Pertussis (whooping cough) and travel

Information about pertussis and the UK vaccination regime Pertussis (whooping cough) and travel

Overview

Pertussis is a highly infectious disease caused by the bacterium Bordetella pertussis. It is transmitted via the respiratory route and starts with non-specific catarrhal symptoms. An intermittent cough causes spasms, typically ending with an inspirational whoop and vomiting. Symptoms are worse at night and the illness can last for two to three months. Young infants are at highest risk of severe complications and death from pertussis. Milder symptoms may be observed in older children and adults who have previously been vaccinated.

Pertussis occurs worldwide and in recent years a number of countries with longstanding vaccine programme have reported resurgences in disease, despite sustained high vaccine coverage [1]. In the UK, pertussis containing vaccine has been routinely offered as a whole cell vaccine since the 1950s. Since 1992, coverage has been consistently 92 percent or higher by the second birthday [2].

Further information about the history and epidemiology of the disease in the UK.

Routine pertussis vaccine in the UK

A total of four doses of acellular pertussis vaccine are offered as part of the UK Immunisation Program: three doses of the combined product DTaP/IPV/Hib; Pediacel or Infanrix IPV Hib are given in infancy at 2, 3 and 4 months of age. A re-enforcing dose of pertussis containing vaccine Infanrix IPV (DTaP/IPV) or Repevax® (dTaP/IPV) is given as a ‘pre-school’ booster at three years four months or soon after [3].

Children who have not completed a primary course should have the outstanding doses at monthly intervals. Where there is no reliable history of previous immunisation, it should be assumed that they are unimmunised and Public Health England recommendations should be followed [4].

Pertussis vaccine in adults and children aged 10 years and over

In England, Wales and Northern Ireland, pertussis vaccination is not available on the NHS for this age group, as pertussis vaccination is not routinely recommended for those aged 10 years and over. There is no current recommendation for a pertussis booster dose for adolescents [2].

Pertussis containing vaccine can be considered as a post exposure measure for those aged more than 10 years old who have had close contact with suspected or confirmed cases of pertussis, based on the criteria set out in the national guidance for the public health management of pertussis, produced by Public Health England [5].

Pregnant women and pertussis

In April 2012, the Health Protection Agency declared a national pertussis outbreak. In response to the high number of infant cases and deaths, the Department of Health launched a new temporary vaccination programme for pregnant women in September 2012 [6].

The aim of this is to boost immunity in the mother during pregnancy to optimise transfer of antibodies from mother to unborn baby and thereby protect the infant from birth until they reach the age of routine immunisations (2 months). In the first year of the programme, risk of pertussis in babies born to mothers vaccinated at least one week before delivery was reduced by more than 90% [6].

In June 2014, due to the continued circulation of pertussis in the population, the Joint Committee on Vaccination and Immunisation recommended this programme, launched in 2012, be extended for a further five years until 2019, when it will be reviewed [6].

In April 2016. the recommendation for vaccination in pregnancy was reviewed and changed; vaccination is currently recommended for pregnant women from 16 weeks to 32 weeks of pregnancy, although the vaccine can be offered after 32 weeks (vaccination should be offered from around 20 weeks, on or after the foetal anomaly scan) [2].

The vaccine has been shown to be safe to pregnant women [7, 8].

Pertussis vaccine and overseas travel

Pertussis vaccine is not routinely offered to those aged 10 years and older in the UK. Therefore, adult travellers with incomplete vaccine histories and those who never received pertussis containing vaccines are not routinely offered pertussis vaccine when travelling overseas.

Visiting newborns

In recent years, in response to large outbreaks of pertussis, several countries outside the UK have recommended pertussis vaccination for adults, family, and close contacts of newborns, with the rationale that vaccination might protect the infant.

However, there is limited evidence of the effectiveness of this ‘cocooning’ approach and vaccination of adults in these circumstances is not recommended for UK travellers. In addition to the UK, many countries now offer pertussis vaccination during pregnancy. Travellers planning to visit friends and relatives who are pregnant or recently delivered can be advised to check the pertussis vaccination status of the mother before visiting.

Infants who have completed their primary schedule are well protected from pertussis. Additional measures that can be taken to protect children less than 12 months of age from respiratory illness include:
  • Good hand hygiene
  • Avoiding close contact with persons known to be infected and those with a respiratory or coughing illness
  • Ensuring individuals cover their nose and mouth when coughing or sneezing and promptly dispose of used tissues hygienically

Blood testing to check immunity to pertussis

An antibody level that is known to be protective against pertussis has not been demonstrated, so blood tests cannot be used to determine immunity [9]. In those who have not recently been vaccinated, blood testing can however be used to determine evidence of recent pertussis infection [10].

Pertussis infection and long lasting immunity

Natural infection confers some immunity, which when boosted by frequent re-exposure to B. pertussis, may persist. However, long lasting immunity cannot be ensured after natural infection, so a history of infection is not specific enough for protection to be presumed [11].

Pertussis vaccination and long lasting immunity

Pertussis vaccination appears to confer protection until at least 10 years of age. There is evidence of waning protection 10 - 15 years after completing a primary vaccine course. However, pertussis vaccine prevents severe disease, so vaccinated individuals who subsequently develop symptomatic disease are unlikely to be at risk of serious complications [12].

Resources

Revised:  August 2015
  1. World Health Organization. Revised guidance on the choice of pertussis vaccines: July 2014. Weekly epidemiological record. 25 July 2014. 30: 337-340. [Accessed 20 August 2015]
  1. Salisbury D, Ramsay M & Noakes K. Immunisation against infectious disease – The Green Book. Department of Health. London. 28 April 2015. Chapter 24: Pertussis. [Accessed 20 August 2015]
  1. Public Health England. The complete routine immunisation schedule from summer 2015. 3 August 2015. [Accessed 20 August 2015]
  2. Public Health England. Vaccination of individuals with uncertain or incomplete immunisation status, 26 August 2014. [Accessed 20 August 2015]
  3. Public Health England. Guidelines for the Public Health Management of Pertussis. 25 October 2012. [Accessed 20 August 2015]
  1. Public Health England. Vaccination against pertussis (whooping cough) for pregnant women: information for healthcare professionals. 30 July 2014. [Accessed 20 August 2015]
  1. Donegan K, King B, Bryan P. Safety of pertussis vaccination in pregnant women in UK: observational study BMJ. 11 July 2014; 349:g4219. [Accessed 20 August 2015]
  1. Public Health England. Research and analysis. Pertussis Vaccination Programme for Pregnant Women: vaccine coverage estimates in England, April to August 2014. 24 July 2015. [Accessed 20 August 2015]
  1. World Health Organization. Biologicals. Acellular pertussis vaccines. 2015. [Accessed 20 August 2015]
  1. Public Health England. Pertussis factsheet for healthcare professionals. 15 August 2013. [Accessed 20 August 2015]
  1. Fine PEM, Mulholland K. Community immunity. In: Plotkin S, Orenstein W and Offit P (eds). Vaccines. Saunders 2008. 573-1592.
  1. Campbell H, Amirthalingam G, Andrews N et al. Accelerating control of pertussis in England and Wales. Emerg Infect Dis [serial on the Internet]. January 2012. [Accessed 20 August 2015]

 

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