Developed at a time when scientific funding was so scarce that lab mice were considered a luxury, the vaccine would go on to prevent thousands of children each year from succumbing to the disease. In the s, Kendrick and Eldering's lab also developed the vaccine that most people receive today, called DTP, that protects against diphtheria and tetanus as well as whooping cough, alongside an African-American female chemist named Loney Gordon. This became a staple early-life vaccine, multiplying the survival rate of children in the United States as it spread across the country.
Back when Eldering and Kendrick began working on their vaccine in the s, an estimated 6, kids in the United States were dying from whooping cough, or pertussis, each year —more than from diphtheria, scarlet fever, tuberculosis or polio. In a vicious cycle, the cough spreads the contagion to others, and is so powerful that it can induce shaken baby syndrome. Babies who get it have a high chance of dying.
Pearl Kendrick, seen here in , was a bacteriologist with the Michigan Department of Health who developed the first successful vaccine for whooping cough in the s with Grace Eldering. As whooping cough ravaged the Grand Rapids area, Kendrick and Eldering worked around the clock to battle the highly contagious disease.
They knocked on doors, analyzed samples, and later recruited locals for field trials of the vaccine. Incredibly, the original s vaccine work began as a side project for Kendrick and Eldering, who both worked in a laboratory at the Michigan Department of Health.
The scientists were motivated by personal experience. Both women had survived whooping cough as children Kendrick in New York, Eldering in Montana and knew firsthand how painful the disease was.
I coughed until I thought it would be the end. While scientists had tried to make whooping cough vaccines since , the vaccines available were not very effective; no one was sure how much or which strain of the bacteria was best to use, and it was difficult to grow in the lab. Pertussis vaccines are administered by intramuscular injection. Each dose of pertussis-containing vaccine contains aluminum as an adjuvant but no preservative.
DTaP diphtheria, tetanus toxoids, and acellular pertussis vaccine is recommended for children age 6 weeks through 6 years. The routine schedule is a primary series of 3 doses at age 2, 4, and 6 months, a booster dose between age 15 through 18 months, and another booster dose between age 4 through 6 years total of 5 doses.
The first 3 doses should be given at 4- to 8-week intervals minimum of 4 weeks. Dose 4 should follow dose 3 by no less than 6 months and should not be administered before age 12 months.
Dose 4 of both brands of DTaP is recommended to be administered at age 15 through 18 months 15 through 20 months for Daptacel. Dose 4 may be given as early as age 12 months if at least 6 months have elapsed since dose 3 and, in the opinion of the vaccine provider, the child is unlikely to return for an additional visit between age 15 through 18 months.
Children who received 4 doses before their fourth birthday should receive a fifth dose of DTaP before entering school. The fifth dose is not necessary but may be given if dose 4 in the series was given on or after the fourth birthday.
Administering the fifth dose increases antibody levels and may decrease the risk of school-age children transmitting the disease to younger siblings who are not fully vaccinated. If a child has a valid contraindication to pertussis vaccine, DT should be used to complete the vaccination series. If the child was age 12 months or older at the time the first dose of DT was administered, 3 doses with dose 3 administered 6 through 12 months after dose 2 will complete the primary DT series.
It is administered to infants at age 2, 4, and 6 months. The 3 doses must be separated by at least 4 weeks between doses. It is administered to infants at age 2, 4, 6, and 15 through 18 months.
The first 3 doses must be separated by at least 4 weeks between doses. Dose 4 must be separated from dose 3 by at least 6 months, and should not be administered before age 12 months. This will result in a 5-dose IPV vaccine series, which is acceptable. Boostrix is approved for persons age 10 years or older. Adacel is approved for a single dose in persons age 10 through 64 years.
A second dose of Adacel is also licensed for administration 8 or more years after the first Tdap dose and for use for tetanus prophylaxis when indicated for wound management if at least 5 years have elapsed since the previous receipt of any tetanus toxoid-containing vaccine.
Adults age 19 years or older who have not previously received Tdap should receive a single dose of Tdap. To reduce the burden of pertussis in infants, a dose of Tdap has been recommended during each pregnancy since , although this practice is an off-label use.
All adolescents and adults should have received a primary series of at least 3 documented doses of tetanus and diphtheria toxoids-containing vaccine i. A person without such documentation should receive a series of 3 doses of tetanus- and diphtheria-containing vaccine. One of these doses, preferably the first, should be Tdap. The remaining 2 doses should be either Td or Tdap. For persons age 7 to 9 years who receive a dose of Tdap as part of the catch-up series, an adolescent Tdap dose should be administered at age 11 through 12 years.
If a Tdap dose is administered at age 10 years or older, the Tdap dose may count as the adolescent Tdap dose. Either brand of Tdap may be used.
Adults age 19 years or older who previously have not received Tdap should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission.
