medicine. Formaldehyde (formalin). PubChem Open Chemistry Database Sept. 1, 2018.

106  Mold M, Shardlaw E, Exley C. Insight into the cellular fate and toxicity of aluminum adjuvants used in clinically approved human vaccinations. Sci Rep 2016; 6: 31578.

107 Burbacher TM, Shen DD et al. Comparison of Blood and Brain Mercury Levels in Infant Monkeys Exposed to Methylmercury or Vaccines Containing ThimerosalNational Center for Biotechnology Information, U.S. National Library of Medicine Apr. 21, 2005.

108  Geier DA, Geier MR. Clinical Implications of Endotoxin Content in Vaccines. Ann Pharmacother 2002; 36(5).

109  Brito LA, Singh M. Acceptable Levels of Endotoxin in Vaccine Formulations During Preclinical Research. J. Pharm. Sci 2011; 100(1): 34-37.

110 Steinman L, Weiss A et al. Pertussis toxin is required for pertussis vaccine encephalopathy. Proc Natl Acad Sci 1985; 82(24): 8733-8736.

111 Munoz JJ, Arai H. Biological Activity of Crystalline Pertussigen from Bordetella pertussis. Infect Immunity 1981; 33(3): 820-826.

112 Donnelly S, Loscher CE et al. Whole cell but Not Acellular Pertussis Vaccines Induce Convulsive Activity in Mice: Evidence for a Role for Toxin-Induced Interleukin-1B in a New Murine Model for Analysis of Neuronal Side Effects of Vaccination. Infect Immun 2001; 69(7): 4217-4223.

113 CDC. Vaccine Excipients & Media Summary (Vaccine Ingredients).Appendix B.The Pink Book, 13th Edition, June 2018

114 Ibid

115 FDA Vaccines Licensed for Use in the United States. Mar. 29. 2018

116 Institute of Medicine. Pertussis and Rubella Vaccines: A Brief Chronology (Appendix B, pp. 320) In: Adverse Effects of Pertussis and Rubella Vaccines. The National Academies Press 1991.

117 Ibid

118 NIH. Historical Record of Vaccine Product Licensing Holders in the United States. (Table H-1). In: The Children’s Vaccine Initiative: Achieving the Vision. The National Academy of Sciences 1993.

119 Madsen, T. Vaccination against whooping cough. JAMA. 1933 101(3):187-88.

120 Byers RK, Moll FC Encephalopathies following prophylactic pertussis vaccine. Pediatrics.1948 Apr;1(4):437-57.

121 Brody M, Sorley RG, Neurologic complications following the administration of pertussis vaccine. N Y State J Med. 1947 May 1;47(9):1016.

122 Kulenkampff M, Schwartzman JS, Wilson J Neurological complications of pertussis inoculation. Arch. Dis. Child. 1974, 49, 46

123 Institute of Medicine. Pertussis and Rubella Vaccines: A Brief Chronology (Appendix B, pp. 320) In: Adverse Effects of Pertussis and Rubella Vaccines. The National Academies Press 1991.

124 Ibid

125 Kuno-Sakai H, Kimura M. Safety and efficacy of acellular pertussis vaccine in Japan, evaluated by 23 years of its use for routine immunization. Pediatr Int. 2004 Dec;46(6):650-5.

126 Coulter HL, Fisher BL. DPT: A Shot in the Dark. Harcourt Brace Jovanovich, 1985; Warner Books 1986; Avery/Putnam 1991.

127  Sato Y, Kimura M, Fukumi H. Development of Pertussis Component Vaccine in Japan. Lancet 1984; 323(8369): 122-126.

128 National Vaccine Information Center. NVIC Position Statement on the National Childhood Vaccine Injury Act of 1986. May 2018.

129 Hinman AR. DTP vaccine litigation. Am J Dis Child 1986; 140(6): 528-530.

130 NVIC No Pharma Liability? No Vaccine Mandates. Mar. 2, 2011

131 NVIC The National Childhood Vaccine Injury Act of 1986

132 NVIC NVIC's History

133 NVIC Vaccine Injury Compensation: Government’s Broken Social Contract with Parents. Nov. 2, 2015

134 Ibid

135 NVIC Back to the Future: Shalala Takes Away Compensation for DPT Injured Children. Aug. 14, 2017

136 NVIC Vaccine Injury Compensation: Government’s Broken Social Contract with Parents. Nov. 2, 2015

137 NVIC No Pharma Liability? No Vaccine Mandates. Mar. 2, 2011

138 BusinessWire National Vaccine Information Center Cites “Betrayal” of Consumers by U.S. Supreme Court Giving Total Liability Shield to Big Pharma. Feb. 23, 2011

