Tetanus, Diphtheria, Pertussis (Tdap) Vaccine

Learn how the Tdap (tetanus, diphtheria, pertussis) vaccine helps protect your newborn baby against serious illness.

  • Getting the Tdap vaccine during pregnancy gives your baby early protection against tetanus, diphtheria, and pertussis (whooping cough).

  • Although all three diseases are harmful, pertussis (whooping cough) is particularly dangerous and even life-threatening for newborn babies.

  • The Tdap vaccine provides the best protection when given between 27–32 weeks of pregnancy. However, it may be given earlier or up until the time of delivery.

  • The Tdap vaccine is safe for pregnant people and their babies. It does not increase the risk of complications during pregnancy or birth.

Tdap Vaccine

The Tdap vaccine provides combined protection against tetanus, diphtheria, and pertussis (also known as ‘whooping cough’). While all three of these infections are harmful, pertussis (whooping cough) is especially dangerous for newborn babies.

The Tdap vaccine is safe and recommended during every pregnancy to protect both you and your baby against the germs that cause tetanus, diphtheria, and pertussis (whooping cough). In Canada, pregnant people can get the Tdap vaccine for free during every pregnancy.1

The best time to get the Tdap vaccine is between 27 and 32 weeks of pregnancy.2 This gives your body enough time to create antibodies that can be passed to your baby and protect them from the moment they’re born. However, it may be given as early as 13 weeks or up until the time of delivery. Talk to your healthcare provider about the best time to get the Tdap vaccine.

Woman wearing medical mask with a bandaid on arm after vaccination.

About Pertussis

Pertussis, also known as ‘whooping cough’, is a serious bacterial infection that targets the nose, throat, and lungs (respiratory tract). Pertussis irritates your airways and causes thick mucus and long, severe coughing fits that usually end with a gasping breath that makes a “whooping” sound.

While pertussis can affect people of all ages, it’s very dangerous for newborn babies. The most serious cases of pertussis happen in babies who are too young to get vaccinated.2 When older children or adults get the disease, they can easily pass it on to babies who have not been vaccinated.

You can protect your newborn baby against this disease by getting the Tdap vaccine during pregnancy. Once you are vaccinated, your body will produce protective antibodies that defend against pertussis. These protective antibodies are shared with your baby during pregnancy, providing them with much-needed protection from the moment they are born until they are old enough to get their own vaccinations.

  • Pertussis spreads very easily from one person to another through the air, like a common cold. When a person with the disease coughs or sneezes, they let out tiny germ-filled drops into the air. If you breathe in these drops, you can catch pertussis, too. For young babies, the source of the infection is most often a family member, usually a parent or a young sibling.3-4

  • Pertussis can be severe and even life-threatening for small babies. In addition to coughing, young babies may experience pauses in their breathing, called ‘apnea,’ which can make them turn blue from lack of oxygen.

    Newborn babies have a higher risk of developing severe illness and complications from pertussis that can lead to hospitalization and even death. Studies have shown us that:

    1. Despite advancements in modern intensive care, babies under three months old who develop serious cases of pertussis have the highest risk of death.⁵⁻⁹

    2. Babies under three months old who develop a severe, potentially life-threatening case of pertussis usually develop pneumonia (infection of the lungs). This can lead to other serious problems like low blood pressure, organ failure, and even death.⁹

    3. The intense coughing fits and pauses in breathing caused by pertussis can cause the brain to not get enough oxygen. This can lead to seizures and even permanent brain damage.10

  • Pregnant people and other adults can get pertussis but in most cases the disease is less severe. Adults with pertussis are likely to experience prolonged coughing fits, sometimes resulting in vomiting, cracked ribs, disturbed sleep, incontinence and fainting.11 While the disease may be less severe for adults, it can be easily passed to young babies who are too young to get their own vaccine.

    Additionally, pregnancy changes your body and immune system in ways that can make it harder to fight off infections. This means that pregnant people are more likely to get very sick compared to people who aren’t pregnant.

    Remember, your health and the health of your growing baby are closely connected. Staying healthy during pregnancy has important benefits for you and your growing baby. Getting vaccinated against pertussis during pregnancy is the best way to protect both you and your baby from harmful germs like pertussis.

