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Malaysian Society of Infectious Diseases & Chemotherapy

Guidelines for Adult Immunisation

Content

Message from Editor

Editorial Panel

Adult Immunisation Schedule

Contraindications and Special Considerations

Temporary Deferral of Immunisation

Route and Site of Administration

Post Vaccination

Anaphylaxis

Vaccine Storage and Disposal of Vaccines

Vaccine Combinations

Multiple Vaccinations

Adverse Event Following Immunisation (AEFI)

Immunosenescence

Cholera

COVID-19

Dengue

Diphtheria

Tetanus

Pertussis

Haemophilus influenzae type b

Hepatitis A

Hepatitis B

Human Papillomavirus (HPV)

Influenza

Japanese Encephalitis (JE)

Measles

Mumps

Rubella

Meningococcal Disease

Mpox

Pneumococcal Disease

Poliomyelitis

Rabies

Respiratory Syncytial Virus (RSV)

Typhoid Fever

Chickenpox (Varicella)

Yellow Fever

Shingles (Zoster)

Passive Immunisation

Avian Influenza

Chikungunya

Clostridioides difficile

Ebola

Human Immunodeficiency Virus (HIV)

Malaria

Zika

Adults Who Missed Childhood Immunisation

Older Adults and Patients With Chronic Ilnesses

Healthcare workers

Human Immunodeficiency Virus (HIV)

Immunocompromised Patients

Miscellaneous Groups

Travelers

Vets & Animal Handlers

Abbreviations

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Available Vaccines

Pertussis

In this chapter:

Introduction

Pertussis, also known as whooping cough, is an upper respiratory tract infection caused by Bordetella pertussis. Transmission occurs through direct contact with respiratory secretions or via aerosolised droplets from infected individuals. The classical presentation is characterised by paroxysmal coughing episodes followed by an inspiratory ‘whoop’. However, infected adolescents and adults experience a milder form of the illness due to varying degrees of immunity acquired from previous childhood vaccination or past infection. In adults, pertussis may present as a prolonged cough lasting for weeks or even months, often leading to misdiagnosis as bronchitis or other respiratory conditions.

Between 2019 and 2024, pertussis cases in Malaysia fluctuated markedly, with sharp declines during the COVID-19 pandemic followed by a resurgence in the post-pandemic period. Under the National Immunisation Programme, the final pertussis booster dose is administered at 18 months of age. As a result, immunity progressively wanes over time, particularly during adolescence, increasing susceptibility among adults who may subsequently act as reservoirs for transmission to vulnerable populations. 

Table 8.1 Vaccines Registered in Malaysia

Notes

  • The pertussis vaccine is available in an acellular form, combined with diphtheria and tetanus vaccines.
  • Tdap is recommended for adolescents and adults and contains lower doses of diphtheria and pertussis compared with the children’s DTaP.
  • Uppercase letters (T) indicate full-strength components; lowercase “d” and “p” indicate reduced doses. The “a” in Tdap stands for acellular, meaning it uses parts of the pertussis bacterium.

Table 8.2 High-risk Group in Malaysia

table 8-2

Implication for Healthcare Workers (HCWs)

  • Primary Recommendation
    • All healthcare workers should receive a dose of Tdap as soon as feasible if they have not previously been vaccinated, in line with recommendations for the general adult population.
  • Revaccination Considerations
    • Revaccination with Tdap may be considered in situations where there is documented or suspected healthcare-associated pertussis transmission.

Evidence of Safety and Effectiveness

A review of 17 clinical trials reported a vaccine protective rate of 88.89% for pertussis. A booster dose of Tdap, the adult formulation, can induce a strong anamnestic response. A randomised trial demonstrated 92% efficacy against confirmed pertussis within 2.5 years of vaccination with a 3-component monovalent pertussis vaccine. 

References

  1. Centers for Disease Control and Prevention. (October 2024). Pertussis vaccination recommendations for healthcare providers. Retrieved August 1, 2025, from https://www.cdc.gov/pertussis/hcp/vaccine-recommendations/index.html
  2. Havers, F. P., Moro, P. L., Hunter, P., Hariri, S., & Bernstein, H. (2020, January 24). Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: Updated recommendations of the Advisory Committee on Immunization Practices — United States, 2019. Morbidity and Mortality Weekly Report, 69(3), 77–83. https://doi.org/10.15585/mmwr.mm6903a5
  3. National Pharmaceutical Regulatory Agency (NPRA) Sistem Pendaftaran Produk & Perlesenan.https://quest3plus.bpfk.gov.my/pmo2/index.php
  4. Ward, J. I., Cherry, J. D., Chang, S. J., Partridge, S., Lee, H., Treanor, J., & Edwards, K. (2005). Efficacy of an acellular pertussis vaccine among adolescents and adults. New England Journal of Medicine,353(15), 1555-1563. https://doi.org/10.1056/NEJMoa050824
  5. World Health Organization. (2024). Pertussis reported cases and incidence: Malaysia [Data from WHO/UNICEF Joint Reporting Form]. WHO Immunization Data portal. Retrieved August 1, 2025, from https://immunizationdata.who.int/global/wiise-detail-page/pertussis-reported-cases-and-incidence?CODE=MYS
  6. Xu, J., Liu, S., Liu, Q., Rong, R., Tang, W., Wang, Q., & Zhou, C. (2019). The effectiveness and safety of pertussis booster vaccination for adolescents and adults: A systematic review and meta-analysis. Medicine,98(16), e15281. https://doi.org/10.1097/MD.0000000000015281