Key points
- Pertussis can cause serious illness in infants, especially during the first few months of life.
- A tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during pregnancy provides the best protection for mothers and newborns.
- Recommend Tdap to your patients during the third trimester of each pregnancy.
Why it's important
Pertussis can cause serious and sometimes life-threatening complications in infants, especially within the first 6 months of life.
Most infant pertussis deaths occur among those too young to have protection from the childhood pertussis vaccine series. Those vaccinations don’t start until infants are 2 months old. That leaves a gap in protection during the first few months of life. Those early months are when infants are at the greatest risk of contracting pertussis and having severe, potentially life-threatening complications.
Tdap during pregnancy provides the best protection
Help protect infants during the time when they’re most vulnerable by administering Tdap during each pregnancy. Optimal timing is between 27 and 36 weeks gestation, preferably during the earlier part of this period. Vaccination during each pregnancy is important for transferring the greatest number of protective antibodies to each infant.
Maternal Tdap vaccination
- Helps protect the mother from getting and passing pertussis on to her infant
- Provides passive immunity to the infant
- Prevents many infant hospitalizations and deaths from pertussis
A strong recommendation from a patient's healthcare provider may be what influences whether they get vaccinated.
Opportunity to increase vaccination coverage
Postpartum Tdap administration isn't optimal
Postpartum Tdap administration doesn't provide immunity to the infant, who's most vulnerable to serious complications from pertussis. These infants remain at risk of contracting pertussis from others, including siblings, grandparents, and other caregivers.
It takes about 2 weeks after Tdap receipt for the mother to have protection against pertussis. This means the mother is still at risk for getting sick and spreading pertussis to her newborn during this time.
Cocooning alone may not be effective and is difficult to implement
The term “cocooning” means vaccinating anyone who comes in close contact with an infant.
Cocooning is difficult and it can be costly to make sure that everyone who's around an infant is vaccinated. Even though cocooning alone may not be sufficient, CDC continues to recommend it for those with expected close contact with infants. People who aren't up to date with their pertussis vaccine should get vaccinated at least 2 weeks before meeting the infant.
Vaccine safety and effectiveness
The Food and Drug Administration (FDA) has approved both Tdap vaccines (Boostrix® and Adacel®) for use during pregnancy.
Both CDC and FDA monitor vaccine safety through the Vaccine Adverse Event Reporting System (VAERS). To date, VAERS has not found any safety signals among pregnant people or their babies after Tdap vaccination.
Tdap can be safely administered earlier in pregnancy
Tdap can be safely administered at any point during pregnancy but CDC recommends early in the third trimester for optimal protection. A patient should receive Tdap anytime during pregnancy if it's indicated for wound care or during a community pertussis outbreak. If Tdap is administered earlier in pregnancy, it shouldn't be repeated between 27 and 36 weeks gestation. CDC recommends only one dose during each pregnancy.
Vaccine effectiveness
Evidence shows that infants are less likely to develop pertussis early in life if their mother got Tdap during pregnancy.
A CDC evaluation found Tdap vaccination during the third trimester of pregnancy prevents 78% of pertussis cases in infants younger than 2 months of age. The same evaluation also found that this vaccination strategy is 91% effective against hospitalized cases.
Another CDC study shows that newborn rates of pertussis significantly decreased since Tdap was first recommended during pregnancy.
Side effects
Most side effects from Tdap vaccination, including vaccination during pregnancy, are mild or moderate, and self-resolving. Severe side effects are extremely rare, especially in adults.
Resources
For patients:
- ACOG resources
- Communication and print resources for whooping cough
- Tdap Vaccination for Pregnant People
For healthcare providers: