Pertussis disease in new mothers: Effect on young infants and strategies for prevention

Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 03/2009; 113(2 Pt 1):399-401. DOI: 10.1097/AOG.0b013e31819388e9
Source: PubMed


Pertussis, or whooping cough, is a major public health problem in the United States, with the incidence of disease and its associated complications having significantly increased in the adolescent and adult populations. These populations serve as the major transmission source of the disease to young infants, a group that is at the highest risk of severe morbidity and mortality from the disease. Studies have shown that new parents, especially mothers, are the source of disease transmission in more than 50% of the cases. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis booster vaccines (Tdap) are licensed for use in adolescent and adult populations. The Centers for Disease Control and Prevention (CDC) recommends that the Tdap vaccine be given to postpartum women as soon as possible after delivery and before hospital discharge to protect them and their newborns against pertussis disease. The American College of Obstetricians and Gynecologists recommends that its membership follow the CDC recommendations. This article includes a further discussion of the rationale for this recommendation and provides possible strategies for vaccine implementation.

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    • "Household members (most frequently the mother) were responsible for 76–83% of transmission of B. pertussis to this high-risk group [40] [41] [42] [43] [44]. "
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    ABSTRACT: Pertussis is an acute infectious illness, caused by the bacteria Bordetella pertussis and commonly known as "whooping cough". Waning immunity after vaccination or after natural infection contributes significantly to the increasing incidence rates in adolescents and adults. Prevention of pertussis in industrialized countries is mainly based on immunization with acellular vaccines in combination with other antigens. A booster dose with an adult-formulation tetanus-diphtheria toxoid and acellular pertussis vaccine (Tdap) is now recommended for all adolescents by several countries, and replacement of the decennial Td dose with a single or more doses of Tdap is recommended for adults. Our review aims at describing the current knowledge on the impact of acellular pertussis vaccination in adolescents and adults, with particular focus on specific risk groups: adolescents, pregnant women and their newborns, and health care workers (HCWs), and secondly at suggesting possible immunization strategies. Data were retrieved by searches of Pubmed, references, from relevant articles and open-access websites. In countries where an adolescent booster dose was adopted, a certain decrease of incidence rates was observed. No serologic correlate of protection after immunization exists, but subjects with high antibody levels against pertussis antigens are less likely to develop the disease. Tdap vaccine was demonstrated to induce antibodies to pertussis antigens exceeding those associated with efficacy in infants, in both adolescents and adults. Tdap use in pregnant women seems to be safe and might represent a useful tool in order to prevent pertussis cases in the first months of life. Neonatal immunization with monovalent acellular pertussis vaccine can efficiently prime T and B cells and act as a basis for future immune responses. Cocooning strategies involving all those surrounding newborns have started to be implemented. Their impact on infant pertussis cases will be evaluated in the coming years. Coverage in HCWs should be increased, given their important role in pertussis transmission in health care settings. Despite the more recent position paper of WHO gives priority to infant and childhood vaccination against pertussis and leaves adolescent, adult and risk group immunization as an option for the future, data are quickly accumulating to support the need to consider pertussis vaccination as a crucial preventative intervention even in adolescents and special risk groups.
    Vaccine 06/2012; 30(35):5179-90. DOI:10.1016/j.vaccine.2012.06.005 · 3.62 Impact Factor
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    ABSTRACT: BACKGROUND: Despite the availability of pediatric vaccines against pertussis ("whooping cough"), the disease is poorly controlled. Adolescents and adults with waning immunity, especially immediate family members, are responsible for 76%-83% of pertussis transmission to infants. Adolescent/adult tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccines were licensed in the United States in 2005, but their use has been low and hospitals' implementation of immunization recommendations suboptimal. Efforts were implemented at two hospitals in Chicago to increase postpartum use of Tdap vaccine and to replace the tetanus and diphtheria toxoids (Td) booster with Tdap vaccine in emergency department (ED) settings. Postpartum Pertussis Vaccination Program at Prentice Women's Hospital: In the program's first 18 months (June 2008-November 2009) 9,540 doses of Tdap vaccine were administered to 78.87% of the postpartum patients. Children's Memorial Hospital: Tdap Use in Emergency Settings: In 2007, uptake of Tdap was slow. During 2008, of 43 ED patients receiving a tetanus toxoid-containing vaccine as part of wound management, 10 were given Tdap (20 had previously received a dose of Tdap vaccine). CONCLUSIONS: Hospital-based Tdap initiatives in postpartum and ED settings can be successfully implemented, provided that support is obtained not only from key decision makers at the hospital but also the health care providers who will be directly involved in implementing those initiatives. It is imperative that hospitals implement programs that increase the use of Tdap vaccine among postpartum women, in emergency settings, and among health care personnel.
    Joint Commission journal on quality and patient safety / Joint Commission Resources 04/2010; 36(4):173-8.
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    ABSTRACT: Despite official recommendations in 2004, antipertussis vaccine coverage in post-partum remains low. Measures used to date to improve the appliance of these recommendations were not implemented. The purpose of this study was to evaluate the effectiveness of a strategy of education and systematic prescription of antipertussis vaccine, on immunization coverage of mothers in the post-partum. This was an analytical, interventional, monocentric study conducted on delivered patients, hospitalized between July 10th and 31st, 2009 in our establishment. Oral (twice: midwife and doctor) and written information about pertussis and order of vaccine were delivered in post-partum. No patient had reliable information on her vaccination status during hospitalization. According to the patients, information by midwife was provided in 70% of cases. At 6 weeks, the immunization coverage was 16% (10/61 patients), including 8% related to the intervention (vaccinated during postpartum) and 11% for fathers (7/61 fathers) with 7% newly vaccinated. Lack of time, omission in proliferation of information context in puerperium and low socio-economic backgrounds may have influenced the non-vaccination. However medical information is so far still perfectible as evidenced by the rate of patients actually sensitized and postponement vaccination after breastfeeding despite official recommendations. Antipertussis vaccination care should also involve physicians before, during and after pregnancy, and pediatricians.
    Gynécologie Obstétrique & Fertilité 06/2010; 38(6):380-4. DOI:10.1016/j.gyobfe.2010.04.002 · 0.52 Impact Factor
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