Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant, Postpartum Women, and Infants

Gynecology & Women's Health, University of Louisville, Louisville, Kentucky 40202, USA.
Clinical obstetrics and gynecology (Impact Factor: 1.77). 06/2012; 55(2):498-509. DOI: 10.1097/GRF.0b013e31824f3b38
Source: PubMed


Pertussis disease in the United States has been increasing since 1976 and many states are reporting epidemics. Pertussis is more severe in infants less than 3 months of age and is characterized by high hospital admission rates, apnea of the infant. The CDC recommends that Tdap be administered to all pregnant women after the 20th week of gestation to provide pertussis antibodies to the fetus which will offer protection against pertussis disease. Tdap is highly immunogenetic in the pregnant women and has an excellent safety profile. Tdap given to the postpartum patient and her cocoon family is an alternative strategy.

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    ABSTRACT: To determine whether it is safe to vaccinate pregnant or postpartum mares with a commercial modified-live virus vaccine against equine viral arteritis (EVA). Design-Randomized controlled study. Animals-73 mares and their foals. Mares were vaccinated during mid gestation, during late gestation, or 2 or 3 days after parturition with a commercial modified-live virus vaccine or were not vaccinated. Foaling outcomes were recorded, and serum, blood, milk, and nasopharyngeal samples were obtained. All mares vaccinated during mid gestation foaled without any problems; 21 of 22 mares in this group had antibody titers against EAV at the time of foaling. Of the 19 mares vaccinated during late gestation, 3 aborted; antibody titers against EAV were detected in 13 of 15 mares from which serum was obtained at the time of foaling. All postparturient vaccinates were seronegative at foaling; all of them seroconverted after vaccination. No adverse effects were detected in any of their foals. When faced with a substantial risk of natural exposure to EAV, it would appear to be safe to vaccinate healthy pregnant mares up to 3 months before foaling and during the immediate postpartum period. Vaccinating mares during the last 2 months of gestation was associated with a risk of abortion; this risk must be weighed against the much greater risk of widespread abortions in unprotected populations of pregnant mares naturally infected with EAV.
    Journal of the American Veterinary Medical Association 03/2011; 238(6):741-50. DOI:10.2460/javma.238.6.741 · 1.56 Impact Factor
  • Article: Pertussis

    Nursing for Women s Health 08/2011; 15(4):325 - 329. DOI:10.1111/j.1751-486X.2011.01653.x
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    ABSTRACT: Background. Pertussis booster vaccine (Tdap) recommendations assume that pertussis-specific antibodies in women immunized preconception, during or after previous pregnancies, persist at sufficient levels to protect newborn infants.Methods. Pertussis-specific IgG was measured by IgG-specific enzyme-linked immunosorbant assay in maternal-umbilical cord serum pairs where mothers received Tdap during the prior 2 years. Geometric mean concentrations (GMCs) of pertussis antibodies and cord: maternal GMC ratios were calculated.Results. One hundred-five mothers (mean age 25.3 years [15.3-38.4]; mean gestation 39 weeks [37-43]) immunized with Tdap vaccine a mean of 13.7 months (2.3-23.9) previously were included; 72 (69%) had received Tdap postpartum, 31 at a routine healthcare visit and 2 as contacts of another newborn. There was no difference in GMCs for pertussis-specific IgG in maternal delivery or infant cord sera for women immunized before (86) or during early pregnancy (19). Placental transport of antibodies was 121% to 186% from mothers immunized before and during pregnancy, respectively. Estimated GMC of IgG to PT was < 5 EU/ml at infant age 2 months (start of infant immunization series). More infants of mothers immunized during pregnancy had PT levels estimated to be more than the lower limit of quantitation of the assay (4 EU/ml) through age 2 months (52% versus 38%; P = 0.34).Conclusions. Infants of mothers immunized preconception or in early pregnancy have insufficient pertussis-specific antibodies to protect against infection. Maternal immunization during the third trimester, immunization of other infant contacts, and reimmunization during subsequent pregnancies may be necessary.
    Clinical Infectious Diseases 10/2012; 56. DOI:10.1093/cid/cis923 · 8.89 Impact Factor
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