Whooping cough vaccination: who gets it and when

Whooping cough is a highly contagious bacterial respiratory infection caused by Bordetella pertussis, which is particularly dangerous for infants in the first months of life due to the risk of apnea, pneumonia, and sudden respiratory arrest. Outbreaks occur every 3-5 years, even in countries with high vaccination coverage, due to natural cycles of pathogen circulation and the waning of post-vaccination immunity. Therefore, vaccination remains a key measure to prevent severe outcomes and mortality in the most vulnerable groups. [1]

There are two types of pertussis vaccines: whole-cell and acellular. Whole-cell preparations contain inactivated pertussis cells and are characterized by higher reactogenicity but stable immunity. Acellular preparations contain purified bacterial antigens and are used in most high-income countries due to their better tolerability. The choice of platform depends on national programs and the balance between efficacy, safety, and cost. [2]

A key strategy for protecting infants is vaccinating pregnant women with Tdap at 27-36 weeks of pregnancy. This approach ensures transplacental transfer of antibodies and reduces the risk of whooping cough in infants during the first months of life, before they have completed their primary series. This recommendation is supported by the Centers for Disease Control and Prevention, professional societies, and is included in current immunization schedules. [3]

The pandemic has seen gaps in vaccination cycles and atypical patterns of respiratory infections. In 2023-2024, Europe experienced a major surge in whooping cough cases, including high rates in Spain. This has led to increased communication about vaccination of adolescents and pregnant women and discussions of additional boosters for specific age groups. Program updates are based on current epidemiological data and a benefit-risk assessment. [4]

What are pertussis vaccines and how do they work?

Acellular preparations induce immunity to a range of Bordetella pertussis antigens, including toxoid, hemagglutinin, pertactin, and filamentous hemagglutinin. The combination of antigens and their amounts vary between vaccines, affecting the intensity of the early response and its sustainability. As circulating strains evolve, immunization programs periodically reassess their composition and schedules to maintain effectiveness. [5]

Whole-cell preparations contain inactivated pathogen cells and provide a broad range of antigens, which is likely associated with a more robust anti-epidemic effect. However, they are more likely to cause fever and local reactions, leading many countries to switch to acellular combinations in pediatric schedules. In global delivery programs, pediatric DTP regimens with a whole-cell component remain dominant due to cost and availability. [6]

Combination vaccines are used in clinical practice: for young children, versions with diphtheria and tetanus components and an acellular pertussis component; for adolescents and adults, Tdap with reduced diphtheria and pertussis antigen content. Combinations simplify schedule adherence, increase coverage, and help synchronize vaccinations with other interventions. [7]

Immunity after vaccination declines over time, especially after acellular regimens, so adolescent and adult boosters are included in the schedule. This explains why the prevention of severe forms in infants is achieved through vaccination of pregnant women and co-exposure of family and close contacts. [8]

Table 1. Types of pertussis vaccines and features

Type	Compound	Pros	Cons	Where is it most often used?
Whole cell	Inactivated Bordetella pertussis cells	Broad antigen spectrum, stable immunity	Higher reactogenicity	Widely used in global childhood vaccination programs
Acellular	Purified B. pertussis antigens	Better tolerability and compatibility	Faster decline of immunity	High-income countries, adolescents and adults

Source: World Health Organization positions and reviews. [9]

Who should be vaccinated and when should it be done?

Children under one year of age are vaccinated against whooping cough as part of a combination regimen according to the national schedule, typically beginning at 2-3 months of age with intervals between doses, followed by boosters in preschool and adolescence. The specific months and number of doses vary by country, but the essence is the same: to establish early protection and maintain it during critical periods of contact. [10]

Adolescents and adults are recommended to receive a Tdap booster at least once in their lifetime, followed by tetanus and diphtheria booster doses every 10 years with Td or Tdap. If needed for pertussis prevention, Tdap can be used as a 10-year booster, as outlined in the current adult schedule. [11]

Pregnant women are recommended to receive one dose of Tdap during each pregnancy, between 27 and 36 weeks, preferably early in this window. If Tdap was administered earlier in pregnancy, there is no need to repeat it during the same pregnancy. This strategy ensures high antibody levels in the infant and reduces the risk of disease before the infant's own vaccinations begin. [12]

