Impact of Maternal Postpartum Tetanus and Diphtheria Toxoids and Acellular Pertussis Immunization on Infant Pertussis Infection

Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 11/2011; 54(1):78-84. DOI: 10.1093/cid/cir765
Source: PubMed


Mothers often are the source of pertussis illness in young infants. The Centers for Disease Control and Prevention recommend tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine for postpartum women before hospital discharge. In January 2008, this recommendation was implemented in a predominantly Hispanic, medically underserved population at Ben Taub General Hospital (BTGH) in Houston (hereafter the intervention population).
A cross-sectional study compared preintervention (July 2000 through December 2007) and postintervention (January 2008 through May 2009) periods. Pertussis diagnosis was determined using International Classification of Diseases, Ninth Revision (ICD-9) codes and microbiology reports from 4 major children's hospitals in Houston. Only those infants ≤6 months of age with laboratory-confirmed pertussis illness were included. The proportions of pertussis-infected infants born at BTGH in the pre- and postintervention periods were compared.
Of 514 infants with pertussis, 378 (73.5%) were identified during preintervention and 136 (26.5%) during postintervention years. These groups were similar in age (mean, 79.3 vs 72 days; P = .08), sex (males, 55% vs 52%; P = .48), length of hospitalization (mean, 9.7 vs 10.7 days; P = .62), mortality (2 deaths each; P = .29) and hospital of pertussis diagnosis. After adjustment for age, sex, and ethnicity, the proportions of pertussis-infected infants born at BTGH and potentially protected through maternal postpartum Tdap immunization were similar for the 2 periods (6.9% vs 8.8%; odds ratio, 1.06; 95% confidence interval, 0.5-2.2; P = .87).
Immunizing only postpartum mothers with Tdap vaccine did not reduce pertussis illness in infants ≤6 months of age. Efforts should be directed at immunizing all household and key contacts of newborns with Tdap, not just mothers.

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    • "studies have uncovered the pivotal role of household members in transmission to the infant. In fact, siblings most commonly introduce the infection in the household, while mothers most often are the infector of the infant (Mooi and de Greeff, 2007; de Greeff et al., 2010b; Castagnini et al., 2012). These findings have led to pleas to add maternal vaccination, i.e. vaccination of pregnant women, to current vaccination programs (Mooi and de Greeff, 2007; Leuridan et al., 2011). "
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    ABSTRACT: Increasing incidence has led to the re-appearance of pertussis as a public health problem in developed countries. Pertussis infection is usually mild in vaccinated children and adults, but it can be fatal in infants who are too young for effective vaccination (≤3 months). Tailoring of control strategies to prevent infection of the infant hinges on the availability of estimates of key epidemiological quantities. Here we estimate the serial interval of pertussis, i.e the time between symptoms onset in a case and its infector, using data from a household-based study carried out in the Netherlands in 2007-2009. We use statistical methodology to tie infected persons to probable infector persons, and obtain statistically supported stratifications of the data by person-type (infant, mother, father, sibling). The analyses show that the mean serial interval is 20 days (95%CI: 16-23 days) when the mother is the infector of the infant, and 28 days (95%CI: 23-33 days) when the infector is the father or a sibling. These time frames offer opportunities for early mitigation of the consequences of infection of an infant once a case has been detected in a household. If preventive measures such as social distancing or antimicrobial treatment are taken promptly they could decrease the probability of infection of the infant.
    Epidemics 06/2014; 7. DOI:10.1016/j.epidem.2014.02.001 · 1.87 Impact Factor
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    • "Pertussis vaccination is the most effective strategy to reduce morbidity and mortality due to pertussis [15]. Therefore, the cocooning strategy, which involves immunizing all household and key persons in close contact with the newborns, with the Tdap, is suggested [16]. Usually, mothers are the key persons in contact with newborns, and therefore, Tdap vaccination for all women of childbearing age is very important for reducing morbidity and mortality due to pertussis among infants aged < 3 months. "
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    ABSTRACT: The number of cases of pertussis reported has increased gradually in the last decade. Pertussis vaccination is the most effective strategy for the prevention of infection. Despite the fact that young infants are at the highest risk for pertussis, the rate of tetanus-diphtheria-acellular pertussis (Tdap) vaccination is presumed to be very low among women of childbearing age in Korea. The purpose of this study was to investigate the perceptions of women of childbearing age regarding Tdap vaccination in Korea. Women of childbearing age, who visited the Department of Obstetrics and Gynecology at 3 University hospitals in the Seoul and Gyeonggi-do provinces of Korea, were surveyed. Individual questionnaires were administered from April to May 2012. Demographic data, Tdap vaccination history, general knowledge about pertussis, and information on factors associated with decision on vaccination were collected. Of the 500 reproductive-age women enrolled, only 4 (0.8%) had received the Tdap. The most common reason for non-vaccination was the lack of awareness of pertussis and information about the Tdap. Totally, 171 (34.2%) responded that they would receive a Tdap vaccination in the future. By multivariate analysis, general confidence in the effectiveness of the vaccine (odds ratio [OR] = 1.88, 95% confidence interval [CI] 1.17 to 3.01) was indicated as an important factor for deciding whether to receive the Tdap vaccine (P < 0.01). The coverage of Tdap vaccination of women of childbearing age, including pregnant women, is very low because of the lack of awareness of pertussis and the Tdap. Education of women of childbearing age about pertussis is very important to increase Tdap vaccination rates among these women, particularly during the perinatal period.
    06/2013; 45(2):217-224. DOI:10.3947/ic.2013.45.2.217
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    Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia 06/2012; 29(3):253-254. DOI:10.4067/S0716-10182012000300001 · 0.49 Impact Factor
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