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Both vaccines are combined with tetanus toxoid and a reduced amount of diphtheria toxoid compared with pediatric DTaP that is, similar quantities of tetanus and diphtheria toxoid to adult formulation Td. Before the availability of vaccine, pertussis was a common cause of morbidity and mortality among children. However, paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis. Inspiratory whoop is not common. These conditions include the presence of an evolving neurologic disorder e. The fourth dose of DTaP may be given if the child is at least 12 months of age, and at least 6 months have elapsed since the third dose of pertussis vaccine was given, and, in the opinion of the immunization provider, the child is unlikely to return for an additional visit at 15—18 months of age. Pertussis antigens appear to allow the organism to evade host defenses, in that lymphocytosis is promoted but chemotaxis is impaired.

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In certain circumstances, vaccination with DTaP vaccine should be delayed until a child with a known or suspected neurologic condition has been evaluated, treatment initiated, and the condition stabilized. This booster dose is not necessary but may be given if the fourth dose in the series was given on or after the fourth birthday. Outbreaks of pertussis were first described in the 16th century, and the organism was first isolated in Increased recognition and diagnosis of pertussis in older age groups probably contributed to this increase of reported cases among adolescents and adults. Case counts for have surpassed , with 48, pertussis cases, with 13 deaths in infants provisional. Adolescents and adults may also develop complications of pertussis, such as difficulty sleeping, urinary incontinence, pneumonia, and rib fracture. Priority should be given to vaccination of healthcare personnel who have direct contact with infants 12 months of age and younger. When studied, the acellular pertussis vaccine was significantly more effective than whole-cell DTP.