    • In Canada, pertussis affects anywhere between 1,000 to 3,000 people each year.12 Globally, there are an estimated 20-40 million cases annually and 400,000 people will die from pertussis.12

    • Pertussis most commonly affects babies under one year old.¹³ The best way to protect yourself and your baby from pertussis is by getting vaccinated during pregnancy.

  • The best way to protect your baby against pertussis in the first few months after birth is to get vaccinated during pregnancy. In Canada, the pertussis vaccine for pregnant people is combined with two other vaccines in a single shot, known as the Tdap vaccine.

    The Tdap vaccine teaches your body to make protective antibodies that will fight off the germs that cause pertussis. During pregnancy, these protective antibodies are passed to your baby through the placenta. This gives your baby early protection against pertussis during the first few months of life when they are more likely to get very sick. Studies show that nine out of ten babies under three months of age are protected against pertussis if their mothers received the pertussis (Tdap) vaccine during pregnancy.14-15

    In Canada, babies can get their own vaccine starting at two months old. The pertussis vaccine for babies is also combined with other important vaccines and is generally given in a series of doses when a baby is 2, 4, and 6 months old and again at 18 months old.16 To keep immunity (protection) strong, other pertussis-containing vaccines are given as “boosters” at different points during childhood and adolescence. Talk with your healthcare provider for more information about when to vaccinate your child.

About Tetanus

Tetanus is an infection caused by a germ (bacteria) found in things like dirt, dust, and the feces (poop) of humans and animals.

The tetanus germ makes a toxin (poison) that affects the nerves controlling your muscles.17 This toxin can make your muscles feel really tight and cause them to twitch or jerk uncontrollably (spasms). It might even make it difficult for you to swallow food or breathe properly.

A common name for tetanus is "lockjaw" because it can make the muscles in your jaw become so tight and painful that you can't open your mouth easily. Tetanus can make you very sick and can be deadly if it isn’t treated properly. Anyone who gets tetanus needs to be treated at a hospital. Luckily, there are vaccines you can get to protect you and your baby against tetanus.

  • Anyone can catch tetanus, but it can be more common and dangerous in newborn babies and pregnant people who haven't been vaccinated against it.18 Tetanus is not contagious, meaning it does not spread from person to person like the common cold or flu. Tetanus germs can be found in places like dirt, soil, dust, and poop from animals and humans. It can enter your body through cuts or wounds, especially if they aren't kept clean or if the skin around them is damaged, like from a burn or frostbite. Things like nails or shards of glass that have been lying on the ground could have this germ on them.

    Pregnant people and their newborn babies can get sick from this germ if there is poor hygiene during childbirth. For example, if a medical instrument used to cut the baby's umbilical cord is not clean, or if unclean material is used to cover the place where the cord was cut, the tetanus germ can get in.18 This can lead to a condition known as “neonatal tetanus,” which can be serious and deadly for newborn babies. This is more common in countries where vaccination rates are low, and unsanitary (unclean) birth practices are more common.18

    Thanks to widespread vaccination, neonatal tetanus has been wiped out in almost all countries around the world. This is mainly because most pregnant individuals get a tetanus shot before giving birth.

  • Tetanus in babies is called neonatal tetanus. Neonatal tetanus can be quite serious for babies because their immune systems aren’t fully developed yet.¹⁹ The signs and symptoms of neonatal tetanus include:

    1. Trouble feeding and or constant crying

    2. Stiff body and muscle spasms: The baby might have sudden jerky movements or seizures. These can be caused by even small things like a loud noise or bright light

    3. Trouble breathing: As the disease gets worse, the baby might have a hard time breathing because their chest muscles get too stiff

    These signs usually start within the first two weeks after the baby is born.²⁰ It's really important to get help from a doctor or healthcare provider right away if you notice any of these symptoms. Neonatal tetanus is a serious disease, but with quick medical attention, it can often be treated.

  • Adults, including pregnant people, who have not been vaccinated are the most at risk for getting tetanus. Signs and symptoms of tetanus generally start between three days and three weeks after getting infected.18 These include: stiffness or locking of the jaw ("lockjaw"), the neck and other muscles in the body, difficulty swallowing, painful body spasms and fever, sweating, and high blood pressure.