139 Meier B Supreme Court to Consider Vaccine Case. The New York Times. Oct. 11, 2010

140 NVIC No Pharma Liability? No Vaccine Mandates. Mar. 2, 2011

141 Ibid

142 CDC Pertussis Vaccination: Acellular Pertussis Vaccine for Reinforcing and Booster Use -- Supplementary ACIP Statement Recommendations of the Immunization Practices Advisory Committee MMWR Feb. 07, 1992; 41(RR-1);1-10

143 CDC. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Mar. 28, 1997;46(RR-7):1–25

144 Ibid

145 CDC  Notice to Readers Recommended Childhood Immunization Schedule -- United States, 1997. MMWR. Jan. 17, 1997; 46(02);35-39

146 CDC Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines - Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Mar. 24, 2006; 55(RR03);1-34

147 CDC Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine - Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for Use of Tdap Among Health-Care Personnel MMWR. Dec. 15, 2006. 55(RR17);1-33

148 Tavernise S. Whooping Cough Study May Offer Clue on Surge. The New York Times. Nov. 25, 2013

149 Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci U S A. 2014 Jan 14;111(2):787-92.

150 CDC Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months --- Advisory Committee on Immunization Practices (ACIP), 2011 MMWR. Oct. 21, 2011

151 FDA Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed. Mar. 1, 2018

152 CDC Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines - Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR. Mar. 24, 2006. 55(RR03);1-34

153 CDC Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months --- Advisory Committee on Immunization Practices (ACIP), 2011 MMWR. Oct. 21, 2011 60(41);1424-1426

154 CDC Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012 MMWR. Feb. 22, 2013  62(07);131-135

155 Infectious Diseases in Children. ACIP recommends Tdap vaccine during each pregnancyHealio.com November 2012. 

156 FDA Adacel Vaccine Product Insert. Sep. 29, 2017

157 FDA Boostrix Vaccine Product Insert. Apr. 26, 2016

158 Gruber MF. Maternal Immunization: US FDA Regulatory Considerations (Abstract). Vaccine 2003; 21(24): 3487-3491.

159 CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged Under 12 Months – ACIP, 2011. Safety of Tdap Vaccine In Pregnant Women. MMWR Oct. 21, 2011; 60(41): 1424-1426.

160 Christian LM, Iams JD, et al. Inflammatory Responses to Trivalent Influenza Virus Vaccine Among Pregnant Women. Vaccine 2011; 29(48): 8982-8987.

161 Furuta M, Sin J, et al. Efficacy and safety of pertussis vaccination for pregnant women – a systematic review of randomised controlled trials and observational studies. BMC Pregnancy Childbirth. 2017; 17: 390.

162 CDC Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR  Apr. 27, 2018 67(2);1–44

163 Pulendran B, Ahmed R. Immunological mechanisms of vaccination. Nat Immunol 2011; 12(6): 509-517.

164 Thakur A, Pedersen LE, Jungersen G. Immune markers and correlates of protection for vaccine induced immune responses. Vaccine 2012; 30(33): 4907-4920.

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171 Fine PE, Clarkson JA. Reflections on the efficacy of pertussis vaccines. Rev Infect Dis 1987; 9(5): 866-883.

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173 Schmitt HJ, Schuind A, Knuf M et al. Acellullar Pertussis Vaccines: The Rationale for an Efficacy Trial in Germany. J Infect Dis 1996; 174(Suppl 3): S287-S290.

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175 Cherry JD. Why Do Pertussis Vaccines Fail? Pediatrics 2012; 129(5).

176  Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci USA. 2014; 111(2): 787–792

177 Misegades LK, Winter K, Harriman K et al. Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010 JAMA 2012; 308(20): 2126-2132.

178 Matthias J, Pritchard S, Martin SW et al. Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA. Emerg Infect Dis Jan. 15, 2016.

179 Klein NP, Bartless S, Fireman B, Baxter R. Waning Tdap Effectiveness in Adolescents. Pediatrics Feb. 3, 2016.

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181 Greco D, Salmaso S, Mastrantonio P et al. A Controlled Trial of Two Acellular Vaccines and One Whole-Cell Vaccine Against Pertussis. N Engl J Med 1996; 334(6): 341-348.

182 Zhang L, Prietsch SOM et al. Acellular vaccines for preventing whooping cough in children (Review)The Cochrane Library 2014, Issue 9.

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187 CDC Pertussis Epidemic in Washington State- 2012 Telebriefing. Jul. 19, 2012

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193 Cherry JD. Why Do Pertussis Vaccines Fail? Pediatrics 2012; 129(5).

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199 Ward JI, Cherry JD, Chang S et al. Efficacy of an Acellular Pertussis Vaccine among Adolescents and Adults. N Eng J Med 2005; 353(15): 1555-1563.

