New Tetanus-Dipththeria-Pertussis (TDap) Recommendations in Pregnancy

04.22.2013

 

There are two forms of the tetanus-diphtheria-pertussis vaccines.  The DTap vaccine is administered to infants and children 6 years and younger.  The TDap vaccine is administered to children 6 years and older, adolescents and adults.

 

In 2012, the American College of Obstetricians and Gynecologists (ACOG) updated its recommendation on the use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (TDap) for pregnant women. The recommendation stated that women who have not received TDap should receive the vaccine after the twentieth week of pregnancy, or if not administered during pregnancy, the vaccine should be administered immediately postpartum to reduce the risk of pertussis transmission in infants too young to receive their own vaccine. This recommendation was updated in response to the 2011 outbreak of pertussis.[1] Since this recommendation was issued, the Washington State Secretary of Health, in April 2012, declared a pertussis epidemic.[2] In response to this more recent pertussis outbreak, the Centers for Disease Control and the Advisory Committee on Immunization Practices (ACIP) have recommended that pregnant women receive the Tdap vaccine with each pregnancy due to the waning of protection of the vaccine after the first year.[1]

 

In a study by the Center for Vaccine Awareness and Research, it was found that if TDap was given pre-pregnancy or in early pregnancy, there were insufficient maternal circulating anti-pertussis antibodies to protect young infants against infection.[3] Mothers who are immunized during the third trimester should develop antibodies that transfer to the fetus, and therefore, provide protection for her infant at a time of high vulnerability to pertussis. Also, immunization during the third trimester would protect the mother herself from pertussis infection; therefore, reducing the risk of pertussis infection for her newborn infant.[4] Another avenue of protection for young infants is called cocoon care. Immunizing family members and other relatives or friends who would be in close contact with the infant would also decrease the risk of transmission of pertussis to the newborn.[5]

 

According to the Centers for Disease Control and Prevention (CDC), there is a theoretical risk of a decreased immune response to the infant’s own DTap (diphtheria toxioid, tetanus toxoid, and acellular pertussis) vaccination if exposed to TDap prior to birth. Even if the infant’s immune response is blunted, the protection that would be provided by the mother’s vaccine would protect the infant during the most vulnerable period for pertussis infection, the first three months of life.[6] Data has shown that pertussis infection is more severe in infants who are younger than three months of age. These infants are more likely to be hospitalized and experience apnea in the course of the disease.[5] The CDC recommends for infants to start their own series of DTap vaccine at two months of age.[6]

 

 Some mothers may have concerns about the use of vaccines during pregnancy. Zheteyeva et al reviewed the safety of TDap vaccine during pregnancy using the Vaccine Adverse Event Reporting System (VAERS) managed by the CDC and FDA (Food and Drug Administration). The authors were unable to identify adverse outcomes when TDap was given during pregnancy in the mothers, fetuses and infants.[7]

Please view the following links for information about the TDap and DTap vaccines:

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-dtap.pdfand 

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-td-tdap.pdf

 

For further updates, please visit the following websites: www.cdc.gov/vaccinesand www.immunizationforwomen.org.

 

Cynthia Pride MSN, CPNP and Thomas W. Hale Ph.D.

 

References:

 

  1. Update on immunization and pregnancy, diphtheria, and pertussis vaccination. Committee Opinion No. 521. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012; 119, pp. 690-1.
  2. Centers for Disease Control and Prevention. (CDC). Pertussis Epidemic—Washington, 2012. MMWR Morb Mortal Wkly Rep. 2012, Jul 20; 61(28), pp.517-22.
  3. Center for Vaccine Awareness and Research. Texas Children’s Hospital, Houston Texas. chealy@bcm.edu.
  4. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced  Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women-Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep.  2013, Feb 22; 62, pp.131-5.
  5. Gall SA. Prevention of pertussis, tetanus, and diphtheria among pregnant, postpartum women, and infants. Clin Obstet Gynecol. 2012, Jun 55 (2): pp. 498-509.
  6. www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm. Accessed 4/2/2013.
  7. Zheteyeva YA, Moro PL, Tepper NK, Rasmussen SA Barash FE, Revzina NV, Kissin D, Lewis PW,Yue X, Haber P, Tokars JI, Vellozzi C, Broder KR. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant women. Am J Obstet Gynecol. 2012. Jul 207(1): pp. 59. E1-7.