If a woman did not receive Tdap during pregnancy, vaccination is administered as soon as possible postpartum, even if Tdap has never been administered previously. The mother is advised to exercise caution in contact with the infant until protection is established in the immediate environment, and family and close contacts are advised to ensure that boosters are up-to-date. [13]

Table 2. Who is recommended to be vaccinated against whooping cough and when

Group	Recommendation
Children in the first year of life	The primary series according to the national calendar from an early age and subsequent boosters
Teenagers	Scheduled Tdap booster at scheduled times
Adults	One dose of Tdap in life, then every 10 years Td or Tdap
Pregnant women	One dose of Tdap in each pregnancy at 27-36 weeks
Close contacts of a newborn	Check and update boosters in advance

Sources: US and World Health Organization schedules and recommendations. [14]

Vaccination during pregnancy: protecting your baby from day one

Administration of Tdap during pregnancy produces high titers of maternal antibodies, which are transferred to the fetus via the placenta and protect the child in the first weeks and months of life. Observations indicate a significant reduction in the risk of whooping cough in children under 2 months of age if the mother is vaccinated within the specified timeframe. This is particularly important, as this age group is most frequently hospitalized and has the highest risk of severe outcomes. [15]

The Centers for Disease Control and Prevention recommends administering Tdap during each pregnancy, regardless of when the woman last received a tetanus or diphtheria booster. If Tdap was previously indicated for an emergency indication, such as tetanus prophylaxis following trauma, it does not need to be repeated during the same pregnancy. The algorithm is flexible and aimed at maximizing infant protection. [16]

In local outbreaks or trauma with a risk of tetanus, Tdap can be administered at any stage of pregnancy, if indicated. The safety of Tdap during pregnancy has been confirmed by large observational studies and long-term practice, and the benefits to the child outweigh the potential risks of minor reactions. This strategy is endorsed by professional societies. [17]

Postpartum Tdap does not replace the pregnancy dose, but remains important for women who have never received Tdap before. It is also recommended to check the vaccination status of family members and caregivers to reduce the risk of introducing infection into the home. This approach is often called the "cocooning strategy." [18]

Table 3. Tdap during pregnancy: a practical guide

Situation	Solution
Planned pregnancy without contraindications	Administer Tdap at 27-36 weeks
Tdap was introduced earlier in the current pregnancy according to indications	Do not repeat in the same pregnancy
Didn't have time to vaccinate during pregnancy	Administer after delivery if Tdap has not been given previously.
Outbreak or injury with risk of tetanus	It can be administered at any time according to indications.

Source: Centers for Disease Control and Prevention clinical guidelines.[19]

Epidemiology and the modern context

After declining cases during the pandemic, Europe experienced a marked increase in whooping cough. In 2023 and the first quarter of 2024, European countries reported a tenfold increase in cases compared to the two previous years. Infants and the elderly remained particularly vulnerable. The situation highlighted the role of boosters in adolescents and adults and the critical importance of the pregnant dose of Tdap. [20]

In Spain, the incidence rate rose in 2023-2024, peaking in spring 2024 and resulting in numerous hospitalizations, primarily among unvaccinated infants and elderly people with comorbidities. High vaccination coverage among pregnant women played a significant protective role, and some regions have proposed enhanced booster strategies for adolescents. These data are important for planning at the autonomous region level. [21]

Scientific reviews note the contribution of immune waning after acellular regimens and possible antigenic changes in strains to pertussis re-emergence, which requires flexible immunization programs and timely communication. However, even with rising incidence, vaccination remains an effective way to prevent severe forms and death in infants. [22]

Whole-cell DTP combinations retain a role in childhood vaccination programs globally, particularly where cost and logistics need to be optimized. The World Health Organization and partners emphasize that the choice of platform should take into account the local epidemiological situation, resources, and coverage goals. [23]

Table 4. Who is most at risk from the epidemic and how to protect themselves

Risk group	Why is it vulnerable?	What works best
Babies up to 2 months	There is no completed series	Tdap during pregnancy and the cocoon strategy
Children and teenagers	Declining immunity	Timely boosters according to the calendar
Elderly	Associated diseases	Tdap update and environment control
Families with newborns	Risk of skidding	Checking boosters at contacts

