Expanded Tdap Recommendations: Administer Tdap to Pregnant Women during Each Pregnancy

January 2013

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
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Expanded Tdap Recommendations: Administer Tdap to Pregnant Women during Each Pregnancy
Published January 2013
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.
At its October 2012 meeting, CDC’s Advisory Committee on Immunization Practices (ACIP) voted to expand its recommendation for the use of Tdap vaccine during pregnancy to provide further protection to pregnant women and infants from pertussis (whooping cough). The new recommendations call for administering Tdap to every pregnant woman during each pregnancy, regardless of previous Tdap vaccination history. Optimal timing for administering the dose is at 27 through 36 weeks’ gestation to maximize the maternal antibody response and the passive antibody transfer to the infant.
If Tdap is not administered during pregnancy and has not been administered at any time before the current pregnancy, Tdap should be given to the mother immediately postpartum, before leaving the hospital or birthing center.
Providers of prenatal care should implement a Tdap immunization program for all pregnant women to assure that all pregnant women and their babies are protected from pertussis.
Prior to this new guidance, the ACIP recommendation for the use of Tdap vaccine in pregnant women was to administer the vaccine during the latter half of pregnancy, beginning as early as the 20th week, to those pregnant women who were previously unvaccinated. Tdap was to be given as a one-time dose.
The recommendations voted on in October 2012 were published in December 2012 on the CDC website in a document titled Provisional Updated Recommendations on Use of Tetanus Toxoid, Reduced Diphtheria toxoid and Acellular Pertussis Vaccine (Tdap) for Pregnant Women*
More Information on the Importance of Administering Tdap in Pregnancy
Of the 27,550 cases of pertussis reported in 2010, 3,350 were in infants younger than 6 months of age, and 25 of those infants died. According to studies of pertussis cases in infants, the source of infection can be traced to the mother in 30 percent to 40 percent of cases.
Administering the Tdap dose likely provides protection against pertussis in early life, before and during the time the baby is receiving his or her first three doses of DTaP vaccine. Tdap will also protect the mother at the time of delivery, making her less likely to transmit pertussis to her infant.
Related Resources
CDC Media Advisory, October 24, 2012: ACIP Recommends Tdap Immunization for Pregnant Women
Provisional Updated Recommendations on Use of Tdap for Pregnant Women
Tdap for Pregnant Women: Information for Providers – CDC web page
*ACIP provisional recommendations become official CDC recommendations once they are accepted by the director of CDC and the Secretary of Health and Human Services and are published in MMWR. In the interim, ACIP provisional recommendations are made available by CDC so that providers have guidance to follow when implementing new recommendations.


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