Rationale: Why Vaccinate Pregnant Women?

Pertussis is on the rise and outbreaks are occurring across the United States. Unfortunately, today’s pertussis vaccines are not long lasting. For this reason, public health efforts are focused on protecting those that are most at risk of contracting pertussis and having severe, potentially life-threatening complications from the infection— infants.

Pertussis Trends

The United States is experiencing a resurgence of pertussis. Since 2010, CDC sees between 10,000 and 50,000 cases of pertussis each year and every state reports cases. In 2012, CDC saw the most cases seen in 60 years. There were 48,277 reported cases of pertussis; 2,269 of those cases were in infants younger than 3 months of age — 15 of those infants died.

Seriousness of Pertussis for Mother and Infant

Pertussis can cause serious and sometimes life-threatening complications in infants, especially within the first 6 months of life. In infants younger than 1 year of age who get pertussis, about half need treatment in the hospital. The younger the infant, the more likely they will need treatment in the hospital. Of those infants who are hospitalized with pertussis, about 61% will experience apnea, 23% will develop pneumonia, and 1% will die. In recent years, up to 20 infants have died each year in the United States. Most pertussis deaths are infants who are too young to be protected by the childhood pertussis vaccine (DTaP).

Adolescents and adults, including pregnant women, can also experience complications from pertussis. Complications are usually less serious in this age group, especially in those who have gotten the vaccine. The cough itself often causes common complications in adolescents and adults, including urinary incontinence (28%), syncope (6%), and rib fractures (4%).

No Pertussis Vaccine Available for Infants at Birth

There are no pertussis vaccines licensed or recommended for newborns at birth. The best way to prevent pertussis in a young infant is

• By vaccinating the mother with Tdap during pregnancy
• Encouraging people around the infant to be up to date with their pertussis vaccines
• Administering the childhood DTaP series on schedule

Maternal Vaccination during Pregnancy Confers Protection to Infant

Transplacental transfer of maternal pertussis antibodies from mother to infant provides some protection against pertussis in early life, before infants are able to receive the primary DTaP series beginning at 2 months of age.

Childhood DTaP Series Starts at 2 Months

It is very important for infants to get their pertussis vaccine (DTaP) according to the childhood immunization schedule so they can start building their own protection against the disease. Clinicians should administer the primary series at 2, 4, and 6 months to build up high levels of protection. They should administer booster shots at 15 through 18 months and at 4 through 6 years to maintain that protection throughout childhood.

Adolescents also need a booster dose of Tdap at 11 or 12 years of age.