0000008036 00000 n
0000005954 00000 n The Tdap vaccines do not contain thimerosal. Pregnant women who live in geographic regions with new outbreaks or epidemics of pertussis should be immunized as soon as feasibly possible for their own protection in accordance with local recommendations for nonpregnant adults. Baxter R, Bartlett J, Fireman B, Lewis E, Klein NP. Centers for Disease Control and Prevention (CDC). xref She should be reassured that Tdap vaccination is safe to give at any point in pregnancy and that getting the vaccine now will directly protect her, indirectly protect her fetus, and also will offer some protection for her newborn from pertussis.
0000006617 00000 n h�b``g``����ƻ���x�b�,w���1�L*�L�G���j�z�H��� ��l� -��p>� _���8H�q X�$� �F7C�f���{���d�&��=�:�8��������@�r�`mdVo�a���t���Z�[L)b�\�����l�%�(������+���0�aC$��Kmf��;֯�v��q� ê�I Z+DC�:��Yӛ6���@gGR�l American College of Obstetricians and Gynecologists
Additional data available since 2013 increasingly demonstrate that administration of Tdap during the late second or early third trimester (with at least 2 weeks from the time of vaccination to delivery) is highly effective in protecting against neonatal pertussis 13 14 15 16. Pertussis antibody concentrations in infants born prematurely to mothers vaccinated in pregnancy. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Available at: U.S. Food and Drug Administration. 0000002409 00000 n Therefore, giving the Tdap vaccine as early as possible in the 27–36-weeks-of-gestation window appears to be the best strategy 18 19. The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. The optimal gestation for pertussis vaccination during pregnancy: a prospective cohort study. Additionally, efforts to stock the Tdap vaccine in the obstetrician–gynecologist’s or other health care provider’s office and administer it as early in the recommended window as possible offers the best chance of vaccine acceptance and neonatal protection.
Sources of infant pertussis infection in the United States.
Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. 0000009443 00000 n
See Evaluating Revaccination of Healthcare Personnelfor additional information. 0000131510 00000 n If a Td booster vaccination is indicated during pregnancy (ie, more than 10 years since the previous Td vaccination) then obstetrician–gynecologists and other health care providers should administer the Tdap vaccine during pregnancy within the 27–36-weeks-of-gestation window 7. It also will maximize antibody transfer to the newborn.
To ensure protection against maternal and neonatal tetanus, pregnant women who have never been vaccinated against tetanus should begin the three-vaccination series, containing tetanus and reduced diphtheria toxoids, during pregnancy. Partners, family members, and infant caregivers should be offered the Tdap vaccine if they have not previously been vaccinated.
In addition, even when maternal vaccination is not completely protective, infants with pertussis whose mothers received Tdap during pregnancy had significantly less morbidity, including risk of hospitalization and intensive care unit admission 13. If a Td booster vaccination is indicated in a pregnant woman for acute wound management, the obstetrician–gynecologist or other health care provider should administer the Tdap vaccine, irrespective of gestational age 7. Resources on maternal vaccines for pregnant women, friends, family, caregivers, ob-gyns, midwives, and other healthcare professionals. While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. Role of maternal pertussis antibodies in infants. 0000144777 00000 n
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0000048388 00000 n Emphasis on receiving the flu and whooping cough vaccines during pregnancy. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care.
The American College of Obstetricians and Gynecologists’ Immunization and Emerging Infections Expert Work Group and Committee on Obstetric Practice support these recommendations. A pregnant woman should not be revaccinated with Tdap in the same pregnancy if she received the vaccine in the first or second trimester. 718. 0000144323 00000 n Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination, General Considerations Surrounding Immunization During Pregnancy, Vaccination of Adolescents and Adults in Contact With Infants, https://www.cdc.gov/pertussis/outbreaks/trends.html, https://www.cdc.gov/vaccinesafety/concerns/thimerosal, http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM09622, Diphtheria-Tetanus-acellular Pertussis vaccines, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. 0000004652 00000 n The Advisory Committee on Immunization Practices and ACOG continue to recommend that adolescent and adult family members and caregivers who previously have not received the Tdap vaccine and who have or anticipate having close contact with an infant younger than 12 months should receive a single dose of Tdap to protect against pertussis 7. Vandelaer J, Birmingham M, Gasse F, Kurian M, Shaw C, Garnier S. Tetanus in developing countries: an update on the Maternal and Neonatal Tetanus Elimination Initiative. 0000328329 00000 n 0000070322 00000 n
0000001916 00000 n – If a pregnant woman has not previously been vaccinated, or if her immunization status is unknown, she should receive two doses of a tetanus toxoid-containing vaccine (TT-CV) one month apart with the second dose given at least two weeks before delivery. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. 0000330726 00000 n Getting the flu shot and the Tdap vaccine during pregnancy can protect you from infection and can also help protect your baby after birth before he or she can be vaccinated. In June 2011, ACIP recommended that pregnant women receive a dose of Tdap if they have not previously received it 7. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants: recommendations of the Advisory Committee on Immunization Practices (ACIP). Infants do not begin their own vaccine series against pertussis until approximately 2 months of age. 0000132195 00000 n Safety of tetanus, diphtheria, and pertussis vaccination during pregnancy: a systematic review. The American College of Obstetricians and Gynecologists has identified additional resources on topics related to this document that may be helpful for ob-gyns, other health care providers, and patients. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. However, the cocooning approach alone is no longer the recommended approach to preventing pertussis disease in newborns (and mothers) 8.