200 Long SS, Lischner HW et al. Serologic evidence of subclinical pertussis in immunized children. Pediatr Infect Dis 1990; 9(10): 700-705.

201 He Q, Viljanen MK, Nikkari S et al. Outcomes of Bordetella pertussis Infection in Different Age Groups in an Immunized Population. J Infect Dis 1994; 170: 873-877.

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203 Wendelboe AM, Van Rie A et al.Duration of immunity against pertussis after natural infection or vaccination. Pediatr Infect Dis J 2005; 24(Suppl 5): S58-S61.

204 Tavernise S. Whooping Cough Study May Offer Clue on Surge. The New York Times. Nov. 25, 2013

205 Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci U S A. 2014 Jan 14;111(2):787-92.

206 Hewlett EK, Burns DL Cotter PA et al. Pertussis Pathogenesis – What We Know and What We Don’t Know. J Infect Dis 2014; 209: 982-985.

207 Robbins JB, Schneerson R, Kubler-Kielb J et al. Toward a new vaccine for pertussis. PNAS 2014; 111(9): 3213-3216.

208 Riolo MA, Rohani.Combating pertussis resurgence: One booster vaccination schedule does not fit all. Proc Nat Acad Sci 2015; 112(5): E472-477.

209 De Celles MD, Magpantay FMG et al.The pertussis enigma: reconciling epidemiology, immunology and evolution. Proc R Soc B 2016; 283.

210 CDC. Pertussis (Whooping Cough) Cases by Year (1922-2014). Sept. 8, 2015.

211 Fine PEM, Clarkson JA. The Recurrence of Whooping Cough: Possible Implications for Assessment of Vaccine Efficacy. Lancet 1982; 1(8273): 666-669.

212 Marchant CD, Loughlin AM, Lett SM et al. Pertussis in Massachusetts, 1981-1991: incidence, serologic diagnosis, and vaccine effectiveness. J Infect Dis 1994; 169(6): 1297-1305.

213 Tanaka M, Vitek CR, Pascual B et al.Trends in Pertussis Among Infants in the United States, 1980-1999.JAMA 2003 Dec 10;290(22):2968-75..

214 Nelson JD. The changing epidemiology of pertussis in young infants. The role of adults as reservoirs of infection. Am J Dis Child 1978 132(4): 371-373.

215 Yih WK, Lett SM, desVignes FN et al. The increasing incidence of pertussis in Massachusetts adolescents and adults 1989-1998. J Infect Dis 2000; 182(5): 1409-1416.

216 Jenkinson D. Duration of effectiveness of pertussis vaccine: evidence form a 10 year community study. Brit Med J 1988; 296: 612-614.

217 Christie CDC, Marx ML, Colin D et al. The 1993 Epidemic of Pertussis in Cincinnati. N Engl J Med 1994; 331: 16-21.

218 DeSerres G, Boulianne N et al. Pertussis in Quebec: ongoing epidemic since the late 1980’s. Can Commun Dis Rep 1995; 21(5): 45-48.

219 CDC. Pertussis Outbreak – Vermont, 1996. MMWR Sept. 5, 1997; 46(35): 822-826.

220  Conley JM, Johnston BL. The role of the acellular pertussis vaccine and the demise of ‘Pertussis Pete.’ Can J Infect Dis 2001; 12(1).

221 Bouchez B, Guiso N. Bordetella pertussis, B. parapertussis, vaccines and cycles of whooping cough. FEMS Pathogens and Disease Aug. 4, 2015 (online).

222 CDC. Pertussis – United States, January 1992-June 1995. MMWR July 21, 1995; 44(28): 525-529.

223 Hinman A, Orenstein WA, Schuchat A. Vaccine Preventable Diseases, Immunization and MMWR 1961-2011. MMWR Oct. 7, 2011; 60(04): 49-57.

224 Mooi FR, van Oirschot H, Heuvelman K et al. Polymorphism in the Bordetella pertussis Virulance Factors P. 69/Pertactin and Pertussis Toxin in The Netherlands: Temporal Trends and Evidence for Vaccine-Driven Evolution Infect Immun 1998; 66(2): 670-675.

225 Simondon F., Guiso N. Genetic evolution under vaccine pressure: the Bordetella pertussis model. Bull Soc Pathol Exot 2000; 93(3): 202-205.

226 De Melker HE, Schellekens JFP, Neppelenbroek SE et al. Reemergence of Pertussis in the Highly Vaccinated Population of the Netherlands: Observations on Surveillance Data. Emerg Infect Dis 2000; 6(4): 348-357.

227 Mooi FR, vanLoo IHM, King AJ . Adaptation of Bordetella pertussis to vaccination: A Cause for Its Reemergence? Emerg Infect Dis 2001; 7(3): 526-528.

