Parents PACK

Tetanus, Diphtheria, Pertussis

General information

Please visit the Vaccine Education Center for general information about Tetanus, Diphtheria, Pertussis and the vaccine.

Additional information from past issues of the Parents PACK newsletter

• Tetanus
• Pertussis
• Questions about tetanus, diphtheria, and pertussis-containing vaccines

Tetanus

The bacteria that causes tetanus is called Clostridium tetani. The bacterial spores are commonly found throughout the environment, but the disease is not infectious in that one person cannot transmit the disease to another person. Instead the bacteria pose a risk when the spores come into contact with punctures or wounds that are not kept clean or include damaged tissues such as from burns, frostbite, or gangrene.

Because of its presence in the environment and the noninfectious nature of this disease, eradication will not be possible through vaccination. Further, people cannot be protected from this disease because everyone around them has had a vaccine; that is, there is no protection from herd immunity.

Two populations most affected by tetanus

In developed countries tetanus is typically thought of as infecting wounds in adults who have injured themselves; however, in the developing world many infants suffer from neonatal tetanus. Infections in newborns result from poor sanitation either during or after delivery. Each year almost 200,000 infants succumb to infections with tetanus.

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Pertussis

The 100-day cough

Imagine having 15 severe coughing spells in a day — coughing spells that cause vomiting and prevent you from sleeping; coughing spells so severe that you get a nosebleed or crack your rib; coughing spells that last for months. . . . Imagine having pertussis.

Commonly referred to as whooping cough, pertussis has also been called the “100-day cough” because of the severe, prolonged coughing it causes. This bacterial infection is transmitted through coughs and sneezes.

Five things you should know about pertussis include:

• Pertussis is very contagious; in fact, 8 of 10 non-immune people will be infected when exposed to someone with the disease.
• Pertussis is commonly misdiagnosed and under-diagnosed.
• You can get pertussis more than once, and protection from the vaccine fades over time.
• Older children and adults commonly transmit pertussis to infants and young children.
• Pertussis can be particularly severe, even deadly in infants.

Misdiagnosis, under-diagnosis, and fading immunity

In 2008, the Centers for Disease Control and Prevention (CDC) recorded more than 13,000 cases of pertussis in the United States. Unfortunately, experts know that this estimate is much lower than the actual number of pertussis infections. That’s because of:

• Misdiagnoses: Because pertussis bacteria are only detected at the beginning of the infection, the test may be negative by the time someone seeks medical care.
• Under-diagnoses: Because many adults who are ill do not go to the doctor, they are never diagnosed with pertussis.
• Fading immunity: Since there is a vaccine, people expect to be immune, but booster doses are needed to maintain immunity. Tdap is the vaccine recommended for booster doses in adolescents and adults.

Susceptible infants

Although a pertussis infection can interfere with day-to-day life, adults tend to recover. Unfortunately, infants and young children with narrow windpipes are not always as lucky. Coughing episodes caused by pertussis often turn babies blue as they struggle to breathe. Sadly, some of them do not survive.

Because the most negatively impacted age group is infants who are too young to get a vaccine, public health officials have started educating new parents about a technique called cocooning. Cocooning is like wrapping your baby in a blanket of protection — when everyone around them has been protected with a recent dose of the pertussis vaccine, babies are less likely to come into contact with the bacteria and, therefore, less likely to become ill before they develop their own protection from DTaP vaccine, which is given at 2 months, 4 months, and 6 months of age. Booster doses are given at 15 to 18 months and again at 4 to 6 years.

Epidemic proportions

Unfortunately, concerns about vaccine safety in some communities have led to decreased use of many vaccines including pertussis-containing vaccines. In June 2010 in California, the number of cases of pertussis were about four-fold higher than in previous years. With 910 cases already diagnosed, 600 more being investigated, and five infant deaths, the director of the state health department warned that California could experience the highest number of pertussis cases in 50 years. Interestingly, all five deaths were infants less than 3 months old, where only cocooning would have worked. Public health officials in other states are equally concerned — worried that California’s situation foreshadows events to come.

One of the groups that is encouraged to get a pertussis vaccine to help control the spread of disease is adolescents. Because immunity fades, adolescents often get mild pertussis infections. Also, adolescents are often around younger siblings and infants; therefore, increasing immunity among adolescents decreases transmission. The Tdap vaccine is recommended for 11- to 12-year-olds and any teens or adults who have not recently had the tetanus-diphtheria (Td) vaccine.

Get information

• Learn more about pertussis and the vaccines »
• Watch videos with pertussis and hear the sounds of a pertussis cough »
• Watch a video for adolescents »

Newborns and Pertussis (Whooping Cough)

Q.  I had a friend whose baby was hospitalized for several weeks with pertussis (whooping cough). I will soon deliver my first baby and want to prevent her from getting sick with this. What can I do?

A. Pertussis can be a dangerous disease for a new baby. Because of their small airways and the amount of mucus caused by infection with pertussis, babies have trouble breathing, often turning blue during their coughing spells. Every year in the U.S. about 15 to 20 children die from pertussis, most are young babies who have not been fully immunized.

