Effectiveness of Prenatal Versus Postpartum Tetanus, Diphtheria, and Acellular Pertussis Vaccination in Preventing Infant Pertussis.
BACKGROUND
Most severe and fatal cases of pertussis occur in infants <8 weeks of age, before initiation of the primary pertussis vaccine series. Women are recommended to receive tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at the start of the third trimester of each pregnancy to optimize transplacental transfer of antibodies to the fetus. This recommendation was made by the Advisory Committee for Immunization Practices based on immunogenicity data, and no studies in the United States have yet evaluated the effectiveness of this strategy in reducing pertussis incidence in infants.


METHODS
We evaluated a cohort of mothers with documented Tdap vaccination histories in the California Immunization Registry to determine whether infants whose mothers received Tdap vaccine at 27-36 weeks gestation had a lower risk of pertussis at <8 weeks of age than infants born to women who received Tdap vaccine within 14 days post partum.


RESULTS
Tdap vaccination received at 27-36 weeks gestation was found to be 85% (95% confidence interval, 33%-98%) more effective than postpartum Tdap vaccination at preventing pertussis in infants <8 weeks of age . Vaccination at 27-36 weeks gestation was more effective at preventing pertussis in infant than vaccination during the second trimester.


CONCLUSIONS
Tdap vaccination at 27-36 weeks gestation was 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age. Efforts should be made by prenatal care providers to provide Tdap vaccine to pregnant women during routine prenatal visits at the earliest opportunity between 27 and 36 weeks gestation.
California Department of Public Health, Immunization Branch, Richmond.|Department of Epidemiology, University of Kentucky, Lexington.
Kathleen
K
Winter
California Department of Public Health, Immunization Branch, Richmond.
Steve
S
Nickell
California Department of Public Health, Immunization Branch, Richmond.
Michael
M
Powell
California Department of Public Health, Immunization Branch, Richmond.
Kathleen
K
Harriman
D000328:Adult; D002140:California / Q000453:epidemiology; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage / Q000276:immunology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014611:Vaccination / Q000379:methods; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
Tdap; pertussis; prenatal vaccination; vaccine effectiveness