228 Weber C, Boursaux-Eude C, Coralie G et al. Polymorphism of Bordetella pertussis Isolates Circulating for the Last 10 Years in France, Where a Single Effective Whole-Cell Vaccine Has Been Used for More than 30 Years. J Clin Microbiol 2001; 39(12): 4296-4403.

229 Bart MJ, van Gent M, van der Heide HGJ et al. Comparative genomics of prevaccination and modern Bordetella pertussis strains. BMC Genomics 2010; 11: 627.

230 Xu Y, Liu B et al. Whole-genome sequencing reveals the effect of vaccination on the evolution of Bordetella pertussis. Sci Rep 2015; 5: 12888.

231 Mooi FR, van Loo IHM, van Gent M et al. Bordetella pertussis Strains with Increased Toxin Production Associated with Pertussis Resurgence. Emerg Infect Dis 2009; 15(8): 1206-1213.

232 Kallonen T, He Q. Bordetella pertussis strain variation and evolution post vaccination. Expert Rev Vaccines 2009; 8(7): 863-875.

233 Mooi FR. Bordetella pertussis and vaccination: the persistence of a genetically monomorphic pathogen. Infect Genet Evol 2010; 10(1): 36-49.

234 Guiso N, Hegerle N. Other Bordetellas, lessons for and from pertussis vaccines. Expert Rev Vaccines 2014; 13(9): 1125-1133.

235 Bouchez V, Hegerle N, Strati F et al. New Data on Vaccine Antigen Deficient Bordetella pertussis Isolates. Vaccines (Basel) 2015; 3(3): 751-770.

236 Bart MJ, Harris SR et al. Global Population Structure and Evolution of Bordetella pertussis and Their Relationship with Vaccination. MBio 2014; 5(2).

237 Bolding J, Kamat D Whooping Cough Caused by Bordetella parapertussis. Infect Med. 2004;21(6) 

238 Bocka J. Pertussis. Medscape. Oct. 20, 2017

239 He Q, Viljanen MK et al. Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population. JAMA. 1998 Aug 19;280(7):635-7.

240 Liese JG, Renner C et al. Clinical and epidemiological picture of B pertussis and B parapertussis infections after introduction of acellular pertussis vaccines. Arch Dis Child. 2003 Aug;88(8):684-7.

241 He Q, Viljanen MK et al. Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population. JAMA. 1998 Aug 19;280(7):635-7.

242 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality: Evaluating Biological Mechanisms of Adverse Events (p. 57-102), Increased Susceptibility (p. 82). Washington, DC: The National Academies Press 2012.

243 Finger H, von Koenig CHW. Chapter 31 Bordetella. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.

244 Geier DA, Geier MR. Clinical Implications of Endotoxin Content in Vaccines. Ann Pharmacother 2002; 36(5).

245 Brito LA, Singh M. Acceptable Levels of Endotoxin in Vaccine Formulations During Preclinical Research. J. Pharm. Sci 2011; 100(1): 34-37.

246 Changming L, Pelech S et al. Pertussis toxin induces angiogenesis in brain microvascular endothelial cells. J Neuroscience Research 2008; 86(12): 2624-2640.

247 Linthicum DS. Development of acute autoimmune encephalomyelitis in mice: factors regulating the effector phase of the disease. Immunobiology 1982; 162(3): 211-220.

248 Sidey FM, Furman BL, Wardlaw AC. Effect of hyperreactivity to endotoxin on the toxicity of pertussis vaccine and pertussis toxin in mice. Vaccine 1989; 7(3): 237-241.

249 Bannatyne RM, Cheung R. Reducing the endotoxic activity of pertussis vaccine. J Hyg (Lond). 1981 Dec; 87(3): 377–381.

250 Globus, JH, Kohn JL Encephalopathy following pertussis vaccine prophylaxis. JAMA 1949;141(8):507-509.

251  Berg JM, Neurological complications of pertussis immunization. Br Med J. 1958 Jul 5; 2(5087): 24–27.

252 Cavanagh NP, Brett EM. et al. The possible adjuvant role of bordetella pertussis and pertussis vaccine in causing severe encephalopathic illness: a presentation of three case histories. Neuropediatrics. 1981 Nov;12(4):374-81.

253 Miller DL, Ross EM et al. Pertussis immunisation and serious acute neurological illness in children. Br Med J (Clin Res Ed). 1981 May 16;282(6276):1595-9.

254 Miller D, Madge N et al Pertussis immunisation and serious acute neurological illnesses in children. BMJ. 1993 Nov 6; 307(6913): 1171–1176.