There are several things that you can do to help protect your baby from pertussis. Babies get a vaccine to protect them from pertussis when they are 2 months, 4 months, and 6 months of age. They get an additional dose at 15 to 18 months. However, babies are most susceptible during their first few months of life either because they have not gotten the vaccine yet or because the dose they received did not fully protect them. During this time, you can protect your baby by making sure that all of the adults (or siblings) who will be around the baby are protected - this is what public health personnel call the "cocooning" method.

There is a vaccine available for adolescents and adults called Tdap. The "p" means that it contains a pertussis component. You should receive the Tdap vaccine between 27 and 36 weeks’ gestation during each pregnancy. If you are past this point in your pregnancy, be sure to ask for the Tdap vaccine before being discharged from the hospital. Your spouse, the baby's grandparents and any other adults who will commonly be around the baby should also get the vaccine in advance of your delivery.

Additionally, you can encourage hand washing before people touch the baby, and if anyone has a cough, try to limit the baby's exposure to this person. Unfortunately, people are not only contagious in the first few weeks of the severe coughing stage, but also in the one- to two-week period leading up to cough onset. During this period, symptoms may resemble cold-like respiratory symptoms (e.g., runny nose, sneezing, occasional cough).

Adolescents and pertussis

Although most adolescents have been immunized against pertussis (whooping cough), immunity fades over time, so your 10- to 19-year-old may be at increased risk of becoming ill.

The severe coughing episodes associated with pertussis can last over 100 days and lead to vomiting, hernia or a broken rib. The Tdap vaccine is available to help protect adolescents against this disease. Like the infant vaccine, this vaccine is administered with tetanus and diphtheria vaccines as a shot. The CDC recommends that 11- and 12-year-olds be given the new vaccine instead of the standard tetanus-diphtheria booster (Td). Additionally, 13- to 18-year-olds who missed the Td booster should get a dose of vaccine.

Daniel's bout with pertussis

The following is a letter we received from a Mom whose son suffered a bout with pertussis when he was 7 years old. It is reprinted here with permission:

Just a quick note to keep in touch with you in the New Year. Two years after Daniel's bout with pertussis, he is an active boy who recently hit a grand slam home run for his baseball team. He's practicing with his basketball team and ready for the season to start this weekend.

He also gets sick much more often than before, and his alarming, bronchial cough reminds us regularly of the illness that may be gone, but its effects still linger. He sees an asthma specialist for his "reactive airway disease," usually controlled by the two doses of an Advair inhaler daily, as well as a nightly dose of Singulair to keep the inflammation and "twitchiness" away from his airwaves. When he labors, we test his breathing, and sometimes must resort to even more medication and curtailed activities.

His reading still isn't what it could be, but with the assistance of a twice-weekly tutor through the past school year, he has made up for much of the concepts missed while he missed so much school when he down with the cough. When asked to complete a reading prompt recently, Daniel's best friend wrote, "The world would be a better place...if there wasn't any whooping cough."

All of this in a child who never had more than a cold before his bout with whooping cough. All this in a child who was immunized, but attended a school where up to forty percent of the children were not - a fact we did not know beforehand. I cannot stress strongly enough how parents must do everything they can to avoid this disease in every possible way. Its effects are devastating to the family, indeed the village, for longer than anyone can predict.

Happy New Year, and all best wishes,

Cheri Rae

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Questions about tetanus, diphtheria, and pertussis-containing vaccines

I have a newborn and we were told to have everyone who will be around her immunized with the Tdap vaccine. My parents have been unable to get the vaccine because they are in their late 60s and were told the vaccine is for people less than 65 years old. What should we do? Should we keep them away from the baby?

The Tdap vaccine contains vaccines to protect against tetanus, diphtheria, and pertussis (whooping cough). Although adults have traditionally gotten a tetanus-diphtheria vaccine every 10 years, the pertussis component has been added more recently and is the reason that adults are recommended to get the Tdap vaccine as their next booster. Adults tend to infect infants, and whooping cough in young infants can be deadly. Infected infants cannot breathe when their airways are constricted with mucus and coughing resulting from pertussis.

Although the vaccine was originally recommended only for adults less than 65 years old, the recommendation was changed in October 2010 due to ongoing pertussis outbreaks primarily in California, but in other locations throughout the U.S. as well.

The original recommendation excluded people 65 and older because the studies were done in people less than 65 years old. However, the theoretical risks associated with vaccines not being extensively tested in this age group are now outweighed by the real risks of spreading pertussis, particularly to infants too young to be immunized. Sadly, ten infants in California have died as a result of pertussis during 2010.

Finally, in response to your last question, you should protect your infant daughter by limiting the number of people she is around in the first few months of life, checking that people have been immunized, and asking people with coughs or colds to delay their visits. 

My daughter had a fever and swelling from her last dose of DTaP vaccine. Is it likely that this will occur the next time too or should I not give her additional doses of that vaccine?

Some children develop pain, swelling or tenderness after a dose of DTaP vaccine. It is possible that the same reaction may happen with the next dose. However, the benefits of getting a vaccine to protect against a disease like whooping cough (the "P" in the DTaP vaccine stands for pertussis, otherwise known as whooping cough) outweigh the discomfort of the vaccine. Whooping cough is still very common in the United States and is a common cause of hospitalization. The pain and swelling might be relieved by giving ibuprofen or acetominophen prior to the vaccine visit; talk to your healthcare provider.

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Updated: January 2012