COMMENTARY

Best Prenatal Care to Prevent Pertussis

Elizabeth Briere, MD, MPH

Disclosures

March 02, 2015

Editorial Collaboration

Medscape &

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Hi. I'm Dr Elizabeth Briere, a medical officer with the Centers for Disease Control and Prevention (CDC). Thanks for tuning in to this CDC Expert Video Commentary on Medscape.

Today, I would like to talk about providing the best prenatal care by recommending women get the tetanus, diptheria, and and pertussis (Tdap) vaccine during every pregnancy. I will share tips on how you can help prevent pertussis by ensuring that pregnant women receive the Tdap vaccine.

The United States has seen a dramatic increase in the number of reported pertussis cases since the 1980s. In fact, we recently saw the most cases we have seen in 60 years. Generally, in recent years, we have seen between 10,000 and 50,000 cases each year.

Although pertussis can be serious for everyone, it is especially dangerous—even deadly—for infants. Most pertussis deaths each year are among infants who are too young to be protected by the childhood pertussis vaccine series that starts at 2 months old. To avoid this gap in protection, women should receive the Tdap vaccine during every pregnancy, preferably between 27 and 36 weeks' gestation, to maximize the transplacental transfer of pertussis antibodies.

Recent studies show that maternal pertussis vaccination is a safe and effective strategy to protect young infants when they are most vulnerable. In England and Wales, where pregnancy Tdap coverage exceeds 60%, researchers found that administering Tdap during pregnancy is more than 90% effective in preventing pertussis infection in infants under 8 weeks old.[1] Several studies have also shown that receipt of Tdap during pregnancy does not increase a woman's risk for preterm birth or negatively affect an infant's growth and development.[2,3]

Yet, too few women are receiving this vaccine, despite the fact that CDC research shows that, in general, pregnant women are quite receptive to this vaccine recommendation, especially if their prenatal care provider recommends the vaccine. The most recent data show that approximately 15% of pregnant women in the United States received the Tdap vaccine during their last pregnancy. Some health systems have had greater success, reaching vaccination rates greater than 50%.

CDC has partnered with several professional associations to work toward making the Tdap recommendation a standard of care in the United States. Here are five facts that we think all clinicians need to know and communicate to their patients who have questions about the vaccine:

Administering Tdap during pregnancy provides the best protection for mother and infant;

Postpartum Tdap administration is not optimal because it does not provide immunity to the infant;

Vaccinating everyone who comes into contact with an infant—known as "cocooning"—may not be effective on its own, is hard to implement, and can be costly;

Tdap should not be offered as part of routine preconception care; if it is, the vaccine should be administered again between 27 and 36 weeks' gestation; and

Tdap can be safely administered earlier in pregnancy if it is indicated—such as for wound care—but if it is, then it should not be repeated again in the third trimester.

Research shows that when patients receive a vaccine recommendation and are offered the vaccine at the same time, they are more likely to be vaccinated. However, we know that stocking the vaccine is not always feasible for all clinicians, often owing to reimbursement issues. For vaccines that you don't stock, it is still critical to make the recommendation and then refer to another immunization provider. Here are a few quick tips to help increase the likelihood that your pregnant patients will follow through on your vaccine referral:

Begin each referral with a vaccine recommendation that includes information on why the vaccine is beneficial and how it is safe for mother and infant;

Provide specific information on where patients can get the vaccines you recommend—examples may include a nearby pharmacy or your patient's general practitioner;

Always write a patient-specific prescription in case it is required;

Anticipate and be prepared to answer questions on why patients cannot be vaccinated in your office;

Emphasize the fact that just because you do not stock a specific vaccine in your office, it does not mean it is not important or that you have concerns about its safety; and

Lastly, have a plan in place to answer questions from other vaccine providers who are concerned about vaccinating your pregnant patients.

You can find tools with all of the tips I have provided and other information tailored for healthcare professionals on our website. That is also where you can stay up to date on the latest research and get materials to share with your pregnant patients, including question-and-answer fact sheets and posters in English and Spanish.

Thanks for tuning in to this CDC expert video commentary on Medscape.

Web Resources

Pregnancy and Whooping Cough

Clinical Information About Pertussis

CDC Expert Commentaries:

Considerations for Antimicrobial Prophylaxis After Exposure to Pertussis

Protect Patients From Deadly Pertussis: Updated Vaccine Guidelines

Pertussis: Recognition and Treatment

Pertussis Diagnosis: Avoid the Pitfalls of PCR

Pertussis Testing Video: Collecting a Nasopharyngeal Swab Clinical Specimen

Pertussis Testing Video: Collecting a Nasopharyngeal Aspirate Clinical Specimen

Elizabeth Briere, MD, MPH, is an epidemiologist with the Meningitis and Vaccine Preventable Diseases Branch within the National Center for Immunization and Respiratory Diseases, where she works on pertussis and other vaccine-preventable diseases. She received her MD from the Medical College of Georgia–Georgia Regents University and completed a residency in pediatrics at the University of Arizona. She received her master's degree in international public health from Tulane University School of Public Health and Tropical Medicine.

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