255 Institutes of Medicine. DPT Vaccine and Chronic Nervous Dysfunction: A New Analysis. Washington, DC. The National Academy Press. 1994

256 Ibid

257 Institute of Medicine. Adverse Effects of Pertussis and Rubella Vaccines. Washington, DC. The National Academies Press. 1991

258 Ibid

259 Ibid

260 Ibid

261 Institutes of Medicine. DPT Vaccine and Chronic Nervous Dysfunction: A New Analysis. Washington, DC. The National Academy Press. 1994

262 Ibid

263 Barkin RM, Pichichero ME. Diphtheria-pertussis-tetanus vaccine: reactogenicity of commercial products. Pediatrics 1979; 63(2): 256-260.

264 Neuroimmunolgy Clinic, KK Women’s and Children’s Hospital. Encephalitis in Children: Symptoms, Complications and Treatment. Health Xchange 2016.

265 DuVernoy TS, Braun MM, the VAERS Study Group. Hypotonic-Hyporesponsive Episodes Reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998Pediatrics 2000; 106(4).

266 Wheless JW, Sirven JI. Seizures in NewbornsEpilepsy Foundation Aug. 27, 2013.

267  Duffy J, Weintraub E et al. Febrile Seizure Risk After Vaccination in Children 6 to 23 Months. Pediatrics 2016; 138(1).

268  Menkes JH, Kinsbourne M. Workshop on Neurologic Complications of Pertussis and Pertussis Vaccination. Neuropediatrics 1990; 21(4): 171-176.

269 HRSA. Encephalopathy, Encephalitis, Acute Dissemination Encephalomyelitis. Vaccine Injury Compensation Program Vaccine Injury Table. Mar. 21, 2017.

270 Pellegrino P, Carnovale C, Perrone V et al. Acute Disseminated Encephalomyelitis Onset: Evaluation Based on Vaccine Adverse Events Reporting SystemPLOS One Oct. 18, 2013.

271 Wolf SM, Forsythe A. Epilepsy and mental retardation following febrile seizures in childhood. Acta Pediatr Scand 1989; 78(2): 291-295.

272 MacDonald BK, Johnson AL et al. Febrile convulsions in 220 children – neurological sequelae at 12 years follow-up. Eur Neurol 1999; 41(4): 179-186.

273 LaRoche SM. Seizures and EncephalopathySemin Neurol 2011; 31(19): 194-201.

274 Rao S, Elkon B et al. Long-Term Outcomes and Risk Factors Associated with Acute Encephalitis in ChildrenJ Ped Infect Dis Soc 2015; 1(1): 20-27.

275 Burton KLO, Williams TA et al. Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): A Meta-AnalysisNeuropsychology Rev 2017; 27(2): 124-133.

276 Cody CL, Baraff LJ, Cherry JD et al. Nature and Rates of Adverse Reactions Associated with DTP and DT Immunizations in Infants and Children. Pediatrics 1981; 68(5).

277 Miller DL, Ross EM et al. Pertussis immunization and serious acute neurological illness in children. British Medical Journal 1981; 282:1595-9.

278 Institute of Medicine Committee to Study New Research on Vaccines. DPT Vaccine and Chronic Nervous System Dysfunction: A New Analysis. Executive Summary (pp.1-2) Washington, D.C. The National Academies Press 1994.

279 CDC. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Mar. 28, 1997;46(RR-7):1–25

280 Ibid

281 CDC Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines - Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR. Mar. 24, 2006. 55(RR03);1-34

282 The Free Library. S.v. CHIRON BIOCINE GENETICALLY ENGINEERED ACELLULAR PERTUSSIS VACCINE PROVES SUPERIOR TO CURRENTLY LICENSED VACCINE.." Retrieved Aug 17 2018 fromhttps://www.thefreelibrary.com/CHIRON+BIOCINE+GENETICALLY+ENGINEERED+ACELLULAR+PERTUSSIS+VACCINE...-a017247344

283 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality. (Evaluating Biological Mechanisms for Adverse Events: Increased Susceptibility). Washington, DC: The National Academies Press. 2012

284 Ibid

285 Ibid

286 Ibid

287 Bale JF Jr. Neurologic complications of immunization. J Child Neurol. 2004 Jun;19(6):405-12.

288 U.S. National Library of Medicine. Anaphylaxis (Anaphylactic Shock). MedLine Plus.

289 CDC. Preventing and Managing Adverse Vaccine Reactions.  Feb. 21, 2018.

290 Bhowmik A, Biswas T. Immune Thrombocytopenia Following Diphtheria Pertussis- Tetanus and Oral Polio Vaccine. Indian Pediatr. 2016 Oct 8;53(10):934-935.

291 O'Leary ST, Glanz JM et al. The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. Pediatrics. 2012 Feb;129(2):248-55.