Sources: Outbreak reports and reviews. [24]

Efficiency and duration of protection

Acellular childhood regimens demonstrate high protection against severe forms of the disease, but immunity declines within a few years after the last dose. Therefore, most schedules include a booster dose during adolescence to maintain herd protection and reduce spread among schoolchildren. This is especially important during periods of cyclical increases in disease incidence. [25]

Vaccinating pregnant women with a single dose of Tdap reduces the risk of whooping cough in children under 2 months of age by tens of percent, as this is the period during which protection by passively transferred antibodies is most pronounced. Effectiveness depends on adherence to the recommended 27-36 weeks of vaccination and program coverage, as demonstrated by observational studies. [26]

In adults, Tdap provides a boost to pertussis antibodies and can be used as a 10-year booster instead of Td. This approach simplifies logistics, maintains immunity, and is compatible with other vaccines when administered simultaneously at different sites. Reactogenicity is usually moderate and short-lived. [27]

Research reviews for 2024–2025 highlight the need to optimize schedules to account for immune waning and pertussis re-emergence. New antigen formulations and booster strategies are being considered, but current recommendations already provide significant population benefits when well implemented. [28]

Table 5. Where the vaccine works most strongly

Target	The most proven benefit
Reducing infant mortality	Tdap dose in each pregnancy
Reduction in hospitalizations in children	Completion of the Primary Series and Preschool Booster
Reducing the spread in schools	Teen booster
Maintaining personal protective equipment in adults	Ten-year boosters using Tdap

Sources: recommendations and reviews of effectiveness. [29]

Safety and tolerability

The most common reactions are pain, redness, and swelling at the injection site, short-term weakness, and low-grade fever. These typically resolve within 1-3 days and do not require specific treatment. Rare serious events are extremely rare and are monitored by pharmacovigilance systems. [30]

The safety of Tdap during pregnancy is confirmed by large data sets. The risk of serious adverse outcomes for mother and fetus does not increase compared to baseline values, and the benefit to the child is clear. Therefore, the pregnancy dose is included in international and national recommendations as the standard of care for newborns. [31]

Current schedules allow for the simultaneous administration of Tdap and other vaccines at different sites if this simplifies schedule adherence. This approach increases coverage and does not compromise the safety profile compared to staggered visits. The decision is made on an individual basis, taking into account tolerability and the purpose of the visit. [32]

Surveillance systems in Europe and the United States regularly publish safety signal updates and risk mitigation recommendations. Transparent reporting helps maintain trust and promptly adjust guidelines as new data emerges. Currently, the benefit-risk balance for Tdap remains compellingly in favor of vaccination. [33]

Table 6. Common and rare reactions to Tdap

Category	Examples	Tactics
Locals	Pain, swelling, redness	Cold through the tissue, rest for the muscle
Systemic lungs	Fatigue, low-grade fever	Symptomatic support
Stress reactions	Dizziness in teenagers	Observation while sitting or lying down for 15 minutes
Rarest serious	Anaphylaxis	Immediate assistance as per standard

Source: Adult Vaccination Schedules and Information Materials. [34]

Contraindications and precautions

An absolute contraindication is a severe allergic reaction to a previous dose or to a vaccine component. In this situation, alternatives for tetanus and diphtheria are considered, and the pertussis component is avoided. The decision is made by the physician based on the patient's medical history and risk of illness. [35]

Unexplained encephalopathy occurring within 7 days of a previous pertussis-containing vaccine is grounds for withholding further administration of the pertussis component until diagnostic evaluation and a decision by a medical consultation are completed. To maintain protection against tetanus and diphtheria, appropriate combinations without pertussis are used. [36]

Acute, severe illnesses with fever should be postponed until the condition stabilizes, to avoid confusing symptoms and reduce discomfort. Mild infections without fever usually do not require post-vaccination. Individual circumstances should be discussed with a doctor. [37]

In complicated pregnancies, the decision on the timing of Tdap administration is made jointly by the obstetrician and the primary care physician. Even in such situations, the benefits to the infant often outweigh the risks, and if vaccination is not possible within the optimal timeframe, the cocooning strategy and booster administration to close contacts should be strengthened. [38]

