Updated February 2019
There is an important recent development in the prevention programme. All pregnant women should be immunised between 28 (now 16 in UK) and 32 weeks but up to 38 weeks it is still worthwhile. This is highly effective (90%) in preventing deaths from whooping cough in babies under 4 months before they are protected by their normal infant immunizations.
Prevention is generally by means of immunization. Prevention can also refer to persons exposed to whooping cough and given antibiotics.
For about fifty years vaccine against whooping cough has been used effectively to drastically reduce the number of infants who would otherwise die of whooping cough.
The traditional vaccine is prepared from killed Bordetella pertussis organisms and given in combination with diphtheria and tetanus toxoids in the first year of life. Some programs give three doses over about three months and others five over 5 years. There are many different programs in different countries.
The main effect of the vaccine is to greatly reduce the number of whooping cough cases in children. Although the children given direct protection in this way are not especially at risk from the disease (in the developed world) this protection indirectly stops their infant brothers and sisters (who are too young to be immunized) getting the illness and possibly dying from it. Immunization prevents the disease but does not necessarily prevent the infection although it must drastically reduce the chance of passing it on by coughing which is the main way. What is very clear but not properly appreciated is that immunization, although imperfect, saves thousands of infant lives by preventing its main means of spread by coughing. But to be effective a high proportion of children need to be immunized.
In recent years a purer form of vaccine has become available and is gradually replacing the traditional type. It is known as acellular pertussis vaccine because it consists, not of whole cells, but various combinations of the several antigens known to play a part in natural immunity.
The new vaccine, as one might expect, is believed to be equally effective but causes fewer reactions when given. Recent evidence suggests it may not be so effective after all, especially as there is there is no agreement about which antigens should be included. There is a belief that that whole cell vaccine is more effective and that the occasional reaction that occurs does not do permanent harm.
Acellular vaccine is very trouble free and has been developed into forms that can be given to adults. It has been suggested a booster at the age of about 15 years and every 10 years thereafter would maintain high immunity levels and prevent spead to the more vulnerable. Although it seems logical, it is not necessarily true as we do not understand the natural boosting that occurs from circulating Bordetella organisms all the time.
For the vaccine to be effective at reducing the incidence in children sufficient to protect infants, about 80% to 90% of children need to be fully immunized.
Whooping cough itself produces immunity for a variable time and some people get it again. If you have had clinical whooping cough it is advised that you still have immunizations. This is because there may be different types, and having the vaccine should give more complete protection.
If somebody has been exposed to whooping cough then prophylactic antibiotics should be given if prevention is deemed necessary. It is believed that this can prevent infection occurring. Booster vaccine can also be given
The recommended antibiotic treatment is with Azithromycin or Clarithromycin. Dosage should be based on local prescribing recommendations. If this cannot be used then co-trimoxazole can be used. It is the same dosage for prevention as for treatment. In the UK Public Health England has published guidelines for professionals on how to manage the disease, including those exposed and at risk. This is the up to date 2016 version on their website.
If an outbreak should occur in a community such as a school or nursery where there are vulnerable individuals, it may best be controlled with both antibiotics and booster immunization of all individuals. A booster dose can give extra protection in as little as 2 weeks.
Few countries recommend whooping cough boosters throughout life and it is logical to do so in the face of more transmissions from adults to infants. Mother to newborn, for example. Many people knowing this problem, and about to welcome a new arrival into a family, are seeking booster shots. In most countries there will be suitable vaccine available, usually the one that is used to boost diphtheria, tetanus, whooping cough and polio in children aged about 3 to 5, who have completed their primary courses of these immunizations.
There are two vaccines licenced for adults and children in the UK, Repevax® and Boostrix®-IPV. These can be obtained from a pharmacy on prescription and need to be given under medical supervision. It boosts tetanus, diphtheria, pertussis and polio.
In the UK it is not a public policy procedure and therefore the cost has to be borne by the patient. It is not known how often it should be repeated, but as a rule of thumb, most experts are likely to advise every 10 years until better information is available.
In the USA there is a similar vaccine called Adacel which is for 11-64 year olds. It contains Tetanus, diphtheria and acellular pertussis vaccine. It is made by Sanofi-Pasteur.
There is also Boostrix (GSK) Tdap which is similar and licenced for 10 years olds and older in the USA.