Contents

14 Pertussis (whooping cough)

14.7 Expected responses and adverse events following immunisation (AEFI)

Unless the specific contraindications and precautions outlined in section 14.6 above are present, practitioners should have no hesitation in advising the administration of acellular pertussis vaccine. Although whole-cell pertussis vaccine has been associated with febrile seizures, there was never any good-quality evidence that it caused any more significant neurological disorder. Disorders for which any causal association with pertussis vaccine have been disproved include infantile spasms, Reye syndrome and sudden unexplained death in infancy (SUDI).63–70 Similar to previous studies, the New Zealand Cot Death Study found a lower rate of SUDI in immunised children.71 Acellular pertussis vaccine has been used in New Zealand since 2000 and is significantly less reactogenic than was the whole-cell pertussis vaccine.

14.7.1 DTaP-IPV-HepB/Hib vaccine

DTaP-IPV-HepB/Hib (Infanrix-hexa) is generally well tolerated in infants aged under 2 years, including preterm (24 to 36 weeks’ gestation) and/or low birthweight (820–2020 grams) infants.72, 73

A higher incidence of local symptoms is associated with administration of DTaP-IPV-HepB/Hib booster dose in the second year of life than following the primary doses.44 Local reactions increase with age and additional doses of vaccine. The reaction may be due to some of the other vaccine components, such as aluminium. These reactions are usually minor and only last a day or so. In a small percentage of vaccine recipients the reactions will be severe enough to limit movement of the arm and may last for about a week. See also section 15.7.2 for information about co-administration with PCV13.

Expected responses and adverse events following immunisation with DTaP-IPV-HepB/Hib vaccine are as follows (see the manufacturer’s data sheet for more information).

In ≥10 percent of vaccine recipients there is:

In ≥1 percent and <10 percent of vaccine recipients there is:

14.7.2 DTaP-IPV vaccineTop

Expected responses and adverse events following immunisation with DTaP-IPV (Infanrix-IPV) are as follows (see the manufacturer’s data sheet for more information).

In ≥10 percent of vaccine recipients there is:

In ≥1 percent and <10 percent of vaccine recipients there is:

14.7.3 Tdap vaccineTop

The adult reduced-concentration Td and Tdap (Boostrix) vaccines have been found to have no safety concerns in those aged 10–64 years and those aged over 65 years.74–76 Administration of Tdap to pregnant women did not identify any concerning patterns in maternal, infant, or fetal outcomes.77

Expected local responses following immunisation of adolescents with Tdap include:78

Expected systemic reactions following immunisation of adolescents with Tdap include:78

headache (16 percent)
fatigue (14 percent)
​– gastrointestinal symptoms: nausea, vomiting, diarrhoea and/or abdominal pain (10 percent).

14.7.4 Adverse events associated with pertussis vaccinesTop

The incidence of major adverse events following primary pertussis immunisation is summarised in Table 14.1.

Table 14.1: Incidence (per 100,000 doses) of major adverse reaction following acellular pertussis vaccine

Event following immunisation Timing Incidence per 100,000 doses
Persistent (>3 hours) inconsolable screaming 0–24 hours 44
Seizures 0–2 days 7
Hypotonic-hyporesponsive episode (HHE) 0–24 hours 0–47 in trials of acellular vaccines
Anaphylaxis 0–1 hour Very rare

Source: Edwards KM, Decker MD. 2008. Pertussis vaccine. In: Plotkin SA, Orenstein WA, Offit PA (eds). Vaccines (5th edition). Philadelphia, PA: WB Saunders Company, Table 21.15.

Swelling involving the entire thigh or upper arm occurs in 2–3 percent of children after administration of the fourth and fifth doses of acellular pertussis vaccine. The pathogenesis is unknown. Resolution occurs without sequelae. Extensive limb swelling after the fourth dose does not predict an increased risk of a similar reaction following the fifth dose of pertussis vaccine.

Neither a hypotonic-hyporesponsive episode (HHE) nor seizures are associated with long-term consequences for the child79–81 (see section 2.4.2). Children who have febrile seizures after pertussis immunisation do not have an increased risk of subsequent seizures or neurodevelopmental disability.82 It is safe to give acellular pertussis vaccine after an HHE has occurred following a previous dose.83