    While being pregnant doesn't increase your chances of getting tetanus, it can make dealing with a tetanus infection more difficult. Pregnancy changes your body and immune system in ways that can make it harder to fight off infections. This means that pregnant people are more likely to get very sick compared to people who aren’t pregnant.

    Remember, your health and the health of your growing baby are closely connected. Staying healthy during pregnancy has important benefits for you and your growing baby. Getting vaccinated is one of the best ways to protect you and your baby against harmful germs like tetanus.

  • Tetanus is not common in Canada because most people get vaccinated against it. People who aren’t vaccinated are more likely to get tetanus. Tetanus is more common in countries where it's hard to get the tetanus vaccine.

  • The best way to protect your baby against tetanus in the first few months after birth is to get vaccinated during pregnancy. In Canada, the tetanus vaccine for pregnant people is combined with two other vaccines in a single shot, known as the Tdap vaccine.

    The Tdap vaccine teaches your body to make protective antibodies that will fight off the germs that cause tetanus. During pregnancy, these protective antibodies are passed to your baby through the placenta. This gives your baby early protection against tetanus until they are old enough to get their own vaccine starting at 2 months old.

About Diphtheria

Diphtheria is a serious infection that mainly affects the nose and throat. It can also cause sores on the skin. The diphtheria germs create a thick, gray layer that covers the throat and tonsils making it hard to breathe or swallow.21 Some people with diphtheria may also have a fever, feel really tired, or have a sore throat.

In serious cases, the poison made by the germs can spread through the body and harm the heart, nerves, and kidneys. Diphtheria can lead to serious breathing problems, heart failure, and paralysis.21 Without medical treatment, diphtheria can be deadly, especially for babies.

  • Diphtheria is very contagious, meaning it can spread from person to person. This can happen when someone with the disease coughs, sneezes, or even talks. People can also catch diphtheria by touching an object, like a toy, that someone with the disease touched. The bacteria can also spread through skin-to-skin contact with someone who is infected.21 Luckily, there are vaccines you can get to protect you and your baby against diphtheria.

  • Anyone can get diphtheria, but it can be more serious and even deadly for newborn babies and young children.22 Common signs and symptoms of diphtheria in newborns include:

    1. Sore throat

    2. Low fever

    3. Runny nose

    4. Trouble breathing

    5. Gray or white patch in the throat or nose: One of the classic signs of diphtheria is a thick, gray or white coating at the back of the throat or in the nose.

    These signs usually start within 2-5 days after the baby catches the bacteria.23 If you notice any of these symptoms in your baby, it's very important to get them to a doctor or healthcare provider right away. Diphtheria can be serious, but it can be treated with medicine if caught early.

  • Anyone who is not vaccinated is at risk of getting diphtheria. Signs and symptoms of diphtheria usually start 2 to 5 days after you've been infected.²³⁻²⁴ These may include a thick, grey-white coating at the back of your throat, nose, or tongue, a high fever, a sore throat, swollen glands in your neck, and difficulties with breathing or swallowing. If left untreated, the toxin (poison) created by diphtheria can spread through the body and harm the heart, kidneys, and nerves.

    While being pregnant doesn't increase your chances of getting diphtheria, it can make dealing with a diphtheria infection more difficult. Pregnancy changes your body and immune system in ways that can make it harder to fight off infections. This means if you get sick with diphtheria while pregnant, you might experience worse symptoms than someone who isn’t pregnant, including fatigue (feeling tired), fever, and trouble breathing. These symptoms can add extra strain on your body, which is already working hard to breathe and pump blood for two.

    Remember, your health and the health of your growing baby are closely connected. Staying healthy during pregnancy has important benefits for you and your growing baby. Getting vaccinated is one of the best ways to protect you and your baby against harmful germs like diphtheria.

  • Fortunately, diphtheria is not common in Canada because most people are vaccinated against it. People who aren’t vaccinated are more likely to get diphtheria. Diphtheria is more common in countries where it's hard to get the diphtheria vaccine.

