Tdap (Pertussis) Vaccine and Pregnancy

Pertussis is on the rise and outbreaks are happening across the United States. On average, about 1,000 infants are hospitalized and typically between five and 15 infants die each year in the United States due to pertussis. Most of these deaths are among infants who are too young to be protected by the childhood pertussis vaccine series that starts when infants are 2 months old.

These first few months of life are when infants are at the greatest risk of contracting pertussis and having severe, potentially life-threatening complications from the infection. To help protect babies during this time when they are most vulnerable, women should get the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during each pregnancy. A strong recommendation from you may be what most influences whether or not your patient’s newborn is protected against pertussis.

5 Facts about Tdap and Pregnancy

1. Tdap during pregnancy provides the best protection for mother and infant.
   • Recommend and administer or refer your patients to receive Tdap during every pregnancy.
   • Optimal timing is between 27 and 36 weeks gestation (preferably during the earlier part of this period) to maximize the maternal antibody response and passive antibody transfer to the infant.
   • Fewer babies will be hospitalized for and die from pertussis when Tdap is given during pregnancy rather than during the postpartum period.

2. Postpartum Tdap administration is NOT optimal.
   • Postpartum Tdap administration does not provide immunity to the infant, who is most vulnerable to the disease’s serious complications.
   • 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, which means the mother is still at risk for catching and spreading the disease to her newborn baby during this time.

3. Cocooning alone may not be effective and is hard 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 is around an infant is vaccinated.

4. Tdap should NOT be offered as part of routine preconception care.
   • Protection from pertussis vaccines does not last as long as vaccine experts would like, so Tdap is recommended during pregnancy in order to provide optimal protection to the infant.
   • If Tdap is administered at a preconception visit, it should be administered again during pregnancy between 27 and 36 weeks gestation.

5. Tdap can be safely administered earlier in pregnancy if needed.
   • Pregnant women should receive Tdap anytime during pregnancy if it is indicated for wound care or during a community pertussis outbreak.
   • If Tdap is administered earlier in pregnancy, it should not be repeated between 27 and 36 weeks gestation; only one dose is recommended during each pregnancy.