292 Martel J. Low Platelet Count (Thrombocytopenia) Healthline. Feb. 8, 2016

293 Pittman, M.  Bordetella pertussis – Bacterial and host factors in the pathogenesis and prevention of whooping cough. In S. Mudd, ed. Infectious agents and host reactions: 1970. Philadelphia: W.B. Saunders, 239-70.

294 Hannik, C.A., Cohen, H. Changes in plasma insulin concentration and temperature of infants after pertussis vaccination. International Symposium on Pertussis,1978. 297-99.

295 Champsaur H et al. 1982. Virologic, immunologic, and genetic factors in insulin dependent diabetes mellitus. Pediatrics 1982.100(1):15-20.

296 Madsen, T. Vaccination against whooping cough. JAMA. 1933 101(3):187-88.

297 Baraff LJ, Ablon WJ, Weiss RC. Possible temporal association between diphtheria-tetanus toxoid-pertussis-vaccination and sudden infant death syndrome. Pediatr Infect Dis. 1983 Jan-Feb;2(1):7-11.

298 Gerathy KC. DPT Immunization and SIDS. Pediatrics 1984 105:169-170.

299 Torch WC. 1982. Diptheria-pertussis-tetanus (DPT) immunization: A potential cause of sudden infant death syndrome (SIDS), American Academy of Neurology, 34th Annual Meeting, 1982. April25-May1. Neurology 32(4):pt. 2.

300 Kessler DA, the Working Group, Natanblut S, et al. A New Approach to Reporting Medication and Device Adverse Effects and Product Problems. JAMA. 1993;269(21):2765-2768.

301 FDA.gov. Kessler DA. Introducing MEDWatch: A New Approach to Reporting Medication and Device Adverse Effects and Product Problems. Reprint from JAMA. June 9, 1993.

302 Braun M. Vaccine adverse event reporting system (VAERS): usefulness and limitations. Johns Hopkins Bloomberg School of Public Health

303 Rosenthanl S, Chen R. The reporting sensitivities of two passive surveillance systems for vaccine adverse events. Am J Public Health 1995; 85: pp. 1706-9.

304 AHRQ Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP:VAERS) Dec 1, 2007-Sep. 30, 2010

305 HRSA. Vaccine Injury Compensation Program (VICP) Data & Statistics. Aug. 31, 2018.

306 Institute of Medicine Committee to Study New Research on Vaccines. DPT Vaccine and Chronic Nervous System Dysfunction: A New Analysis. Executive Summary (pp.1-2) Washington, D.C. The National Academies Press 1994.

307 NVIC. Do You Know How to Recognize a Vaccine Reaction? Aug 27, 2018

308 Pineau A, Durand C et al. Role of aluminum in skin reactions after diphtheria-tetanus-pertussis-poliomyelitis vaccination: an experimental study in rabbits. Toxocology 1992; 73(1): 117-125.

309 Pichichero ME, Edwards KM et al. Safety and Immunogenicity of Six Acellular Pertussis Vaccines and One Whole-Cell Pertussis Vaccine Given as a Fifth Dose in Four to Six Year old Children. Pediatrics 2000; 105(1).

310 Markel H, Oski JA et al. The Crying Infant. In: The Portable Pediatrician 1992; pp.70-72.

311 Neuroimmunolgy Clinic, KK Women’s and Children’s Hospital. Encephalitis in Children: Symptoms, Complications and Treatment. Health Xchange 2016.

312 DuVernoy TS, Braun MM, the VAERS Study Group. Hypotonic-Hyporesponsive Episodes Reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998. Pediatrics 2000; 106(4).

313 Wheless JW, Sirven JI. Seizures in NewbornsEpilepsy Foundation Aug. 27, 2013.

314 Sun Y, Christensen J et al. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus and Haemophilus influenzae type B. JAMA 2012; 307(8): 523-531.

315 Duffy J, Weintraub E et al. Febrile Seizure Risk After Vaccination in Children 6 to 23 Months. Pediatrics 2016; 138(1).

316 Wolf SM, Forsythe A. Epilepsy and mental retardation following febrile seizures in childhood. Acta Pediatr Scand 1989; 78(2): 291-295.

317 MacDonald BK, Johnson AL et al. Febrile convulsions in 220 children – neurological sequelae at 12 years follow-up. Eur Neurol 1999; 41(4): 179-186.

318 LaRoche SM. Seizures and EncephalopathySemin Neurol 2011; 31(19): 194-201.

319 HRSA. Encephalopathy, Encephalitis, Acute Dissemination Encephalomyelitis. Vaccine Injury Compensation Program Vaccine Injury Table. Mar. 21, 2017.