  • The best way to protect your baby against diphtheria in the first few months after birth is to get vaccinated during pregnancy. In Canada, the diphtheria vaccine for pregnant people is combined with two other vaccines in a single shot, known as the Tdap vaccine.

    The Tdap vaccine teaches your body to make protective antibodies that will fight off the germs that cause diphtheria. During pregnancy, these protective antibodies are passed to your baby through the placenta. This gives your baby early protection against diphtheria until they are old enough to get their own vaccine starting at 2 months old.

The Tdap vaccine protects against tetanus, diphtheria and pertussis (whooping cough).

About the Tdap Vaccine

  • The Tdap vaccine is like a “practice run” for your body’s natural defences, known as your “immune system.” When you get vaccinated, your immune system gets the chance to safely practice recognizing and fighting a bad germ without the risks of a real infection. If you are ever exposed to the real germ in the future, your body will already know how to fight and get rid of it before it can make you sick.

    The Tdap vaccine works by training your immune system to recognize and fight off the germs (bacteria) that cause tetanus, diphtheria, and pertussis infections.

    Here’s how it works:

    • The vaccine introduces your body to inactivated (dead) pieces of tetanus, diphtheria, and pertussis bacteria, called antigens. These antigens are safe because they’re not alive – they’ve been killed or “switched off.”

    • Once you get vaccinated, your body treats these dead antigens as unwelcome intruders. It responds by making protective antibodies to fight and get rid of them.

    • These protective antibodies will be ready to spot and attack the real germs if you ever get them in the future.

    It usually takes a couple weeks after receiving the vaccine for your body to start producing these protective antibodies. When you're pregnant, this process might take slightly longer. Getting the Tdap vaccine at the recommended time (ideally between 27-32 weeks of pregnancy) gives your body enough time to make protective antibodies and pass them to your baby.

    See video: How Vaccines Protect Moms and Babies

    See infographic: How Flu and Tdap Vaccines Work

  • When you get a vaccine, your body responds by making protective antibodies that fight off harmful germs. When you’re pregnant, these protective antibodies pass to your baby through the placenta. These antibodies help protect your baby at birth and over the first few months of life until they are old enough to get their own vaccines.

    It’s important to know that only the protective antibodies your body makes pass to your baby in significant amounts. These antibodies will protect your baby at birth and over the first few months until they are old enough to get their own vaccines. This means your baby will have a layer of protection when they need it the most.

    Vaccine ingredients generally stay close to the injection site, in your muscle and lymphatic system. Once the vaccine has finished training your immune system to defend against tetanus, diphtheria, and pertussis germs, your body will naturally break down and get rid of the vaccine ingredients, just like it gets rid of other materials it doesn’t need anymore. The vaccine ingredients are out of your body after several weeks.

    Getting the Tdap vaccine between 27–32 weeks of pregnancy gives your body enough time to create protective antibodies and pass them to your baby. This way, your baby will be protected against tetanus, diphtheria, and pertussis (whooping cough) from the moment they are born.² However, you can get the vaccine as early as 13 weeks or even right up until the time of delivery in certain circumstances. For example, if there’s a chance you might give birth early (before 37 weeks), your healthcare provider may recommend getting the Tdap vaccine earlier in your pregnancy.³

    Talk with your healthcare provider for more information on the best time to receive the Tdap vaccine.

    See video: How Vaccines Protect Moms and Babies

    See infographic: How Flu and Tdap Vaccines Work

  • The Tdap vaccine is very effective.

    In Canada, the Tdap vaccine is mainly used during pregnancy to prevent pertussis (whooping cough). While the vaccine also protects against tetanus and diphtheria, pertussis is the main concern because it is still common and very dangerous for young babies.

