title: Enhanced surveillance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines in pregnancy in the Vaccine Adverse Event Reporting System (VAERS), 2011-2015.
abstract: BACKGROUND
  In October 2011, the Advisory Committee on Immunization Practices (ACIP) issued updated recommendations that all pregnant women routinely receive a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine.
  
  
  OBJECTIVE
  We characterized reports to the Vaccine Adverse Event Reporting System (VAERS) in pregnant women who received Tdap after this updated recommendation (2011-2015) and compared the pattern of adverse events (AEs) with the period before the updated recommendation (2005-2010).
  
  
  METHODS
  We searched the VAERS database for reports of AEs in pregnant women who received Tdap vaccine after the routine recommendation (11/01/2011-6/30/2015) and compared it to published data before the routine Tdap recommendation (01/01/2005-06/30/2010). We conducted clinical review of reports and available medical records. The clinical pattern of reports in the post-recommendation period was compared with the pattern before the routine Tdap recommendation.
  
  
  RESULTS
  We found 392 reports of Tdap vaccination after the routine recommendation. One neonatal death but no maternal deaths were reported. No maternal or neonatal deaths were reported before the recommendation. We observed an increase in proportion of reports for stillbirths (1.5-2.8%) and injection site reactions/arm pain (4.5-11.9%) after the recommendation compared to the period before the routine recommendation for Tdap during pregnancy. We noted a decrease in reports of spontaneous abortion (16.7-1%). After the 2011 Tdap recommendation, in most reports, vaccination (79%) occurred during the third trimester compared to 4% before the 2011 Tdap recommendation. Twenty-six reports of repeat Tdap were received in VAERS; 13 did not report an AE. One medical facility accounted for 27% of all submitted reports.
  
  
  CONCLUSIONS
  No new or unexpected vaccine AEs were noted among pregnant women who received Tdap after routine recommendations for maternal Tdap vaccination. Changes in reporting patterns would be expected, given the broader use of Tdap in pregnant women in the third trimester.
authors.affiliation: Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), <add>1600 Clifton Road, MS D26</add>, Atlanta, GA 30333, USA. Electronic address: pmoro@cdc.gov.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Moro
authors.affiliation: Birth Defects Branch, Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities (NCBDDD), CDC, Atlanta, GA 30333, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Cragan
authors.affiliation: Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), CDC, Atlanta, GA 30333, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Tepper
authors.affiliation: Community Interventions for Infection Control Unit, Division of Global Migration and Quarantine, CDC, Atlanta, GA 30333, USA.
authors.forename: Yenlik
authors.initials: Y
authors.lastname: Zheteyeva
authors.affiliation: Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), <add>1600 Clifton Road, MS D26</add>, Atlanta, GA 30333, USA.
authors.forename: Oidda
authors.initials: O
authors.lastname: Museru
authors.affiliation: Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), <add>1600 Clifton Road, MS D26</add>, Atlanta, GA 30333, USA.
authors.forename: Paige
authors.initials: P
authors.lastname: Lewis
authors.affiliation: Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), <add>1600 Clifton Road, MS D26</add>, Atlanta, GA 30333, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Broder
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D026683:Advisory Committees; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011247:Pregnancy; D014481:United States; D055815:Young Adult
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: Adverse events; Epidemiology; Pregnancy; Surveillance; Tdap; Vaccine safety