Pertussis Vaccine After Pertussis Infection
Persons who have a history of pertussis should receive a pertussis-containing vaccine (DTaP or Tdap) according to the routine recommendation, without any delay or modification to the standard schedule. 1
Rationale for Continued Vaccination
Natural infection does not provide adequate long-term protection. Although pertussis disease likely confers some natural immunity, the immune response may be suboptimal against subsequent pertussis disease, and the duration of protection induced by infection does not provide long-term immunity. 1
Age-Specific Recommendations
Children Under 7 Years Old
- Continue the DTaP vaccination series according to the routine schedule, regardless of prior pertussis infection. 1
- Use DTaP for all remaining doses in the primary series (typically 5 doses total by age 4-6 years). 1
Persons 7 Years and Older
- Administer Tdap according to routine recommendations, typically as a single dose for adolescents aged 11-12 years or adults who have never received Tdap. 1
- Follow with Td boosters every 10 years thereafter. 1
Pregnant Women
- Administer Tdap during the third trimester (27-36 weeks gestation) of each pregnancy, regardless of prior pertussis infection or previous Tdap vaccination. 2
Important Clinical Context
The 1991 ACIP guidelines present a notable contrast to current recommendations. Older guidance stated that children with satisfactorily documented pertussis (culture-confirmed or epidemiologically linked to a culture-proven case) do not need pertussis vaccine. 1 However, the 2018 ACIP guidelines explicitly supersede this recommendation, now stating that all persons with a history of pertussis should receive pertussis-containing vaccines according to routine schedules. 1
This change reflects evolving understanding that:
- Waning immunity begins 5-10 years post-vaccination or infection. 3
- Neither vaccination nor natural disease provides lifelong protective immunity. 3
- Vaccinated individuals with breakthrough infections can still transmit disease to others. 3
Common Pitfalls to Avoid
- Do not skip or delay pertussis vaccination based on documented prior infection. The current standard of care requires continuation of the routine schedule. 1
- Do not assume natural infection provides adequate protection. The immune response from infection is suboptimal and does not confer long-term immunity. 1
- Do not confuse old guidance with current recommendations. The 1991 recommendation to withhold pertussis vaccine after documented infection has been replaced by the 2018 guidance to continue routine vaccination. 1
- Do not dismiss pertussis in vaccinated individuals. Breakthrough infections occur regularly due to waning immunity, and these individuals require the same vaccination schedule as those without prior infection. 3
Special Wound Management Considerations
- For tetanus-prone wounds in persons requiring tetanus prophylaxis, use DTaP (if <7 years) or Tdap (if ≥7 years and no prior Tdap) even if the person has a history of pertussis infection. 1, 4, 2
- Tdap may be administered for wound management if at least 5 years have elapsed since previous receipt of a tetanus toxoid-containing vaccine. 2