Tdap for Pregnant Women: Information for  For Health Care Professionals

http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

*On This Page:*

  * Pertussis Epidemiology 
  * Seriousness of Pertussis for Mother and Infant 
  * Tdap Vaccine Safety for Mother and Infant 
  * Breastfeeding Safety after Tdap Vaccination 
  * Transfer of Pertussis Antibodies to Infant through Maternal Tdap Vaccination 

  * Pertussis Vaccine for Infant at Birth 
  * DTaP Effectiveness for Infant if Mother Vaccinated with Tdap during Pregnancy 
  * Postpartum Tdap Vaccination as an Option <#postpartum>
  * Cocooning 
  * Patients with Unknown or Uncertain Tdap Vaccination Status

In June 2011, the Advisory Committee on Immunization Practices (ACIP) voted to recommend that women's health care providers should implement a maternal Tdap vaccination program for women who have not previously received the vaccine. Health care providers should administer Tdap preferably during the third or late second trimester of pregnancy (after 20 weeks gestation).


Pertussis Epidemiology

In 2010, 27,550 cases of pertussis were reported in the United States;
3,350 of those cases were in infants younger than 6 months of age ? 25
of those infants died. Studies have shown that when the source of
pertussis was identified, mothers were responsible for 30?40% of infant
infections.


Seriousness of Pertussis for Mother and Infant

It's expected that vaccinating your patients with Tdap during pregnancy
will prevent more infant hospitalizations and deaths from pertussis than
cocooning alone.

Pertussis can cause serious and sometimes life-threatening complications
in infants, especially within the first 6 months of life. In infants
younger than 1 year of age who get pertussis, more than half must be
hospitalized. The younger the infant, the more likely treatment in the
hospital will be needed. Of those infants who are hospitalized with
pertussis about 1 in 5 will get pneumonia and 1 in 100 will die.

Adolescents and adults can also experience complications from pertussis.
They are usually less serious in this age group, especially in those who
have been vaccinated. Common complications in adolescents and adults are
often caused by the cough itself, including urinary incontinence (28%),
syncope (6%) and rib fractures (4%).

Tdap Vaccine Safety for Mother and Infant

In addition to vaccinating your patients with Tdap, you should educate
them about encouraging others ? including dads, grandparents and other
caregivers ? to get vaccinated with Tdap at least two weeks before
coming into contact with their infants.

ACIP concluded that there is no elevated frequency or an unusual
occurrence of adverse events among pregnant women who have received Tdap
vaccine, or in their newborns. Tdap vaccine is recommended after 20
weeks gestation because that optimizes antibody transfer and protection
at birth. *The immune response to the vaccine peaks two weeks after
administration.*

Both tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT)
vaccines have been used extensively in pregnant women worldwide since
the 1960s to prevent neonatal tetanus. Td and TT vaccines administered
during pregnancy have not been shown to harm either the mother or
baby/fetus.


Breastfeeding Safety after Tdap Vaccination

Breastfeeding is not a contraindication for receiving Tdap vaccine. Tdap
vaccine can and should be given to women who plan to breastfeed.
Breastfeeding is fully compatible with Tdap vaccination, and preventing
pertussis in mothers can reduce the chance that the infant will get
pertussis. Also, by breastfeeding, mothers can pass antibodies they?ve
made in response to the Tdap shot on to their infants, which may reduce
an infant?s chances of getting sick with pertussis. This is especially
important for infants younger than 6 months of age, who have no other
way of receiving enough pertussis antibodies, since they are not fully
protected until their third dose of DTaP vaccine at 6 months of age.

Transfer of Pertussis Antibodies to Infant through Maternal Tdap Vaccination

Transplacental transfer of maternal pertussis antibodies from mother to
infant may provide protection against pertussis in early life, before
beginning the primary DTaP series. There is evidence of efficient
transplacental transfer of pertussis antibodies to infants. The
effectiveness of maternal antibodies in preventing infant pertussis is
not yet known, but pertussis antibodies can protect against some disease
and the severe outcomes that come along with it. *And, a woman
vaccinated with Tdap vaccine during pregnancy will also herself be
protected at time of delivery and will be less likely to transmit
pertussis to her newborn infant.*


Pertussis Vaccine for Infant at Birth

There are currently no pertussis vaccines licensed or recommended for
newborns at birth. The best way to prevent pertussis in a young infant
is by vaccinating the mother during pregnancy.