    Getting the Tdap vaccine as recommended during pregnancy has been shown to provide excellent protection against pertussis infections for nine out of ten babies under three months of age.14-15

    • The USA and UK were the first to introduce programs providing pertussis vaccines during pregnancy. Several studies from these countries have shown that 91 – 93% of babies whose mothers were vaccinated during pregnancy are protected against pertussis for the first two to three months of life.14-15, 27

    • Research also shows that babies born to mothers who were vaccinated against pertussis during pregnancy have a lower risk of being admitted to hospital. Those that are admitted to hospital are less likely to be admitted to intensive care and tend to have shorter hospital stays.28

Tdap Vaccine Safety

  • Yes. Research from all over the world has proven that the Tdap vaccine is safe and effective for pregnant individuals and their babies.29

    Just like the flu vaccine recommended during pregnancy, the Tdap vaccine is an inactivated vaccine. This means it uses a safe, dead version of the germs that cause tetanus, diphtheria, and pertussis. These dead germ pieces can’t give you the disease or cause any harm to you or your baby. Inactivated vaccines like the flu and Tdap are considered safe during pregnancy.

  • No. Research tells us that getting the Tdap vaccine during pregnancy does not increase the risk of pregnancy complications. A review of several studies30 confirmed that receiving the Tdap vaccine in pregnancy does not increase the likelihood of:

    • Preterm birth (birth before 37 weeks of pregnancy)

    • Stillbirth or neonatal death (death during the first 28 days of life)

    • Babies that are small for gestational age

    • Low birth weight (less than 2.5kg)

    • Birth defects.

  • No, there's no chance that you or your baby will catch tetanus, diphtheria, or pertussis from the Tdap vaccine. That's because the vaccine does not contain any 'live' bacteria. Instead, the Tdap vaccine uses harmless, dead pieces of the germs that cause these diseases. Since these germ pieces aren't alive, they can't make you sick or harm you or your baby in any way.

    Vaccines that do contain ‘live’ germs, like the MMR (measles-mumps-rubella) vaccine, are not recommended to people during pregnancy.

  • A very small number of people have a severe allergic reaction to vaccines called ‘anaphylaxis,’ where they can develop swelling, hives, breathing difficulties, lowered blood pressure and in severe cases, shock.

    Anaphylactic reactions are very rare – they occur in about one in a million people who have a vaccination.31 This is why pharmacies and clinics ask people to wait around 15 minutes after getting a vaccine before leaving a pharmacy or clinic. Healthcare providers are trained to respond to an anaphylactic reaction.

    See Infographic: Tdap Vaccine: Benefits & What to Expect 

  • The only medical reason to not get the Tdap vaccine is if you have previously had an anaphylactic reaction to a component of the Tdap vaccine in the past. Talk to your healthcare provider if you've experienced a serious reaction to the Tdap vaccine before.

    See Infographic: Tdap Vaccine: Benefits & What to Expect 

Doctor places bandaid on arm of White pregnant woman wearing surgical mask after vaccination.

Vaccine Reactions

After getting vaccinated, some people may experience temporary side effects that typically last from a few hours to a few days. These are normal as it shows that your body is working to build immunity (protection) against the disease.

Most people who have the Tdap vaccine have no reaction at all. Some people have mild reactions that last between 12 and 24 hours and are easily treated at home.

  • Up to seven in every 100 women get some redness or soreness at the spot where the needle went in.32 This is called a ‘local reaction’.

    People who have had a pertussis vaccine before are slightly more likely to have a local reaction than people who are having the vaccine for the first time. The redness and soreness will get better in a day or two, but in the meantime, you can put a cool, damp cloth on the spot to soothe it, or take an over-the-counter pain medication, such as acetaminophen (Tylenol), if you feel you need to. Check with your healthcare provider before taking any other pain medications.

    See Infographic: Tdap Vaccine: Benefits & What to Expect 

  • Around three in every 100 women experience a headache after vaccination.32 The headache will get better by itself, but you can take over-the-counter pain medication such as acetaminophen (Tylenol) if you feel you need to. Check with your healthcare provider before taking any other pain medications.

    See Infographic: Tdap Vaccine: Benefits & What to Expect 

  • Around two in every 100 women develop a fever of around 38.5°C or more.32 If you have a fever after your vaccination, drink plenty of water and consider using some acetaminophen (Tylenol) to help bring the temperature down. Check with your healthcare provider before taking any other pain medications.

    See Infographic: Tdap Vaccine: Benefits & What to Expect 

  • Very few women (around three in every 1,000) experience a reaction serious enough to require them to attend a hospital emergency department.32 Follow-up with those women indicated that all symptoms resolved and that both mother and baby remained healthy.

