Tetanus, Diphtheria, Pertussis | The Children's Hospital of Philadelphia

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Tetanus, Diphtheria, Pertussis

General information

Please visit the Vaccine Education Center for general information about Tetanus, Diphtheria, Pertussis and the vaccine.

Additional information from past issues of the Parents PACK newsletter


The bacteria that causes tetanus is called Clostridium tetani. The bacterial spores are commonly found throughout the environment, but the disease is not infectious in that one person cannot transmit the disease to another person. Instead the bacteria pose a risk when the spores come into contact with punctures or wounds that are not kept clean or include damaged tissues such as from burns, frostbite, or gangrene.

Because of its presence in the environment and the noninfectious nature of this disease, eradication will not be possible through vaccination. Further, people cannot be protected from this disease because everyone around them has had a vaccine; that is, there is no protection from herd immunity.

Two populations most affected by tetanus

In developed countries tetanus is typically thought of as infecting wounds in adults who have injured themselves; however, in the developing world many infants suffer from neonatal tetanus. Infections in newborns result from poor sanitation either during or after delivery. Each year almost 200,000 infants succumb to infections with tetanus.



The 100-day cough

Imagine having 15 severe coughing spells in a day — coughing spells that cause vomiting and prevent you from sleeping; coughing spells so severe that you get a nosebleed or crack your rib; coughing spells that last for months. . . . Imagine having pertussis.

Commonly referred to as whooping cough, pertussis has also been called the “100-day cough” because of the severe, prolonged coughing it causes. This bacterial infection is transmitted through coughs and sneezes.

Five things you should know about pertussis include:

Misdiagnosis, under-diagnosis, and fading immunity

In 2012, the Centers for Disease Control and Prevention (CDC) recorded recorded the most cases of pertussis in decades. In fact, more than 41,000 cases of pertussis and 18 deaths were reported in the United States. Unfortunately, experts know that this estimate is much lower than the actual number of pertussis infections. That’s because of:

Susceptible infants

Although a pertussis infection can interfere with day-to-day life, adults tend to recover. Unfortunately, infants and young children with narrow windpipes are not always as lucky. Coughing episodes caused by pertussis often turn babies blue as they struggle to breathe. Sadly, some of them do not survive.

Because the most negatively impacted age group is infants who are too young to get a vaccine, public health officials have recommended pregnant women receive a dose of Tdap between 27 and 36 weeks’ gestation, and they’ve started educating new parents about a technique called cocooning. Cocooning is like wrapping your baby in a blanket of protection — when everyone around them has been protected with a recent dose of the pertussis vaccine, babies are less likely to come into contact with the bacteria and, therefore, less likely to become ill before they develop their own protection from DTaP vaccine, which is given at 2 months, 4 months, and 6 months of age. Booster doses are given at 15 to 18 months and again at 4 to 6 years.

Get information

Newborns and Pertussis (Whooping Cough)

Q.  I had a friend whose baby was hospitalized for several weeks with pertussis (whooping cough). I will soon deliver my first baby and want to prevent her from getting sick with this. What can I do?

A. Pertussis can be a dangerous disease for a new baby. Because of their small airways and the amount of mucus caused by infection with pertussis, babies have trouble breathing, often turning blue during their coughing spells. Every year in the U.S. about 15 to 20 children die from pertussis, most are young babies who have not been fully immunized.

There are several things that you can do to help protect your baby from pertussis. Babies get a vaccine to protect them from pertussis when they are 2 months, 4 months, and 6 months of age. They get an additional dose at 15 to 18 months. However, babies are most susceptible during their first few months of life either because they have not gotten the vaccine yet or because the dose they received did not fully protect them. During this time, you can protect your baby by making sure that all of the adults (or siblings) who will be around the baby are protected - this is what public health personnel call the "cocooning" method.

There is a vaccine available for adolescents and adults called Tdap. The "p" means that it contains a pertussis component. You should receive the Tdap vaccine between 27 and 36 weeks’ gestation during each pregnancy. If you are past this point in your pregnancy, be sure to ask for the Tdap vaccine before being discharged from the hospital. Your spouse, the baby's grandparents and any other adults who will commonly be around the baby should also get the vaccine in advance of your delivery.

Additionally, you can encourage hand washing before people touch the baby, and if anyone has a cough, try to limit the baby's exposure to this person. Unfortunately, people are not only contagious in the first few weeks of the severe coughing stage, but also in the one- to two-week period leading up to cough onset. During this period, symptoms may resemble cold-like respiratory symptoms (e.g., runny nose, sneezing, occasional cough).

Adolescents and pertussis

Although most adolescents have been immunized against pertussis (whooping cough), immunity fades over time, so your 10- to 19-year-old may be at increased risk of becoming ill.

The severe coughing episodes associated with pertussis can last over 100 days and lead to vomiting, hernia or a broken rib. The Tdap vaccine is available to help protect adolescents against this disease. Like the infant vaccine, this vaccine is administered with tetanus and diphtheria vaccines as a shot. The CDC recommends that 11- and 12-year-olds be given the new vaccine instead of the standard tetanus-diphtheria booster (Td). Additionally, 13- to 18-year-olds who missed the Td booster should get a dose of Tdap vaccine.

Daniel's bout with pertussis

The following is a letter we received from a Mom whose son suffered a bout with pertussis when he was 7 years old. It is reprinted here with permission.

