Tdap Vaccine for Whooping Cough

The Tdap vaccine protects the body from three diseases: tetanus, diphtheria, and whooping cough.

• Whooping Cough - is a very serious and contagious respiratory disease. Whooping cough causes severe persistent coughing, which may result in cracked ribs, pneumonia, and other health complications. It also causes severe breathing problems. Initially, it may appear as an ordinary cold, but later, there are severe intense coughing spells with a whooping noise that can be heard when the person tries to breathe after coughing. Moreover, pertussis can cause a difficulty in breathing, sleep disturbances, vomiting, weight loss, rib fractures, and incontinence. Adults are at a risk of passing the disease to babies. For babies, whooping cough is a life-threatening disease, especially for those who are less than one year of age. Babies can likely get the infection from other household members and from infected individuals who are in close contact with them.

• Tetanus - is also called as lockjaw. Individuals who are infected with the bacterium Clostridium tetani, which causes tetanus, experience jaw spasms, which make them unable to open their mouth, hence, the term “lockjaw”.

• Diphtheria - causes breathing problems due to the thick coating on the airway, throat, and nose. It can also cause heart failure, paralysis, and even death.

Tdap

The Tdap vaccine protects adults and adolescents from whooping cough. Vaccinating both adults and adolescents may provide protection for babies as well. If this vaccine is given before or during pregnancy, there are chances that the child may get some antibodies from the mother, thereby getting the essential protection the child needs.

There have been cases of an average of 3,055 infants with whooping cough since 2004 in the US. Each year, there are more than 19 deaths due to this bacterial disease, especially children under two years old. Whooping cough has been found to be more prevalent in adults and adolescents. Annually, 600,000 adults die because of this disease.

Recommendation

The Centers for Disease Control and Prevention or CDC recommends the Tdap vaccine for:

• Children in the age group of 11-18 years old or those who have completed their course of DTaP vaccine series.
• Adults in the age group of 19-64 and adults in the age group of 65 and above.
• Pregnant women should get the Tdap vaccine during each pregnancy between the 27th and 36th week of gestation.
• Caregivers including parents, grandparents, and babysitters who take care of 1-year-old babies and younger.
• People who have direct contact with the patients.
• New mothers who never received the Tdap vaccine during their pregnancy.
• Those traveling to countries where pertussis is prevalent.

Safety of Tdap During Pregnancy

This vaccine was introduced in the year 2005, and since then, there have been no reports of any problems in pregnant women who have received the vaccine. Hence, it is considered safe during pregnancy. The Tdap vaccine given to pregnant mothers can help protect the babies by making sure that pertussis does not infect newborns since they are still too young to receive the vaccination. After receiving the shot, it may take a month for the body to make antibodies. Thus, doctors usually advise mothers to get vaccinated before leaving the hospital or birth center.

Tdap for Babies

DTaP is a vaccine that is given to babies at the age of 2 months, 4 months, 6 months, and 15 months. They receive the vaccine again at the age of 4-6 years old. The pertussis vaccine is given as a part of DTaP.

Tdap is a booster dose that offers the best protection against three life-threatening diseases: pertussis, diphtheria, and tetanus. It is available under the brand names Adacel and Boostrix. Tdap actually stands for tetanus, diphtheria, and acellular pertussis. It is an inactive vaccine. The dead bacteria present in the vaccine do not make the person sick.

Risks

The following people should not receive the vaccine:

• Those who had serious allergic reactions to any of the ingredients in the vaccine.
• Those who had seizures or coma within one week of receiving childhood vaccinations for pertussis.

Discuss with the doctor about the following conditions:

• Any problem with the nervous system or epilepsy
• Guillain-Barré syndrome
• Receiving the vaccine even during mild illness or low-grade fever or colds
• Any history of severe swelling or pain after receiving Tdap
• If you had a similar vaccine that caused any of these symptoms: very high fever, fainting, severe pain, tenderness, swelling, redness, and epilepsy.
• If you have a history of seizure, weakened immune system due to certain medications, undergoing cancer treatment, bone marrow transplantation, or any type of disease.
• A time gap of fewer than 10 years since you received the last tetanus shot.

The vaccine is injected into the muscle. It is a one-time injection and is given once every 10 years.

Side Effects of Tdap and Td Vaccines

Vaccines also have side effects like any other drugs. However, life-threatening reactions due to vaccination rarely occur. 

The Tdap vaccine has mild side effects, which include:

• Pain
• Redness
• Swelling in the area where the shot was given
• Headache
• Tiredness
• Stomach upset
• Nausea
• Vomiting
• Diarrhea
• Swollen glands
• Muscle ache
• Mild fever and body pain

Call your doctor immediately if you experience any of the following side effects within a week after receiving the shot:

• Walking or coordination problems
• Vision problems
• Sudden pain in the arms and shoulders
• Numbness and tingling in the feet and legs
• Seizure
• Redness, bleeding, and pain in area where the shot was given

There have been reports of fever in 1 out of 250 adults and swelling of the arm in 3 out of 100 people.

Allergic Reactions

Some individuals may also develop serious allergic reactions. This may happen one in a million. Signs of allergic reactions include:

• Behavioral changes
• Difficulty in breathing
• High fever
• Wheezing
• Pale skin
• Weakness
• Rapid heartbeat
• Hoarse voice
• Dizziness
• Hives 

Contact the doctor immediately if you experience these signs after receiving the vaccine. Some of these signs may develop within a few minutes of receiving the shot.