320 Pellegrino P, Carnovale C, Perrone V et al. Acute Disseminated Encephalomyelitis Onset: Evaluation Based on Vaccine Adverse Events Reporting System. PLOS One Oct. 18, 2013.

321 Rao S, Elkon B et al. Long-Term Outcomes and Risk Factors Associated with Acute Encephalitis in Children. J Ped Infect Dis Soc 2015; 1(1): 20-27.

322  Iro MA, Sadarangani M et al. Immunoglobulin in the Treatment of Encephalitis (IgNiTE): protocol for a multicenter randomized controlled trial. BMJ Open 2016; 6(11).

323 Burton KLO, Williams TA et al. Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): A Meta-Analysis. Neuropsychology Rev 2017; 27(2): 124-133.

324 Institute of Medicine Committee to Study New Research on Vaccines. DPT Vaccine and Chronic Nervous System Dysfunction: A New Analysis. Executive Summary (pp.1-2) Washington, D.C. The National Academies Press 1994.

325 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS - Some children should not get DTaP vaccine or should wait. Aug. 24, 2018

326 NVIC. Report Vaccine Reactions: It’s the Law!

327 DHHS. Vaccine Adverse Event Reporting System (VAERS). Two Ways to Submit an Online Report to VAERS. Also Online VAERS Reporting Demonstration. July 2017.

328 Werne J, Garrow I. Fatal anaphylactic shock occurrence in identical twins following second injection of diptheria toxoid and pertussis antigen. JAMA 1946 131(9): 730-35.

329  Stetler HC, Orenstein WA et al. History of convulsions and use of pertussis vaccine. J Pediatr 1985; 107(2): 175-179.

330 Coulter HL, Fisher BL. DPT: A Shot in the Dark. Harcourt Brace Jovanovich, 1985; Warner, 1986; Avery 1991; Penguin Books

331 IBID

332 CDC Recommendation of the Immunization Practices Advisory Committee Pertussis Immunization; Family History of Convulsions and Use of Antipyretics -- Supplementary ACIP Statement. MMWR. May 15, 1987 36(18);281-2

333 Ibid

334 Lee J, Robinson JL, Spady DW Frequency of apnea, bradycardia and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenza type B immunization in hospitalized preterm infants. BMC Pediatr. 2006 Jun 19;6:20.

335 Buijs SC, Boersma B. Cardiorespiratory events after first immunization in premature infants: a prospective cohort study. Ned Tijdschr Geneeskd. 2012;156(3):A3797.

336 FDA Vaccines Licensed for Use in the United States. Mar. 29. 2018

337 Coulter HL, Fisher BL. DPT: A Shot in the Dark. Harcourt Brace Jovanovich, 1985; Warner, 1986; Avery 1991; Penguin Books

338 Romagnani S. Human TH1 and TH2 subsets: regulation of differentiation and role in protection and immunopathology. Int Arch Allergy Immunol. 1992;98(4):279-85.

339 Rook GA, Zumla A. Gulf War syndrome: is it due to a systemic shift in cytokine balance towards a Th2 profile? Lancet. 1997 Jun 21;349(9068):1831-3.

340 Hopper, J.M. Illness after whooping cough vaccination. Medical Officer 1961. (October 20), 241-44

341 Hanik, C.A. Major reactions after DPT-polio vaccination in the Netherlands. International Symposium of Pertussis, Bilthoven. Symposium Series on Immunobiological Standardization. 1969.  13 161-70: Basel, Mughen, New York: Karger.

342 Hurwitz EL, Morgenstern H Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000 Feb;23(2):81-90.

343 Fisher BL. In the Wake of Vaccines. A Special Report for Mothering Magazine. Issue 126, September/October 2004

344 L Steinman, A Weiss, N Adelman et al. Pertussis toxin is required for pertussis vaccine encephalopathy. Proc Natl Acad Sci U S A. 1985 Dec; 82(24): 8733–8736.

345 Coulter HL, Fisher BL. DPT: A Shot in the Dark. Harcourt Brace Jovanovich, 1985; Warner, 1986; Avery 1991; Penguin Books

346 WebMD Casein Allergy Overview. Jun. 17, 2018

347 CDC Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Apr. 27, 2018 / 67(2);1–44

348 Infectious Diseases in Children. ACIP recommends Tdap vaccine during each pregnancyHealio.com November 2012. 

349 Gruber MF. Maternal Immunization: US FDA Regulatory Considerations (Abstract). Vaccine 2003; 21(24): 3487-3491.

350 CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged Under 12 Months – ACIP, 2011. Safety of Tdap Vaccine In Pregnant Women. MMWR Oct. 21, 2011; 60(41): 1424-1426.

