Who Should Not Get Pertussis Vaccine?
For the first 40 years of use of whole cell pertussis (DPT) vaccine, ABSOLUTE CONTRAINDICATIONS to pertussis vaccination included1:
- 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. 2
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: 3
- 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): 4
- 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.5 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.6 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.
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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1 CDC. HPV (Human Papillomavirus) VIS. Dec. 2, 2016
3 FDA. Gardasil 9 – Product insert. Feb. 9, 2018
1 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
2 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
3 CDC Diphtheria, Tetanus, and Pertussis Vaccine Recommendations. May 8, 2018
5 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS - Some children should not get DTaP vaccine or should wait. Aug 24, 2018
6 World Health Organization. Pertussis Vaccines: Position Paper. (p. 449). WHO Weekly Epidemiological Record 2015; 90(35): 433-460.