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Example case: An emergency department (ED) physician calls you about a patient, gravida 4, para 3, at 13 weeks of gestation who is being seen after accidentally stepping on a rusty nail. Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy.
The Advisory Committee on Immunization Practices continued to reconsider this topic in the face of persistent increases in pertussis disease, including infant deaths 9 in the United States. Effectiveness of maternal influenza immunization in mothers and infants [published erratum appears in N Engl J Med 2009;360:648]. 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. Issues that were considered included an imperative to minimize the significant burden of disease in vulnerable newborns, the reassuring safety data 10 11 on use of Tdap in adults, and the evolving immunogenicity data that demonstrate considerable waning of immunity after immunization 12. Pertussis outbreak trends. 30 81 Please try reloading page. All rights reserved. 0000333314 00000 n 0000005459 00000 n Given the rapid evolution of data surrounding this topic, immunization guidelines are likely to change over time, and ACOG will continue to issue updates accordingly. 0000137549 00000 n
^��6`�����2S�����n�V����o��n�Զ/�~����.�X~x+����©�Ѷ���F>/�ޱ�oW�#e�|�pΩ����������uo��*�����;]+���d$)�ִ�ϗ�_�IO\�V�'�e��� S)5�z���~��ӥl?è���Bђ���-q�}�Э��g�*��pKSi��T�XGN��U�\Ak3��a�s�C��^v�_��W�+����V(�^y1Z���l������ �� ��|@�$�ҼՒ� ��)�a�V�pj�Y���b���+(Td��S��o ��]&4�t���3Vns�kI^�`a�Яa�����}o����k� �Ջ�e��C�:\�qGii2�q $eA�W���&��JEm. Obstet Gynecol 2017;130:e153–7.This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary.
0000205915 00000 n To maximize the maternal antibody response and passive antibody transfer and levels in the newborn, vaccination as early as possible in the 27–36-weeks-of-gestation window is recommended. For women who are Rh negative, another strategy worth consideration is to administer Tdap vaccination during the same visit as Rho(D) immune globulin administration. Thimerosal in vaccines.
Obstetrician–gynecologists are encouraged to stock and administer the Tdap vaccine in their offices. There are certain circumstances in which it is appropriate to administer the Tdap vaccine outside of the 27–36-weeks-of-gestation window. Td-1 : early in pregnancy Td-2 : 4 weeks after Td-1 Td-B: if pregnancy occur within 3 years of last pregnancy and 2 Td doses were received Age Vaccination schedule after Td introduction At birth 6 weeks 10 weeks 14 weeks 9 months 5-6 years 10 & 16 years For pregnant woman 16-24 months Tetanus and Diphtheria disease burden 0000137878 00000 n Dabrera G, Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, et al. 0000002298 00000 n
As part of standard wound management care to prevent tetanus, a tetanus toxoid-containing vaccine is recommended in a pregnant woman if 5 years or more have elapsed since her previous tetanus and diphtheria (Td) vaccination. The patient cannot remember when she last received a tetanus booster and the ED physician is confused about when to administer the indicated tetanus booster because the Centers for Disease Control and Prevention guidelines recommend the administration of Tdap between 27 weeks and 36 weeks of gestation. Starting in 2006, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommended an approach to combat neonatal pertussis infection referred to as “cocooning” 6. Committee Opinion No.