Just a quick note to keep in touch with you in the New Year. Two years after Daniel's bout with pertussis, he is an active boy who recently hit a grand slam home run for his baseball team. He's practicing with his basketball team and ready for the season to start this weekend. He also gets sick much more often than before, and his alarming, bronchial cough reminds us regularly of the illness that may be gone, but its effects still linger. He sees an asthma specialist for his "reactive airway disease," usually controlled by the two doses of an Advair inhaler daily, as well as a nightly dose of Singulair to keep the inflammation and "twitchiness" away from his airwaves. When he labors, we test his breathing, and sometimes must resort to even more medication and curtailed activities.

His reading still isn't what it could be, but with the assistance of a twice-weekly tutor through the past school year, he has made up for much of the concepts missed while he missed so much school when he came down with the cough. When asked to complete a reading prompt recently, Daniel's best friend wrote, "The world would be a better place...if there wasn't any whooping cough."

All of this in a child who never had more than a cold before his bout with whooping cough. All this in a child who was immunized, but attended a school where up to forty percent of the children were not - a fact we did not know beforehand. I cannot stress strongly enough how parents must do everything they can to avoid this disease in every possible way. Its effects are devastating to the family, indeed the village, for longer than anyone can predict.

Happy New Year, and all best wishes,
Cheri Rae

Duration of protection after recovering from pertussis

Q. I am going to be around an infant soon, and I heard that I should get a Tdap vaccine. I had whooping cough as a child, so do I still need to get the vaccine?

A. Yes. Protection after a pertussis infection is not lifelong. Because infants are at increased risk of suffering complications and death from pertussis infections, adults and teens who will be around them, including childcare providers, should have a single dose of the Tdap vaccine.

Similarly, protection from the pertussis (whooping cough) vaccine is not lifelong, so even teens and adults who were immunized as children and have not received a Tdap booster should get the vaccine before spending any significant time with an infant.

Learn more about vaccines for adults»


Questions about tetanus, diphtheria, and pertussis-containing vaccines

Booster vaccine for pertussis

Q. I received the DTP vaccine series as a child but have not received a booster for pertussis since then. Do I need one?

A. Yes. Adults who have not previously gotten the Tdap vaccine should receive a single dose. Some people are recommended to get the vaccine as soon as possible, including healthcare workers and people who will be in contact with infants. Pregnant women should get the Tdap vaccine between 27 and 36 weeks’ gestation during each pregnancy because pertussis can be fatal to young infants.

Read about a mom who lost her 3-week-old baby when they both got pertussis»

The Tdap vaccine is also recommended for all adolescents 11 or 12 years old.

Learn more about the Tdap vaccine and the diseases it prevents»


Tdap vaccine for people over 65

Q. I have a newborn and we were told to have everyone who will be around her immunized with the Tdap vaccine. My parents have been unable to get the vaccine because they are in their late 60s and were told the vaccine is for people less than 65 years old. What should we do? Should we keep them away from the baby?

A. The Tdap vaccine contains vaccines to protect against tetanus, diphtheria, and pertussis (whooping cough). Although adults have traditionally gotten a tetanus-diphtheria vaccine every 10 years, the pertussis component has been added more recently and is the reason that adults are recommended to get the Tdap vaccine as their next booster. Adults tend to infect infants, and whooping cough in young infants can be deadly. Infected infants cannot breathe when their airways are constricted with mucus and coughing resulting from pertussis.

Although the vaccine was originally recommended only for adults less than 65 years old, the recommendation was changed in October 2010 due to ongoing pertussis outbreaks primarily in California, but in other locations throughout the U.S. as well.

The original recommendation excluded people 65 and older because the studies were done in people less than 65 years old. However, the theoretical risks associated with vaccines not being extensively tested in this age group are now outweighed by the real risks of spreading pertussis, particularly to infants too young to be immunized. Sadly, ten infants in California have died as a result of pertussis during 2010.

Finally, in response to your last question, you should protect your infant daughter by limiting the number of people she is around in the first few months of life, checking that people have been immunized, and asking people with coughs or colds to delay their visits. 

My daughter had a fever and swelling from her last dose of DTaP vaccine. Is it likely that this will occur the next time too or should I not give her additional doses of that vaccine?

Some children develop pain, swelling or tenderness after a dose of DTaP vaccine. It is possible that the same reaction may happen with the next dose. However, the benefits of getting a vaccine to protect against a disease like whooping cough (the "P" in the DTaP vaccine stands for pertussis, otherwise known as whooping cough) outweigh the discomfort of the vaccine. Whooping cough is still very common in the United States and is a common cause of hospitalization. The pain and swelling might be relieved by giving ibuprofen or acetominophen prior to the vaccine visit; talk to your healthcare provider.

New Tdap recommendations

Q. I am pregnant and heard that I should get the Tdap vaccine, but I had it during a previous pregnancy. Do I need to get it again?

 A. Yes, the Advisory Committee on Immunization Practices (ACIP) recommends that all women receive a dose of Tdap between 27 and 36 weeks’ gestation during each pregnancy. If, however, you are past this point in your pregnancy, be sure to receive a dose of Tdap prior to leaving the hospital after delivery.

Whooping cough is a highly contagious disease. It is particularly deadly among infants due to severe coughing spells that cause them to struggle to breathe against a narrowed windpipe. Babies cannot be vaccinated against whooping cough until they are 2 months old and are not considered fully immune until they’ve had three doses of DTaP, typically by 6 months of age. For this reason, the best way to protect your baby is to practice cocooning, in which everyone who may come in contact with your baby is vaccinated.


Updated: January 2013

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Pertussis Vaccine Q&A

"Pertussis: What you should know" Q&A sheet: