New Pertussis Vaccine Recommendations in Pregnancy

NACI Released a New Pertussis Vaccine Statement

Yesterday, NACI released the above statement on the immunization with Tdap (tetanus, diphtheria and acellular pertussis) vaccine during pregnancy.

What is the Change?

Immunization with Tdap vaccine should ideally be provided in every pregnancy between 27 and 32 weeks of gestation. However, Tdap immunization may be provided from 13 weeks up to the time of delivery in view of programmatic and unique patient considerations.

Recommendation: NACI recommends that immunization with Tdap vaccine should be offered in every pregnancy, irrespective of previous Tdap immunization history (Strong NACI Recommendation). NACI concludes that there is good evidence to recommend immunization (Grade A Evidence)

Why the Change?

Due to high susceptibility to pertussis infection, infants who have not initiated vaccination or completed the primary series of pertussis immunization are at highest risk for pertussis complications, including hospitalization and death. Immunization in pregnancy is safe and provides protection to infants until they are able to receive the pertussis vaccine at two months of age.

Due to the varying cycle activity of pertussis in Canada, routine immunization with Tdap vaccine in pregnancy is preferred over its use as an outbreak control measure only. Use of Tdap vaccine during outbreak situations is considered to be logistically challenging and less effective for preventing pertussis in infants compared to routine maternal immunization in pregnancy.

Are There Any Safety Concerns?

  1. In four RCTs that reported on the safety of Tdap in pregnancy, no differences in reporting any injection site or systemic reactions were observed independent of the vaccine used in the control group (placebo or tetanus toxoid).
  2. In RCTs, no differences in the frequency of adverse outcomes in women who received Tdap in pregnancy and women who received placebo (0.9% saline or TT) were reported.
  3. In RCTs, no differences in the frequency of adverse neonatal outcomes including infants’ gestational age, birth weight, Apgar scores, neonatal examination or complications, as well as differences in the infants’ growth and development up to 13 months of age were found between women who received Tdap in pregnancy and women who received placebo (0.9% saline or TT).

What Does This Mean for HCP’s?

Clinicians should start discussing the importance of Tdap immunization during pregnancy.  This can help to reduce the risk of a serious and sometimes fatal infection in the newborn.   The immunogenicity and safety of the Tdap vaccine in pregnancy looks very good.

Clinicians should always revisit adult routine vaccines before pregnancy to ensure the patient’s immunizations are current.

For pregnant women, Tdap now has a strong recommendation with the influenza vaccine to reduce serious infections for the mother and child.

Where Can I Read More?

HCP’s wanting to read the statement can download it at the link below:

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