Overview
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Boostrix is administered as part of the National Immunisation Schedule at 11 years of age. The vaccine is delivered in the school-based vaccination programme to children in Year 7 in most parts of the country.
Boostrix is funded from the second trimester of every pregnancy and recommended to be administered from 16 weeks, preferably within the second trimester, to help protect both mother and her newborn infant against pertussis (whooping cough). By immunising the mother in pregnancy, the baby can be protected from whooping cough in two ways:
1. By the antibodies produced by mother following immunisation and passed to baby across the placenta
2. The mother is protected from catching whooping cough and passing it to her baby
It is important to emphasise that this protection is temporary and the infant should receive their own immunisations on time, starting at 6 weeks, so they develop their own, longer-term immunity.
Boostrix vaccine boosts immunity against diphtheria, tetanus and whooping cough. Fully immunised children will have received previous doses of the three vaccines contained in Boostrix:
- Infanrix-hexa delivered at 6 weeks, 3 months and 5 months of age provides the 'primary' course
- Infanrix-IPV delivered at 4 years provides a booster adding protection before the child goes to school
Boostrix is funded for eligible individuals:
- Those who need a tetanus booster immunisation because of a wound
- For some people aged from 45 years old*.
- Everyone from 65 years old*
* a) only eligible for dose from 45 years if have received fewer than four tetanus doses in their life-time; b) from age 65 years, if it has been more than 10 years since previous dose of Td or Tdap.
Children (older than 7 years) who are not fully immunised may receive Boostrix as part of a catch-up programme. A primary course of 3 doses of Tdap vaccines (at a minimum of 4-weekly intervals) is recommended and funded for unimmunised or partially immunised adults.
This funded vaccine is available from ProPharma. Boostrix is also the vaccine available for purchase by individuals who are not eligible for a funded vaccine. Boostrix for non-funded individuals is available from Healthcare Logistics.
Responses to vaccine
- Pain and swelling around the injection site may prevent normal everyday activities for 24–48 hours
- Headache or nausea
- Muscle or joint stiffness or pain
- Hives
- Sterile abscess at the injection site
Other formulations and brands
Adacel
Schedule and administration
Boostrix is funded, and often provided as part of school-based immunisation programmes, at 11 years of age (Year 7).
Boostrix replaced the tetanus- and diphtheria-only vaccine (ADT Booster) for individuals who need a tetanus booster immunisation because of a wound and adults needing catch-up immunisation and booster immunisation at 45 years and 65 years of age
Boostrix is funded from the second trimester of every pregnancy and recommended to be administered from 16 weeks, preferably within the second trimester. Administration of Tdap from 16 weeks of pregnancy allows time for the woman’s immune system to produce antibody protection against pertussis. It also ensures there is enough time before birth for the antibodies to pass through the placenta into the growing baby.
The level of maternal antibody in the newborn varies between mothers and babies. The antibodies are temporary but are expected to protect the newborn against severe pertussis disease for at least two months. This is the time the infant is most vulnerable before they can start their own immunisation programme.
A secondary outcome of maternal Tdap vaccination may be a reduction in the risk that the woman will catch pertussis and pass it to her baby at delivery or during their first year of life.
If the vaccine is administered less than two weeks before baby’s birth, there may not be adequate time for the woman’s antibody levels to be boosted or for antibodies to pass onto her baby before birth. However, Tdap vaccination may still reduce the risk the woman will catch pertussis and pass it to her baby during their first year of life when their risk of complications from pertussis is very high. It will not protect the baby in the earliest weeks of their life when they are at the very highest risk.
Boostrix is recommended, though not funded unless provided by employers, for:
- Health care staff who work with infants less than one year of age
- Staff working in longterm care facilities
- Early childhood education staff
- Students in training for occupations with children
- Household and other close contacts of infants less than one year of age
- Adults with a medical condition not specified in the Schedule but in whom prevention of pertussis is important, e.g. those with chronic respiratory/lung disease
Special groups
Boostrix is funded for:
- pregnant women for each pregnancy
- adults post-haematopoietic stem cell transplant (up to four additional doses)
- parents or primary caregivers of infants admitted to a Neonatal Intensive Care Unit or Specialist Care Baby Unit for more than 3 days and whose mother did not receive a maternal Tdap vaccination at least 14 days before the baby’s birth.
Catch-up doses
Catch-up doses of Boostrix are funded for children and adolescents from 10 years to under 18 years of age who require catch-up immunisation against these diseases, including those who missed their 11-year-old booster immunisation.
Boostrix may be used and is funded for children aged between 7-10 years instead of Infanrix-hexa (DTaP-IPV-HepB/Hib) or Infanrix-IPV (DTaP-IPV), when Hib, hepatitis B or polio protection is not required. Boostrix is not approved for use in a primary course or for children in the 7–10 years age group. However, no safety concerns are expected with off-label use. Vaccine choice will be determined by the antigens required and parental consent.
Storage and preparation
No special considerations, store as per cold chain between 2°C to 8°C.
Administration
Boostrix can be administered concurrently with other vaccines, including all the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used.