Table 7. Brief information on contraindications

Situation	Tactics
Anaphylaxis to a component	Do not administer the drug; find alternatives
Severe reaction after pertussis-containing dose	Temporary refusal of the pertussis component, further examination
Severe acute infection	Postpone until recovery
Pregnancy with complications	Individual decision on timing, strengthen the cocoon strategy

Source: Schedules and clinical guidelines. [39]

Vaccination for trauma patients and healthcare workers

For injuries with a tetanus risk in adults without a current booster, a dose of Tdap or Td is indicated, depending on the vaccination status. For contaminated wounds, a booster is recommended if 5 years or more have passed, and for clean wounds, a booster is recommended if 10 years have passed. If Tdap has never been administered, Tdap is preferred, combining tetanus prophylaxis with a renewed pertussis protection. [40]

It is important for healthcare workers and educators to have a current Tdap vaccination because they interact with vulnerable patients and children. A documented dose of Tdap and subsequent 10-year boosters help reduce the risk of transmission in healthcare settings and schools. Employers may request supporting records. [41]

In the event of outbreaks in organized groups, regional authorities may recommend accelerated boosters for adolescents or specific groups of adults in addition to the standard schedule. Such decisions are made based on epidemiological data and health service capacity. [42]

For families expecting a child, it's helpful to check the vaccination status of all household members and nannies in advance. An up-to-date dose of Tdap for adults and adolescents in the newborn's environment significantly reduces the risk of whooping cough being introduced into the home during the first weeks of the child's life. [43]

Table 8. Wounds and boosters: when to update protection

Situation	When do you need a booster?
Clean wound, 10 years or more have passed	Enter the booster
Contaminated wound, 5 years or more have passed	Enter the booster
Never had Tdap	Select Tdap as the priority option
Health workers and teachers	Maintain up-to-date vaccination status

Sources: adult vaccination schedules and materials on trauma prophylaxis of tetanus. [44]

Frequently asked questions

Can Tdap be administered concurrently with other vaccines?
Yes, if necessary, Tdap can be administered on the same day with other vaccines at different sites, simplifying the schedule and not compromising tolerability. The decision is made by the physician based on the individual situation. [45]

If a teenager misses a booster, what should they do?
They should catch up on the schedule as soon as possible. Tdap is used for catch-up vaccination of teenagers and adults, after which maintenance boosters are given every 10 years with Td or Tdap. [46]

Should I get vaccinated if I've already had whooping cough?
Yes. Having had whooping cough does not provide lifelong immunity, so scheduled vaccinations are still necessary to maintain protection and reduce the risk of spreading the infection. Consult your doctor for the specific regimen. [47]

Why vaccinate a pregnant woman each time if she was already vaccinated with Tdap in a previous pregnancy?
Because antibody levels decline over time, a single dose during a previous pregnancy does not provide sufficient protection for the next child. Therefore, another dose of Tdap is administered during each new pregnancy. [48]

Table 9. Quick action plan for a family with a newborn

Step	Who is responsible?	Term
Vaccinate the expectant mother with Tdap	Women's consultation	27-36 weeks
Check your dad and grandparents for Tdap	Family	Before giving birth
Check the status of nannies and close contacts	Parents	Before the baby arrives home
Bring the children's schedule up to date	Pediatrician	According to the calendar

Sources: recommendations for pregnant women and the environment of newborns. [49]

Final conclusions

Whooping cough remains a significant threat to infants, and vaccination is the primary way to prevent severe outcomes. Children require an early primary series and boosters, adolescents and adults require booster shots every 10 years, and pregnant women require one dose of Tdap during each pregnancy at 27-36 weeks. These steps together provide a powerful barrier against infection in the family and community. [50]

The European surge in 2023-2024 is a reminder that waning immunity and gaps in vaccination schedules create potential for epidemic waves. With high vaccination discipline and diligent adherence to the pregnancy dose, the incidence of hospitalizations and deaths in very young children can be dramatically reduced. Updating booster shots for adolescents and adults, especially those with newborns, is a practical measure worth implementing for all families. [51]