Protecting infants from pertussis

Results of a clinical trial designed to show whether giving pertussis vaccine at birth could protect against life-threatening whooping cough in the first 3 months of life have been published in JAMA Paediatrics.  The study was funded by the National Health and Medical Research Council and led by the National Centre for Immunisation Research & Surveillance (NCIRS), based at Kids Research.

The collaborative study between NCIRS and the Universities of Sydney, Melbourne, Adelaide, and Western Australia, together with the Murdoch Children’s, Robinson and Telethon Research Institutes is the largest ever trial of a pertussis vaccine at birth, which included 440 newborns in Sydney, Melbourne, Adelaide and Perth.

The trial used a special pertussis-only vaccine (without diphtheria or tetanus) and randomised infants within 5 days of birth to receive only hepatitis B vaccine (HBV) or HBV and pertussis. Hepatitis B vaccine at birth has been recommended in Australia since 2000. Babies received usual vaccines at 6 weeks, 4 months and 6 months. The study found significantly higher pertussis antibody levels at 6 and 10 weeks of age in babies who had the birth vaccine, levels not achieved until at least 4 months of age currently. Since even one dose of pertussis vaccine provides good protection against death from pertussis, this is a major finding.

Receipt of a birth dose of pertussis vaccine was safe and well-tolerated, with no increase in side effects compared with HBV only.

Since the trial started, data from a country-wide emergency program in England have shown giving a dose of standard pertussis vaccine (with diphtheria or tetanus) to mothers is effective in preventing severe whooping cough in the first 3 months of life in their infants, and this evidence has resulted in the vaccine being provided for all pregnant women through the Australian National Immunisation Program from July 2018. However, infants whose mothers are not vaccinated or are born prematurely are not protected.

"The pertussis-only vaccine is an attractive option for immunising mothers too. If such a vaccine were licensed and available in Australia, it would provide the full range of options to protect babies younger than 3 months of age from severe pertussis," said Associate Professor Nick Wood, who led the study.