Contents

14 Pertussis (whooping cough)

14.4 Vaccines

Whole-cell pertussis vaccine for routine use was introduced in 1960 and was replaced with acellular pertussis vaccine in 2000. The current schedule of three acellular pertussis-containing vaccines in the first year of life plus booster doses at ages 4 and 11 years has been in effect since 2006. See Appendix 1 for more information about the history of pertussis-containing vaccines in New Zealand.

14.4.1 Available vaccines

Funded pertussis vaccines

The acellular pertussis-containing vaccines funded as part of the Schedule are:
  • DTaP-IPV-HepB/Hib (Infanrix-hexa, GSK): diphtheria, tetanus, acellular pertussis, inactivated polio, hepatitis B and Haemophilus influenzae type b vaccine
  • DTaP-IPV (Infanrix-IPV, GSK): diphtheria, tetanus, acellular pertussis and inactivated polio vaccine
  • ​Tdap (Boostrix, GSK): a smaller adult dose of diphtheria and pertussis vaccine, together with tetanus vaccine.

See section 5.4.1 for more information.

Other vaccines

Other acellular pertussis-containing vaccines registered (approved for use) and available (marketed) in New Zealand include:

14.4.2 Efficacy and effectivenessTop

Immunogenicity

A review of published data on DTaP-IPV-HepB/Hib found it to be highly immunogenic in infants aged under 2 years for primary and booster vaccination.43 In clinical studies there was a strong immune response against the vaccine antigens, which persisted for up to approximately six years after vaccination. A review of published clinical trial and post-marketing surveillance data supported the immunogenicity of DTaP IPV-HepB/Hib across a range of schedules and when administered concurrently with other vaccines.44

Efficacy and effectiveness

The acellular pertussis vaccines approved for use in New Zealand have been shown to provide around 81–85 percent efficacy (95% CI: 51–100) after three infant doses, with follow-up studies suggesting sustained efficacy to age 6 years.45–47

Clinical trial data suggests that acellular pertussis vaccines, while effective, may be less effective than some whole-cell vaccines in preventing whooping cough.

Duration of protection

Protection against pertussis begins to wane within several years of completion of a three-dose primary and two-dose booster dose immunisation series. The US has a pertussis immunisation schedule that includes three doses of acellular vaccine during infancy and booster doses at 15 to 18 months and 4 to 6 years.48 The risk of pertussis increases in the six years after receipt of the fifth dose of this series, indicating a waning in vaccine-induced immunity over this time interval. Children and adolescents who have received acellular pertussis vaccine for their entire pertussis immunisation series are at greater risk of pertussis than children whose immunisation series included some doses of whole-cell vaccine and some doses of acellular vaccine.49

In adults, a trial of a monovalent acellular pertussis vaccine in the US among people aged 15–65 years found an efficacy of 92 percent (95% CI: 32–99) after a median of 22 months of follow-up.50 Antibodies to pertussis toxoid, filamentous hemagglutinin and pertactin have been shown to persist five years after receipt of Tdap (Boostrix) in a study of Australian adults aged 18 years and older.51 However, the duration of protection is unknown.

14.4.3 Transport, storage and handlingTop

Transport according to the National Guidelines for Vaccine Storage and Distribution.52 Store at +2oC to +8oC. Do not freeze.

DTaP-IPV-HepB/Hib should be stored in the dark.

DTaP-IPV-HepB/Hib (Infanrix-hexa) must be reconstituted by adding the entire contents of the supplied container of the DTaP IPV-HepB vaccine to the vial containing the Hib pellet. After adding the vaccine to the pellet, the mixture should be shaken until the pellet is completely dissolved. Use the reconstituted vaccine as soon as possible. If storage is necessary, hold at room temperature for up to eight hours.

14.4.4 Dosage and administrationTop

The dose of DTaP-IPV-HepB/Hib, DTaP-IPV and Tdap is 0.5 mL, administered by intramuscular injection (see section 2.3).

Co-administration with other vaccines

DTaP-IPV-HepB/Hib, DTaP-IPV and Tdap can be administered simultaneously (at separate sites) with other vaccines or immunoglobulins.

Following an analysis of post-marketing reporting rates, there is a potential increased risk of convulsions (with or without fever) and hypotonic-hyporesponsive episodes when co-administering DTaP-IPV-HepB/Hib (Infanrix-hexa) and PCV13 (Prevenar 13) compared to the use of DTaP-IPV-HepB/Hib alone.53–57. (See also section 15.7.2.)