DTaP Effectiveness for Infant if Mother Vaccinated with Tdap during Pregnancy

By vaccinating a woman with Tdap during pregnancy her infant will gain
pertussis antibodies during the most vulnerable time ? before three
months of age. However, providing this early immunity may also interfere
with the infant?s immune response to DTaP vaccine. The infant?s immune
response to DTaP may not be as strong, but the clinical implications may
not be significant. The benefits of vaccinating during pregnancy and
protecting a newborn outweigh the potential risk of blunting the
infant?s response to DTaP vaccine. Since infants are at greatest risk of
severe disease and death from pertussis before 3 months of age ? when
their immune systems are least developed ? any protection that can be
provided is critical. Infants should receive their DTaP vaccines on
schedule </vaccines/schedules/hcp/index.html>, starting at 2 months of age.


Postpartum Tdap Vaccination as an Option

Not all hospitals routinely vaccinate with Tdap postpartum, so you can
make sure your patients and their infants are protected.

Vaccination with Tdap during pregnancy is ideal. However, if a woman
does not get vaccinated during pregnancy, administer the vaccine
immediately postpartum, before she leaves the hospital or birthing
center. Also advise your patient that other adults who will be around
her newborn, such as husbands grandparents, older siblings, and
babysitters, should also be vaccinated.

Cocooning

The strategy of protecting infants from pertussis by vaccinating those
in close contact with them is known as "cocooning." ACIP has recommended
cocooning with Tdap vaccine since 2005 and continues to recommend this
strategy for all those with expected close contact with newborns.
Cocooning enhances maternal vaccination to provide maximum protection to
the infant. In addition to vaccinating your patients, you should educate
them about encouraging others ? including dads, grandparents and other
caregivers - to get vaccinated with Tdap at least two weeks before
coming into contact with their infants.

Full implementation of cocooning has proven to be a challenge;
vaccinating during pregnancy provides the best opportunity to protect
infants from pertussis.


Patients with Unknown or Uncertain Tdap Vaccination Status

ACIP recommends that if Tdap vaccination status cannot be confirmed with
written, dated records, the patient is considered unvaccinated and is
therefore eligible to be vaccinated with Tdap. Tdap should be
administered regardless of when Td was last received.


References

 1. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who
    was the source?
    <http://www.ncbi.nlm.nih.gov/pubmed/15545851>External Web Site
    Policy /Pediatr Infect Dis J./ 2004;23:985-89.
 2. CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced
    Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine in Pregnant
    Women and Persons Who Have or Anticipate Having Close Contact with
    an Infant Aged Less than 12 Months ? Advisory Committee on
    Immunization Practices (ACIP), 2011
    <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm?s_cid=mm6041a4_e%0d%0a>.
    /MMWR/. 2011;60(41):1424-6.
 3. Cortese MM, Bisgard KM. Pertussis. In: Wallace RB, Kohatsu N, Kast
    JM, ed. Maxcy-Rosenau-Last Public Health & Preventive Medicine,
    Fifteenth Edition. /The McGraw-Hill Companies, Inc./; 2008:111-14.
 4. Tanaka M, Vitek CR, Pascual FB, et al. Trends in pertussis among
    infants in the United States, 1980-1999
    <http://jama.jamanetwork.com/article.aspx?volume=290&issue=22&page=2968>External
    Web Site Policy. /JAMA/. 2003;290:2968-75.
 5. Wendelboe AM, Njamkepo E, Bourillon A, et al. Transmission of
    /Bordetella pertussis/ to young infants
    <http://www.ncbi.nlm.nih.gov/pubmed/17414390>External Web Site
    Policy. /Pediatr Infect Dis J/. 2007;26:293-99.

 

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