Recommended Regimen for Whooping Cough (Pertussis) Vaccine
The recommended pertussis vaccination regimen consists of a 5-dose DTaP series for children under 7 years (at 2,4,6,15-18 months, and 4-6 years), followed by a Tdap booster for adolescents and adults, with additional Tdap vaccination during each pregnancy between 27-36 weeks gestation. 1, 2
Childhood Vaccination Schedule
Primary Series (Infants and Young Children)
- DTaP vaccine (Diphtheria, Tetanus, acellular Pertussis):
- Dose 1: 2 months of age (can start as early as 6 weeks)
- Dose 2: 4 months of age
- Dose 3: 6 months of age
- Dose 4: 15-18 months of age
- Dose 5: 4-6 years of age (before entering kindergarten) 2
Note: The fifth dose is not necessary if the fourth dose was administered after the child's fourth birthday 3
Administration Details
- Route: Intramuscular injection
- Site: Anterolateral aspect of the thigh for infants <12 months; deltoid muscle for children ≥12 months 2
- Dosage: 0.5 mL per dose 2
Adolescent and Adult Vaccination
Adolescents (11-18 years)
- Single dose of Tdap (Tetanus, reduced-diphtheria, acellular pertussis) vaccine at age 11-12 years 3, 1
- This is regardless of interval since the last tetanus or diphtheria toxoid-containing vaccine
Adults (19-64 years)
- Single dose of Tdap if not previously received 1
- Tdap can replace any dose in the 10-year Td booster schedule 4
Adults ≥65 years
- Single dose of Tdap is recommended 1
Special Populations
Pregnant Women
- Tdap with each pregnancy between 27-36 weeks gestation (preferably during the early part of this window) 1, 4
- This provides passive antibody transfer to the newborn for protection during the vulnerable first months of life
Healthcare Workers
- Single dose of Tdap regardless of when the last Td was given 1
Catch-up Vaccination
- For children with interrupted vaccination schedules, continue where left off - no need to restart the series 3
- Minimum intervals between doses should be maintained:
- 4 weeks between doses 1-2 and 2-3
- 6 months between doses 3-4 and 4-5
Contraindications and Precautions
Absolute Contraindications
- Severe allergic reaction (anaphylaxis) to a previous dose or vaccine component 2
- Encephalopathy within 7 days of a previous pertussis-containing vaccine 2
- Progressive neurologic disorder, including uncontrolled epilepsy 2
Precautions
- Moderate or severe acute illness
- Guillain-Barré syndrome within 6 weeks of a previous tetanus toxoid-containing vaccine 2
- Temperature ≥40.5°C (105°F) within 48 hours of a previous dose 2
Rationale and Evidence
The current pertussis vaccination strategy addresses several key issues:
Waning immunity: Protection from both natural infection and vaccination wanes after 5-10 years 3, 1
Reservoir of infection: Adolescents and adults with waning immunity serve as reservoirs for transmission to vulnerable infants 5, 6
Infant protection: Maternal vaccination during pregnancy provides critical antibody transfer to protect newborns before they can be vaccinated 1, 7
Disease burden reduction: Universal vaccination has dramatically reduced pertussis incidence, though it remains one of the most poorly controlled vaccine-preventable diseases 7, 6
Common Pitfalls to Avoid
- Delaying booster doses: Timely administration of all doses is crucial for maintaining immunity
- Missing maternal vaccination: Vaccination during each pregnancy is essential for infant protection
- Neglecting adult boosters: Adults need at least one Tdap dose regardless of prior vaccination history
- Restarting incomplete series: If the schedule is interrupted, continue where left off rather than restarting
The shift from whole-cell to acellular pertussis vaccines has improved safety profiles but may have contributed to waning immunity concerns, highlighting the importance of adhering to recommended booster schedules 6.