Ingredients of Tdap

In some countries, the whole-cell pertussis vaccine is used, but in the US, it is not used anymore. DTP contains whole B. pertussis bacteria, which are dead bacteria. They have been inactivated by heat and chemicals, aluminum adjuvant, and thimerosal, which is a mercury preservative. Next, they are purified and packaged in vials as a single dose.

It contains reduced bioactive pertussis toxin, less endotoxin, and trace amounts or no amounts of mercury along with an aluminum adjuvant. The amounts of inactivated pertussis toxin, pertactin, fimbriae, polysorbate 80, filamentous hemagglutinin, glutaraldehyde, aluminum and thimerosal, and 2-phenoxyethanol may vary in amounts. In larger combination shots, other ingredients are also included.

The Effectiveness of the Pertussis Vaccine

The effectiveness of the vaccine usually depends on the following conditions:

• The health of the individual when the vaccination was given
• The history of the person with regard to reaction to vaccines
• Other environmental toxins or factors that the child is exposed to

Several toxins are present in the B. pertussis bacterium that causes inflammation in the body.

One of the most lethal toxins is the pertussis toxin that induces leukocytosis, lymphocytosis, stimulates the secretion of insulin, and sensitizes histamine. They are involved with the immune system's response to inflammation. Whenever scientists wanted to induce histamine, endotoxin sensitivity, or serotonin, they injected the pertussis vaccine in laboratory animals since it can cross the blood-brain barrier. The most dreaded complication of pertussis and whopping cough vaccination is brain inflammation, which permanently damages the brain.

Tdap contains 10-25 mcg inactivated pertussis toxin in one dose. It may induce brain inflammation due to the retention of varying amounts of bioactivity.

Potential High-Risk factors for Tdap

• Family History - One of the serious risk factors is having a family history of convulsions or neurological diseases. The vaccine is also contraindicated if the person has a family or personal history of seizures, epilepsy, and other central nervous system disorders.

• Low Birth Weight - Premature babies are at a higher risk of contracting whooping cough because their neurological, respiratory, and immunological system is not yet fully developed. But giving them Tdap also puts them at a risk of adverse reactions, too.

• Milk Allergy - Having a family history of allergies, especially casein allergy, may put a person at risk for pertussis vaccine reactions. 

• Sickness - When the child has a bacterial or viral infection at the time of vaccination, the body may not be able to provide protection and not able to give an antibody response.

• History of Severe Allergies and Autoimmune Disorders - There have been reports of individuals developing autoimmune disorders and allergies after vaccination.

• Cerebral Irritation in the Neonatal Period - An infant may be vulnerable to the inflammatory response of the vaccine if the infant shows symptoms of cerebral irritation such as high pitched screaming with an arching back and other neurological signs. Cerebral irritation may be due to a difficult labor and birth. It may also be due to meningitis or any other infection.

Drugs That May Affect Tdap

Inform your doctor if you have received any drugs or treatment that may weaken your immune system. They include medications for rheumatoid arthritis, autoimmune disorders, and psoriasis as well as drugs that prevent organ transplant rejection, and oral, nasal, or injectable steroid medications.

The doctor may recommend that you get the vaccination once the treatment is complete.

Tdap and DTaP

Tdap contains lesser quantities of proteins of diphtheria and pertussis, which is why it is different from DTaP. Moreover, it is likely to cause fewer side effects such as pain, tenderness, and redness in adults and adolescents.

How is the vaccine for whooping cough made?

The bacteria that causes whooping cough makes the toxin called the pertussis toxin. Those who develop an immune response to the pertussis toxin are protected against the disease. The vaccine is made by taking some amount of these toxins and inactivating them. Now, these inactivated toxins are called as toxoids. These toxoids, when injected into the body in the form of a vaccine, mount an immune response against the toxin. However, they do not cause the disease.

In 1996, the latest version was released. It is purer than the whole-cell vaccine for pertussis and it is known as acellular pertussis vaccine. In the old vaccine, the inactivated form of the whole pertussis bacteria was present. The new vaccine was developed due to the advancement in chemistry and protein purification.

The risk of side effects was higher with the old pertusis vaccine. Mild side effects would include pain, tenderness, fever, and drowsiness. Severe ones would include inconsolable crying, very high fever, and seizures.

However, the side effects are much at a lower rate in case of the new acellular pertusis vaccine. Mild side facts include pain and tenderness at the site where shot is given. Severe reactions include high fever, seizures, hypotonic-hyporesponsive episodes, lethargy, poor muscle tone, and inconsolable crying.

Protecting Newborns from Pertussis

For newborns, having whooping cough could be a life-threatening condition. Newborns may have trouble breathing since their airway is small and the mucus builds up more during the infection. Children who were not fully immunized have died in the US. To protect the babies, get them vaccinated when they are 2 months, 4 months, and 6 months old. An additional booster dose can be given when they reach 15-18 months old.

During the first few months of life, babies do not receive all vaccinations at once. For this reason, young babies are most susceptible to different kinds of diseases. They can be protected by following the cocooning method to make sure that all those who are around the baby are themselves protected from diseases. Before touching the baby, wash your hands thoroughly. Moreover, if anyone is coughing, encourage them to frequently wash their hands. Limit the exposure of the baby to many people. Symptoms are similar to colds. People in the first few weeks are also at a higher risk of passing the infection to babies.