    See Infographic: Tdap Vaccine: Benefits & What to Expect 

  • If your symptoms last longer than a couple of days, or if you are worried about how you feel after your vaccination, you can call your doctor or get help by calling the toll-free health information and advice phone service available in your province/territory:

    • For British Columbia, Alberta, Saskatchewan, Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland and Labrador, New Brunswick, Prince Edward Island, the Yukon, the Northwest Territories: Call 811

    • For Manitoba: Call 1-888-315-9257

    • For Nunavut: Call 211

    You can also get help by visiting your nearest emergency department or urgent care centre. If you develop any serious symptoms that you think could be an allergic reaction after your vaccination, call emergency services right away by dialling 911.

Vaccine Timing

  • The Tdap vaccine can be given as early as 13 weeks and right up until the time of delivery. However, we know that it works best if given at least four weeks before birth.25

    For the best protection, the National Advisory Committee on Immunization (NACI) recommends that pregnant individuals receive the Tdap vaccine between 27–32 weeks of pregnancy.25 This gives your body enough time to create protective antibodies that can be passed to your developing baby through the placenta, protecting them from the moment they are born and over the first few months of life.25

    The best timing can depend on your health and individual circumstances. For example, if you are at a higher risk of preterm birth (birth that happens before 37 weeks of pregnancy), your healthcare provider may recommend getting the Tdap vaccine earlier in your pregnancy.26 Talk with your healthcare provider about the best time to receive the vaccine, as they can offer recommendations based on your individual health status and circumstances.

  • It is recommended that pregnant individuals get the Tdap vaccine during every new pregnancy. The protection from the vaccine decreases over time, so it’s important to get a new Tdap vaccine in every pregnancy even if you’ve had it before.

  • Choosing to wait until after your baby is born to get the Tdap vaccine means your baby won't be protected against pertussis at birth. If you get vaccinated while breastfeeding, your baby will get some antibodies from your breastmilk, but this protection isn't as strong as the protection they would get from the antibodies that cross the placenta during pregnancy. Getting the Tdap vaccine at the recommended time during pregnancy has been shown to be 85% more effective than vaccination after pregnancy.28

    Your body also takes a couple of weeks to make these protective antibodies after you get vaccinated. This means your baby won’t be protected for at least the first few weeks after birth, when they are more likely to get very sick.

    That's why getting the Tdap vaccine, along with the flu and COVID-19 vaccines, is strongly recommended during pregnancy. The protective antibodies you create are shared with your baby through the placenta, keeping them safe from the moment they're born.

    The best time to get the Tdap vaccine is between 27 and 32 weeks of pregnancy, so your body has time to make protective antibodies and pass them to your baby.

Additional Information

  • Yes. Getting your family members vaccinated against pertussis is particularly important because about 80% of babies that catch pertussis get it from parents or siblings.³ Anyone likely to be in close contact with your baby, including other parents, siblings and grandparents, should also be fully vaccinated. Siblings should have their vaccinations up to date, and any adults who have not had a Tdap vaccination in the last ten years or longer should get a booster dose.

  • Depending on where you live, you can get a Tdap vaccination at a pharmacy, public health clinic or travel clinic. Your family doctor may also offer vaccinations. It is recommended to check with your local health department or healthcare provider for more information on where to get a Tdap vaccination in your area. You can also contact the toll-free health information and advice phone service available in your province/territory to find out more information:

    • For British Columbia, Alberta, Saskatchewan, Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland and Labrador, New Brunswick, Prince Edward Island, the Yukon, the Northwest Territories: Call 811

    • For Manitoba: Call 1-888-315-9257

    • For Nunavut: Call 211

Getting the Tdap vaccine during pregnancy gives your baby early protection against pertussis until they are old enough to get their own vaccines.

Key Facts

  • Pertussis is a serious bacterial infection of the nose, throat and lungs commonly called ‘whooping cough’.

  • Babies usually catch pertussis from family members, especially parents and siblings.

  • Pertussis is most severe and life threatening for babies less than three months old.

  • The most effective way to protect your baby against pertussis is to get the Tdap vaccination in each pregnancy.