For adults age 19 through 64 years, either brand of Tdap may be used. Adults age 65 years or older should be vaccinated with Boostrix, if feasible.
However, either vaccine administered to a person age 65 years or older is immunogenic and would provide protection. A dose of either vaccine would be considered valid. Adolescents and adults who have not previously received Tdap, and have or anticipate having close contact with an infant younger than age 12 months e. Ideally, these persons should receive Tdap at least 2 weeks before beginning close contact with the infant.
Health care personnel should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap, regardless of the time since their most recent Td vaccination. When Tdap is indicated e. After receipt of Tdap, persons should continue to receive a dose of Td or Tdap for routine booster immunization against tetanus and diphtheria every 10 years unless needed sooner for tetanus prophylaxis as part of wound management. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks of gestation, preferably during the earlier part of this period, although Tdap may be administered at any time during pregnancy.
For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum. Tdap should be administered during each pregnancy preferred or during the postpartum period regardless of the interval since the last tetanus- or diphtheria toxoid-containing vaccine.
Since , several studies conducted in Europe and Africa have evaluated the efficacy of DTaP vaccines administered to infants. These studies varied in type and number of vaccines, design, case definition, and laboratory method used to confirm the diagnosis of pertussis, so comparison among studies must be made with caution. For both vaccines, the antibody response to a single dose of Tdap was similar to that following 3 doses of DTaP in infants.
Studies on the persistence of antipertussis antibodies following a dose of Tdap show antibody levels in healthy, nonpregnant adults peak during the first month after vaccination, with antibody levels declining after 1 year. Because antibody levels wane substantially during the first year after vaccination, ACIP concluded a single dose of Tdap during one pregnancy would not be sufficient to provide protection for subsequent pregnancies.
As with other vaccines, a history of a severe allergic reaction anaphylaxis to a vaccine component or following a prior dose is a contraindication to further doses. Moderate or severe acute illness with or without fever in a patient is considered a precaution to vaccination, although persons with minor illness may be vaccinated. Contraindications to combination vaccines that contain DTaP include the contraindications to the individual component vaccines e.
Presentations of some pertussis-containing vaccines contain latex rubber. A progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy is a precaution for DTaP and Tdap vaccination. For persons with a known or suspected neurologic condition, vaccination with DTaP or Tdap should be delayed until the condition has been evaluated, treatment initiated, and the condition stabilized.
These conditions include the presence of an evolving neurologic disorder e. A family history of seizures or other neurologic diseases, or stable or resolved neurologic conditions e. A history of Arthus-type hypersensitivity reactions after a previous dose of diphtheria toxoid-containing or tetanus toxoid—containing vaccine is a precaution for DTaP, Tdap, DT, and Td vaccination; vaccination should be deferred until at least 10 years have elapsed since the last tetanus-toxoid-containing vaccine.
DTaP vaccine may cause local reactions, such as pain, redness, or swelling. Mild systemic reactions such as drowsiness, fretfulness, and low-grade fever may also occur. These reactions are self-limited and can be managed with symptomatic treatment with acetaminophen or ibuprofen. Rates of these moderate or severe systemic reactions vary by symptom and vaccine but generally occur in fewer than 1 in 10, doses. Exaggerated local Arthus-type reactions are rarely reported but may occur following receipt of a vaccine containing diphtheria or tetanus toxoids.
Temperature of Tdap recipients also reported a variety of nonspecific systemic events, such as headache, fatigue and gastrointestinal symptoms.
Manufacturer package inserts contain additional information. For information on guidance for state and local health department staff who are involved in surveillance activities for vaccine-preventable diseases, please consult the Manual for the Surveillance of Vaccine-Preventable Diseases.
The editors would like to acknowledge Jennifer Liang, Stacey Martin, and Cindy Weinbaum for their contributions to this chapter. American Academy of Pediatrics. MMWR ;60 41 —6. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices — United States, MMWR ;69 3 — Cherry J, The epidemiology of pertussis: a comparison of the epidemiology of the disease pertussis with the epidemiology of Bordetella pertussis infection.
Pediatrics ; 5 —7. Edwards K, Decker M. Pertussis Vaccines. MMWR ;69 33 — Greenberg D. This is partly challenged by more recent studies that allege a long-lived, if imperfect, protection afforded by DTaP. Understanding of the transmission and contact networks is incomplete, and studies looking at vaccine evasion in B.
In the meantime, several countries are experimenting with new vaccination schedules and vaccination of pregnant women, and the search for a better vaccine continues. Boom, J. Cherry, J. The year odyssey of pertussis and pertussis vaccines—mistakes made and implications for the future. Pediatric Infect. Duration of immunity and effectiveness of diphtheria—tetanus—acellular pertussis vaccines in children. JAMA Pediatr. Pertussis vaccines.
WHO position paper — September Wkly Epidemiol. University of Washington UW. Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.
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