CDC recommends pertussis vaccination before giving birth

An advisory panel to the Centers for Disease Control and Prevention (CDC) recommends that physicians administer the tetanus diphtheria acellular pertussis (Tdap) vaccine to pregnant women after 20 weeks' gestation. The new recommendation by the Advisory Committee on Immunization Practices (ACIP), posted online June 22 ( http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-jun11/05-6-pertuss-tdap-vac.pdf ) and reported online July 12 by American Medical News ( http://www.ama-assn.org/amednews/2011/07/11/hlsb0712.htm) represents a shift from previous guidance to administer the vaccine just after childbirth. This so-called cocoon strategy of immunizing individuals who have close contacts with infants has not been as effective as hoped, the CDC noted.

According to the ACIP, vaccination with Tdap during pregnancy results in passage of pertussis antibodies from the mother to her unborn child, helping to protect newborns against pertussis until they can receive the first dose of the DTaP vaccine at 2 months of age. The remaining 4 doses of DTaP are administered between 4 months and 6 years of age.

Pregnant women who never have been vaccinated against tetanus should receive 3 vaccinations containing tetanus and reduced diphtheria toxoids (Td) during pregnancy to protect against maternal and neonatal tetanus, the ACIP also said at a June 22 meeting in Atlanta. For these women, Tdap should replace 1 dose of Td, preferably during the third or late second trimester (ie, after 20 weeks' gestation) of pregnancy.

Sharon Phelan, MD, FACOG, comments: Whooping cough still kills despite vaccinations. The vaccination schedule in the past that gave adults boosters to only tetanus and diphtheria but not pertussis has allowed a larger number of adults to be susceptible to pertussis. The tragedy is that many people who die from pertussis now are neonates who are too young to be immunized. The concept of "cocooning" the caregivers of a newborn by immunizing the parents postpartum against pertussis is not as successful as had been hoped. The new recommendation from the CDC is to immunize pregnant women against pertussis during pregnancy. This will provide passive immunity to the newborn, a strategy that should be embraced by the obstetrical providers in much the same way that they have adopted the stronger message for flu shots during pregnancy.