  • Nine out of ten babies under three months of age are protected against pertussis if their mothers had the pertussis vaccine during pregnancy.

  • During pregnancy, the Tdap vaccine works by producing antibodies that cross the placenta to give your baby much needed protection against pertussis at birth.

  • The Tdap vaccine is free for all pregnant people in Canada, every time they are pregnant.

  • Having the Tdap vaccine in pregnancy is safe for both babies and pregnant people.

    1. Public Health Agency of Canada. (2023). Provincial and territorial routine vaccination programs for healthy, previously immunized adults. https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/routine-vaccination-healthy-previously-immunized-adult.html

    2. Public Health Agency of Canada. (2023, September 8). Pertussis (whooping cough) vaccines: Canadian Immunization Guide. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-15-pertussis-vaccine.html

    3. Wiley, K. E., Zuo, Y., Macartney, K. K., & McIntyre, P. B. (2013). Sources of pertussis infection in young infants: A review of key evidence informing targeting of the cocoon strategy. Vaccine, 31(4), 618-625.

    4. Bertilone, C., Wallace, T., & Selvey, L. A. (2014). Finding the 'who' in whooping cough: Vaccinated siblings are important pertussis sources in infants 6 months of age and under. Communicable Diseases Intelligence Quarterly Report, 38(3), E195-E200.

    5. Winter, K., Zipprich, J., Harriman, K., et al. (2015). Risk factors associated with infant deaths from pertussis: A case-control study. Clinical Infectious Diseases, 61(7), 1099-1106.

    6. Murray, E. L., Nieves, D., Bradley, J. S., et al. (2013). Characteristics of severe Bordetella pertussis infection among infants ≤90 days of age admitted to pediatric intensive care units - Southern California, September 2009-June 2011. Journal of Pediatric Infectious Diseases Society, 2(1), 1-6.

    7. Centers for Disease Control and Prevention. (2002). Pertussis--United States, 1997-2000. MMWR. Morbidity and Mortality Weekly Report, 51(4), 73-76.

    8. Halperin, S. A., Wang, E. E., Law, B., et al. (1999). Epidemiological features of pertussis in hospitalized patients in Canada, 1991-1997: Report of the Immunization Monitoring Program--Active (IMPACT). Clinical Infectious Diseases, 28(6), 1238-1243.

    9. Mikelova, L. K., Halperin, S. A., Scheifele, D., et al. (2003). Predictors of death in infants hospitalized with pertussis: A case-control study of 16 pertussis deaths in Canada. The Journal of Pediatrics, 143(5), 576-581.

    10. Olsen, M., Thygesen, S. K., Østergaard, J. R., et al. (2015). Hospital-diagnosed pertussis infection in children and long-term risk of epilepsy. JAMA, 314(17), 1844-1849.

    11. De Serres, G., Shadmani, R., Duval, B., et al. (2000). Morbidity of pertussis in adolescents and adults. The Journal of Infectious Diseases, 182(1), 174-179.

    12. Public Health Agency of Canada. (2020, January 7). Pertussis (whooping cough). https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/pertussis-whooping-cough.html

    13. Bhagat, D., Saboui, M., Huang, G., et al. (2023). Pertussis epidemiology in Canada, 2005-2019. Canada Communicable Disease Report, 49(1), 21-28.

    14. Amirthalingam, G., Andrews, N., Campbell, H., et al. (2014). Effectiveness of maternal pertussis vaccination in England: An observational study. The Lancet, 384(9953), 1521-1528.

    15. Baxter, R., Bartlett, J., Fireman, B., Lewis, E., & Klein, N. P. (2017). Effectiveness of vaccination during pregnancy to prevent infant pertussis. Pediatrics, 139(5), e20164091.

    16. Public Health Agency of Canada. (2023, September 8). Pertussis (whooping cough) vaccines: Canadian Immunization Guide for health professionals. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-15-pertussis-vaccine.html

    17. Public Health Agency of Canada. (2023, May 15). Tetanus. https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/tetanus.html

    18. World Health Organization. (2023, August 24). Tetanus. [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/tetanus

    19. Mackin, D. W., & Walker, S. P. (2021). The historical aspects of vaccination in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 76, 13–22.

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