TDaP Vaccine During Pregnancy

According to the latest CDC information, the TDaP vaccine is now recommended
for ALL pregnant women even those who have had it before

The age group hit the hardest by pertussis (whooping cough) is children under 6 months of age, because they have not completed their infant series of vaccine shots and so they are more susceptible. This is why experts advise pregnant women, their spouses and other caretakers in the home to have a pertussis booster vaccine (called TDaP), to prevent exposure to the pertussis bacterium from the infant’s close contacts.

In the 1940’s, prior to the introduction of the vaccine, there were 250,000 cases per year of Pertussis in the U.S., and a significant number of infant deaths. In 1976, there were only 1,000 cases reported.

However, the United States has experienced substantial increases in reported pertussis cases over the past several years. Provisional case counts for 2012 have surpassed the last peak year, 2010, with 41,880 pertussis cases and 14 deaths in infants aged <12 months (CDC, unpublished data, 2012). To reduce this burden, optimizing the current vaccination program and protecting infants who are at highest risk for death are immediate priorities.

Guidelines from the ACIP (Advisory Committee on Immunization Practices)

Since the 2011 ACIP vaccination recommendation, uptake of TDaP among pregnant women has been low; one survey of 1,231 women (August 2011 to April 2012) estimated that only 2.6% of women received Tdap during their recent pregnancy. New data indicate that maternal anti-pertussis antibodies are short-lived; therefore, Tdap vaccination in one pregnancy will not provide high levels of antibodies to protect newborns during subsequent pregnancies. (1)

On October 24, 2012, ACIP voted to recommend use of TDaP during every pregnancy. These updated recommendations on use of TdaP in pregnant women aim to optimize strategies for preventing pertussis morbidity and mortality in infants. (1)

The TdaP vaccine is now recommended for all women in the third trimester (ideally 27th through 36th week of their pregnancy), even if they have previously received TdaP vaccine. TdaP is especially important for anyone in close contact with infants younger than 12 months old – for example, parents, guardians, grandparents, babysitters, nannies, teachers, and those who have not previously received the TdaP vaccine. (2)

Other adults who are not close contacts of children younger than 12 months old, should receive a one-time dose of the TdaP vaccine. After your initial dose of TdaP, you'll need the Td (tetanus and diphtheria) booster every 10 years. You don't need to wait to get the TdaP vaccine if you have recently received the Td booster vaccine. (2)

The "Cocooning" Effect

ACIP recommends that adolescents and adults (e.g., parents, siblings, grandparents, child-care providers, and health-care personnel) who have or anticipate having close contact with an infant aged <12 months should receive a single dose of TdaP to protect against pertussis if they have not received Tdap previously. Guidance will be forthcoming on re-vaccination of persons who anticipate close contact with an infant, including postpartum women who previously have received TdaP. (1)

References

1) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm

2) http://www.cdc.gov/features/adultvaccines/