Guidance

Occupational pertussis vaccination of healthcare workers

Updated 15 August 2024

Applies to England

Pertussis

Pertussis (whooping cough) is an acute bacterial respiratory infection. Initial symptoms resemble a common cold which can progress to include spasmodic coughing, choking spells and vomiting after coughing.

The risk of severe complications is highest in very young babies - 97% of the deaths from pertussis in the last 12 years have been in infants aged 3 months or less who cannot be fully protected by immunisation.

In adults, the characteristic ‘whoop’ noise can be absent on coughing but it is usually an unpleasant illness that can be difficult to diagnose. Sometimes the only symptom is a cough which can be severe and may persist for months.

The bacteria are present in the back of the throat and can be spread by coughing and sneezing. An infected person can pass the infection to other people for 21 days from the onset of coughing if not treated with appropriate antibiotics.

Pertussis and healthcare workers

Healthcare workers (HCWs) can be an important source of infection to vulnerable infants. In recent years, the number of reported cases and incidents linked to healthcare settings in England has increased. In addition to putting vulnerable infants at risk of disease, such incidents have been disruptive and resource intensive, requiring staff exclusion, extensive contact tracing, antibiotic chemoprophylaxis and vaccination in line with UK Health Security Agency (UKHSA) guidelines.

Benefits of vaccinating healthcare workers

Vaccination of HCWs with pertussis vaccine can help prevent nosocomial transmission to infants. Therefore, in 2016, the Joint Committee on Vaccination and Immunisation (JCVI) advised that HCWs with direct contact with vulnerable patients (pregnant women and/or infants) are priority groups for immunisation. However, due to a global shortage of pertussis vaccine it had not been possible to fully implement the JCVI advice at that time.

Once supplies of vaccine started to improve, pertussis vaccines became available to order by NHS Occupational Health departments from July 2019.

Recommendations

Recommended groups for vaccination

JCVI has advised that health professionals who have not received a pertussis-containing vaccine in the last 5 years and have regular contact with pregnant women and/or young infants (young infants are those under 3 months of age) are prioritised for occupational vaccination.

Given the variability in intensity and frequency of contact with pregnant women and/or infants and the current limited availability of vaccine, these HCWs are categorised into 3 groups, as below. Please note that the examples listed in the priority groups below are not exhaustive and are illustrative of the types of roles that would be considered under each of the groups.

Priority group 1: HCWs with regular and close clinical contact with severely ill young infants (under 3 months) and women in the last month of pregnancy

This includes clinical staff working with women in the last month of pregnancy (for example, in midwifery, obstetrics and maternity settings) and neonatal and paediatric intensive care staff who are likely to have close and/or prolonged clinical contact with severely ill young infants (under 3 months of age).

Priority group 2: HCWs with regular clinical contact with young, unimmunised infants in hospital or community settings

This includes staff working in general paediatric settings (for example, general paediatric wards), some specialised settings (for example, paediatric cardiology, paediatric emergency medicine, paediatric infectious diseases, paediatric respiratory and paediatric surgery) and health visitor staff.

Priority group 3: HCWs with intermitted clinical contact with young, unimmunised infants in the community

This includes HCWs in general practice.

When healthcare workers should be vaccinated

All HCWs in priority group 1 have been eligible for vaccination since July 2019. In the context of widespread pertussis transmission across all age groups and regions currently, from July 2024 eligibility for vaccination has been extended so that the offer of occupational vaccination is now to the following groups in the order indicated below:

• all HCWs in priority group 1 to receive a first occupational dose if they have not received a pertussis-containing vaccination in the last 5 years
• all HCWs in priority group 2 to receive a single occupational dose, provided they have not received a pertussis-containing vaccination in the preceding 5 years
• HCWs in priority group 1 to be offered a further booster if more than 5 years since their first occupational dose

The approach outlined above reflects the importance of maximising uptake of the first occupational dose amongst HCWs in priority group 1, given the nature of contact with vulnerable infants and women in the last month of pregnancy for HCWs in this group, before progressing to those in priority group 2, and before offering a booster to those group 1 HCWs who have previously received a dose under the occupational offer.

Eligible HCWs in priority group 2 should be given a single dose. There are currently no recommendations for additional booster doses for this priority group.

HCWs in any of the priority groups who are pregnant should be vaccinated as recommended under the maternal pertussis programme (ideally between 20 and 32 weeks, although vaccine can be given from as early as 16 weeks)

The vaccine

The recommended vaccines are the acellular pertussis-containing vaccines Repevax, ADACEL and Boostrix-IPV. These are combination vaccines that, in addition to pertussis antigens, contain other antigens including diphtheria toxoid, tetanus toxoid, and inactivated poliovirus.

Repevax diphtheria/tetanus/5-component acellular pertussis/inactivated polio vaccine (dTaP/IPV)

Manufactured by Sanofi Pasteur. Occupational Health departments should contact 0800 854 430 (option 1) or register for VAXISHOP to order vaccines online.

ADACEL (diphtheria/tetanus/5-component acellular pertussis)

Manufactured by Sanofi Pasteur. Order details as above. ADACEL does not contain IPV.

Boostrix-IPV, diphtheria/tetanus/3-component acellular pertussis/inactivated polio vaccine (dTaP/IPV)

Manufactured by GlaxoSmithKline. Occupational Health departments should contact AAH Pharmaceuticals on 0344 561 8899 (option 1) to order vaccines.

All pertussis-containing vaccines are supplied as single doses of 0.5 ml. They are inactivated so do not contain live organisms and cannot cause the diseases which they protect against.

Vaccines should be stored in the original packaging at +2˚C to +8˚C and protected from light.

Contraindications

There are very few individuals who cannot receive pertussis-containing vaccines. When there is doubt, appropriate advice should be sought from their consultant (if applicable), a local screening and immunisation team, or a consultant in health protection rather than withhold vaccine.

The vaccines should not be given to those who have had either:

• a confirmed anaphylactic reaction to a previous dose of a diphtheria, tetanus, polio or pertussis containing vaccine

or:

• a confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B (which may be present in the vaccine in trace amounts)

Precautions

Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. If an individual is acutely unwell, immunisation should be postponed until they have fully recovered.

Pregnant women should normally receive a pertussis-containing vaccine around the time of their mid-pregnancy scan (usually 20 weeks) up to week 32, but can receive it from 16 weeks. Pertussis-containing vaccination can be given to those who are breastfeeding. Pertussis vaccines can also be given to those with immunosuppression and HIV infection, but they may not make a full antibody response and may require re-immunisation on specialist advice.

Incidents and outbreaks in healthcare settings

See Pertussis: guidelines for public health management.