The vaccine is administered intramuscularly, into the deltoid.
Nomenclature
DTaP, Tdap, dTpa, DTwP and DPT
Components: All these vaccines protect against diphtheria, tetanus, and pertussis.
Strength: Upper-case letters indicate a full-strength dose; lower-case letters indicate a reduced dose.
Acellular Pertussis: The “a” in the name stands for "acellular," meaning the vaccine uses parts of the Bordetella pertussis bacterium rather than the whole bacterium (seen as DTwP), which was used in older vaccines but caused more side effects.
Vaccine Safety
Boostrix should not be given to:
- Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine; a previous dose of diphtheria, tetanus or pertussis vaccine or a component of the vaccine
- Administration of Boostrix should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation
People in the following groups should seek specialist advice before receiving the vaccine:
- Those with bleeding disorders, such as haemophilia. The vaccine should be administered in accordance with the haematologist’s instructions. It may, in this situation only, be given subcutaneously
In the case of a child with a clinically unstable evolving neurological disorder, withholding vaccination until the clinical situation has stabilised should be considered on an individual basis after careful consideration of the risks and benefits.
Women who are breastfeeding can safely have Boostrix. No adverse consequences for breastfed infants have been observed following vaccination of lactating women.
Vaccine Effectiveness
After administration of Boostrix to individuals who have previously completed a primary course of tetanus, diphtheria and pertussis immunisations, serology of 9 in 10 individuals demonstrated protection against tetanus and diphtheria.
Since unvaccinated children from 7 years of age and adults are expected to have some immunity to pertussis as a result of exposure to the disease in the community, a single dose of Boostrix is expected boost their existing protection against pertussis. However, a single dose of Boostrix will not provide protection against tetanus and diphtheria in a previously unvaccinated person.
The current estimate from the CDC around Tdap vaccination is that 70% of adolescents, who have previously been fully immunised with DTaP as part of their primary infant series, will be protected against pertussis. Adolescents and adults who received Tdap and still get pertussis have less severe disease with fewer coughing fits, shorter illness and are less likely to have disease complications.
One research paper suggests that the effectiveness of Tdap against pertussis wanes within 2-4 years in adolescents who have only received acellular pertussis vaccines during their lifetime. Therefore, it is especially important for young mothers to receive a Tdap booster during pregnancy.
When given in pregnancy, studies in the UK have shown that more than 9 out of 10 infants are protected against severe pertussis in the first 8 weeks of life. US-based studies have also demonstrated that prenatal Tdap vaccination significantly reduces the risk of hospitalisation and death of young infants from pertussis and that it was 85% more effective than vaccination of mothers after birth (within 14 days postpartum).
Pertussis immunity following vaccination only lasts for around 5 years, and repeat doses are needed in those most at risk of infection, such as health and childcare workers.
References
- Acosta AM, DeBolt C, Tasslimi A, et al. Tdap vaccine effectiveness in adolescents during the 2012 Washington State pertussis epidemic. Pediatrics (2015) 135(6) DOI: 10.1542/peds.2014-3358.
- Campbell H, Gupta S, Dolan GP, Kapadia SJ, Kumar Singh A, Andrews N, et al. Review of vaccination in pregnancy to prevent pertussis in early infancy. J Med Microbiol. 2018;67(10):1426-56.
- Dabrera G, Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, Fry NK, Ramsay M. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-2013.Clin Infect Dis. 2015 Feb 1;60(3):333-7. doi: 10.1093/cid/ciu821. Epub 2014 Oct 19.
- Eberhardt CS, Blanchard-Rohner G, Lemaître B, Combescure C, Othenin-Girard V, Chilin A, et al. Pertussis antibody transfer to preterm neonates after second- versus third-trimester maternal immunization. Clin Infect Dis. 2017;64(8):1129-32.
- Ezeanolue E, Harriman K, Hunter P, Kroger A, Pellegrini C. Centers for Disease Control and Prevention. General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP);[updated 2020 July 27; cited 2020 September 28]. Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
- Healy C, Rench MA, Swaim LS, et al. Association between third-trimester tdap immunization and neonatal pertussis antibody concentration. JAMA. 2018;320(14):1464-70.
- Health New Zealand | Te Whatu Ora, Immunisation handbook [Internet]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook
- Petousis-Harris, Walls T, Watson D et al. Safety of Tdap vaccine in pregnant women: an observational study. BMJ Open 2016;6:e010911 doi:10.1136/bmjopen-2015-010911.
- Walls T, Graham P, Petousis-Harris H, Hill L, Austin N. Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational study. BMJ Open 2016;6:e009536 doi:10.1136/bmjopen-2015-009536.
- Winter K, Nickell S, Powell M and Harriman K. Effectiveness of prenatal versus postpartum Tdap vaccination in preventing infant pertussis. Clin Infect Dis (2016) Sep 13 doi: 10.1093/cid/ciw634.
- Winter K, Cherry JD and Harriman K. Effectiveness of prenatal Tdap vaccination on pertussis severity in infants. Clin Infect Dis. 2016 Sep 13.doi: 10.1093/cid/ciw633.
