Pertussis Vaccine: Receiving Tdap During Pregnancy

The Risks and Dangers of Pertussis

Pertussis is on the rise, and outbreaks are occurring across the United States. Infants are most at risk of contracting pertussis and having severe, potentially life-threatening complications from the infection. In fact, the incidence rate of pertussis among infants is higher than the rate in any other age group, and the majority of pertussis-related deaths occur in infants younger than 3 months of age.

Pertussis by the Numbers

• 28,660 Pertussis cases in the United States (18% increase from 2013)
  
• 6,951 Pertussis cases in California (other states reporting more than 1,000 pertussis cases were Colorado, Michigan, Ohio, Texas, and Wisconsin)
• 2,974 Pertussis cases in infants younger than 6 months of age (10.4% of all reported cases)

Tdap Vaccine Recommendation

Public health efforts are focused on protecting infants until they are old enough to receive their own vaccines to build immunity against pertussis.

For this reason, pregnant women should receive a dose of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy, ideally between 27 and 36 weeks of gestation. By getting the Tdap vaccine during pregnancy, a mother builds antibodies that are transferred to her baby to provide protection against pertussis until the infant can start getting the diphtheria, tetanus, and pertussis (DTaP) vaccine at 2 months of age.

Tdap Vaccine Safety

The Tdap vaccine is safe for both mother and baby at any time during pregnancy, but vaccination is recommended between 27 and 36 weeks of gestation because the maternal immune response to the vaccine peaks approximately two weeks after administration. This recommended timing optimizes passive antibody transfer to the baby and provides the best protection at birth.

Tdap Vaccine Effectiveness

Early evidence shows that infants whose mothers are vaccinated with Tdap during pregnancy are less likely to develop pertussis during the critical first few months of life. One study from the United Kingdom suggests that up to 90% of infants are protected against pertussis when the mother is vaccinated during pregnancy.

Studies suggest that postpartum Tdap vaccination in women is not effective in reducing pertussis in infants 6 months of age or younger.

Talk to Your Pregnant Patients about Tdap Vaccine

Your pregnant patients turn to you as a trusted prenatal care provider. A strong recommendation from you is the best predictor of vaccination that ensures children are born with protection against pertussis.

If a pregnant patient is unsure about getting the Tdap vaccine, consider using the SHARE mnemonic from the Centers for Disease Control and Prevention (CDC):

• Share specific reasons why the Tdap vaccine is right for pregnant women during every pregnancy.
• Highlight positive experiences (personal or in your practice) that reinforce the benefits of the Tdap vaccine.
• Address your patient’s questions and concerns about the vaccine in plain, understandable language.
• Remind your patient that vaccines protect her and her family from many other serious diseases.
• Explain the potential costs of getting pertussis, especially for infants.