351 Christian LM, Iams JD, et al. Inflammatory Responses to Trivalent Influenza Virus Vaccine Among Pregnant Women. Vaccine 2011; 29(48): 8982-8987.

352 FDA Adacel Vaccine Product Insert. Sep. 29, 2017

353 FDA Boostrix Vaccine Product Insert. Apr. 26, 2016

354 U.S. Dept. of Health & Human Services. FDA Pregnancy Categories. Sept. 29, 2017

355 FDA Adacel Vaccine Product Insert. Sep. 29, 2017

356 Ibid

357 U.S. Dept. of Health & Human Services. FDA Pregnancy Categories. Sept. 29, 2017

358 FDA Boostrix Vaccine Product Insert. Apr. 26, 2016

359 Ibid

360 Schmidt CW.Uncertain Inheritance: Transgenerational Effects of Environmental Exposures. Environmental Health Perspectives October 2013;12(10).

361 CDC. Vaccine Excipients & Media Summary (Vaccine Ingredients).Appendix B.The Pink Book, 13th Edition, June 2018

362 Tomlejenovic L, Shaw CA. Aluminum Vaccine Adjuvants: Are They Safe? Curr Med Chem. 2011; 19(17): 2630-2637.

363 Krewski D, Yokel RA, Nieboer E et al. Human Health Risk Assessment for Aluminum, Aluminum Oxide, Aluminum HydroxideJ Toxicol Environ Health B Crit Rev 2007; 10(Suppl 1); 1-269.

364 Elce D, Celik A. Genotoxicity of thimerosal in cultured human lymphocytes with and without metabolic activation sister chromatid exchange analysis proliferation index and mitotic index. Toxicology in Vitro June 2008; 22(4): 927-934.

365 Speit G, Neuss S, Schutz P et al. The genotoxic potential of gluteraldehyde in mammalian cells in vitro in comparison with formaldehyde. Mutation Research 2008; 649: 146-154.

366 Toxicology Data Network. 2-PhenoxyethanolNational Library of Medicine. Webpage last reviewed Jan. 19, 2012.

367 ScienceLab.com. Material Safety Data Sheet: Polysorbate 80(Tween 80). ScienceLab.com. Webpage last updated May 21, 2013. 

368 Gajdova M, Jakubousky J, Valky J. Delayed effects of neonatal exposure to Tween 80 on female reproductive organs in rats. Abstract. Food Chem Toxicol 1993; 31(3): 183-190.

369 FDA. Summary: Potential for contamination of biological products with the agent of bovine spongiform encephalopathy (BSE). Transmissable Spongiform Encephalopathies Advisory Committee (TSEAC) and Vaccines & Related Biological Products Advisory Committee (VRBPAC). July 27, 2000.

370 Food and Drug Administration (FDA). Guidance for Industry: Consideration for Developmental Toxicity Studies for Preventive and Therapeutic Vaccines for Infectious Disease Indications (Non-Binding Recommendations). Design of Developmental Toxicity Studies: General Considerations and Recommendations. Centers for Biologics Evaluation Research (CBER) February 2006.

371 Zeteyeva YA, Moro PL, Tepper HK et al. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid and acelullar pertussis vaccines in pregnant women. Am J Obstet Gynecol 2012 207(1)

372 CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged Under 12 Months – ACIP, 2011.Safety of Tdap in Pregnant Women. MMWR Oct. 21, 2011; 60(41): 1424-1426.  

373 Furuta M, Sin J, et al. Efficacy and safety of pertussis vaccination for pregnant women – a systematic review of randomised controlled trials and observational studies. BMC Pregnancy Childbirth. 2017; 17: 390.

374 Businesswire NVIC Cites “Betrayal” of Consumers by U.S. Supreme Court Giving Total Liability Shield to Big Pharma. NVIC Press Release Feb. 23, 2011.

375 Feemster KA. Advisory Commission on Childhood Vaccines Maternal Immunization Working Group Draft RecommendationsACCV June 7, 2013.

376 Federal Register. Proposed Rules. Vol. 83, No. 65. Apr. 4, 2018

377 CDC Recommendation of the Immunization Practices Advisory Committee (ACIP) Diphtheria, Tetanus, and Pertussis: Guidelines for Vaccine Prophylaxis and Other Preventive Measures. MMWR. July 12, 1985  34(27);405-14,419-26

378 CDC Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use and Other Preventive Measures Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Aug. 8, 1991 40(RR10);1-28

379 CDC Diphtheria, Tetanus, and Pertussis Vaccine Recommendations. May 8, 2018

380 Ibid

381 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS - Some children should not get DTaP vaccine or should wait. Aug 24, 2018

382 World Health Organization. Pertussis Vaccines: Position Paper. (p. 449). WHO Weekly Epidemiological Record 2015; 90(35): 433-460.


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