Introduction
It is recommended that all pregnant women in the U.S. receive tetanus, diphtheria,
acellular pertussis (Tdap) immunization to prevent infant pertussis. This study’s
objective was to examine the clinical effectiveness of prenatal Tdap, and whether
effectiveness varies by gestational age at immunization.
Methods
A nationwide cohort study of pregnant women with deliveries in 2010–2014 and their
infants was performed. Commercial insurance claims data were analyzed in 2016–2017
to identify Tdap receipt by the pregnant women, and hospitalizations and outpatient
visits for pertussis in their infants until the infants reached 18 months of age.
Pertussis occurrence was compared between infants of mothers who received prenatal
Tdap (overall and stratified by gestational age at administration) and infants of
unvaccinated mothers.
Results
There were 675,167 mother–infant pairs in the cohort. Among infants whose mothers
received prenatal Tdap, the rate of pertussis was 43% lower (hazard ratio=0.57, 95%
CI=0.35, 0.92) than infants whose mothers did not receive prenatal or postpartum Tdap;
this reduction was consistent across pertussis definitions (hazard ratio for inpatient-only
pertussis=0.32, 95% CI=0.11, 0.91). Pertussis rates were also lower for infants whose
mothers received Tdap during the third trimester. Infants whose mothers received Tdap
at <27 weeks of gestation did not experience reductions in pertussis rates (hazard
ratio for pertussis=1.10, 95% CI=0.54, 2.25).
Conclusions
Infants of mothers who received prenatal Tdap experienced half the rate of pertussis
as compared with infants of unimmunized mothers. These results do not provide evidence
to support changing the currently recommended timing of Tdap administration in pregnancy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Centers for Disease Control and Prevention (CDC). Pertussis: surveillance and reporting, 2012–2016. www.cdc.gov/pertussis/surv-reporting.html. Accessed August 23, 2017.
- Pertussis hospitalizations among infants in the United States, 1993 to 2004.Pediatrics. 2008; 121: 484-492https://doi.org/10.1542/peds.2007-1393
- Severity of notified whooping cough.Br Med J. 1976; 1: 117-119https://doi.org/10.1136/bmj.1.6002.117
- Pertussis symptoms in adolescents and children versus infants: the influence of vaccination and age.Clin Pediatr (Phila). 2007; 46: 718-723https://doi.org/10.1177/0009922807302093
- Clinical and microbiologic features of children presenting with pertussis to a Canadian pediatric hospital during an eleven-year period.Pediatr Infect Dis J. 1994; 13: 617-622https://doi.org/10.1097/00006454-199407000-00007
- Dose-response to a two-component acellular pertussis vaccine in infants and comparison with whole-cell vaccine.Biologicals. 1998; 26: 145-153https://doi.org/10.1006/biol.1998.9999
- Pertussis vaccine effectiveness among children 6 to 59 months of age in the United States, 1998–2001.Pediatrics. 2005; 116: e285-e294https://doi.org/10.1542/peds.2004-2759
- Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2006; 55: 1-34
- Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged 12 months – Advisory Committee on Immunization Practices (ACIP), 2011.MMWR Morb Mortal Wkly Rep. 2011; 60: 1424-1426
- Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants.Clin Infect Dis. 2013; 56: 539-544https://doi.org/10.1093/cid/cis923
- Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices (ACIP), 2012.MMWR Morb Mortal Wkly Rep. 2013; 62: 131-135
- Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis.Clin Infect Dis. 2016; 62: 829-836https://doi.org/10.1093/cid/ciw027
- The effect of timing of maternal tetanus, diphtheria, and acellular pertussis (Tdap) immunization during pregnancy on newborn pertussis antibody levels—a prospective study.Vaccine. 2014; 32: 5787-5793https://doi.org/10.1016/j.vaccine.2014.08.038
- Immune responses in infants whose mothers received Tdap vaccine during pregnancy.Pediatr Infect Dis J. 2013; 32: 1257-1260https://doi.org/10.1097/INF.0b013e3182a09b6a
- The influence of maternally derived antibody and infant age at vaccination on infant vaccine responses: an individual participant meta-analysis.JAMA Pediatr. 2017; 171: 637-646https://doi.org/10.1001/jamapediatrics.2017.0638
- MarketScan User Guide, Commercial Claims and Encounters, Medicare Supplemental and Coordination of Benefits.Thomson Reuters (Healthcare) Inc., Ann Arbor, MI2008
- Predictors of low uptake of prenatal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis immunization in privately insured women in the United States.Obstet Gynecol. 2017; 129: 629-637https://doi.org/10.1097/AOG.0000000000001927
Powell TM, Bagnell ME, editors. Your “survival” guide to using time-dependent covariates. SAS Global Forum 2012. http://support.sas.com/resources/papers/proceedings12/168-2012.pdf. Accessed August 29, 2017.
- Effectiveness of maternal pertussis vaccination in England: an observational study.Lancet. 2014; 384: 1521-1528https://doi.org/10.1016/S0140-6736(14)60686-3
- A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012–2013.Clin Infect Dis. 2015; 60: 333-337https://doi.org/10.1093/cid/ciu821
- Impact of the U.S. maternal tetanus, diphtheria, and acellular pertussis vaccination program on preventing pertussis in infants 2 months of age: a case-control evaluation.Clin Infect Dis. 2017; 65: 1977-1983https://doi.org/10.1093/cid/cix724
- Effectiveness of vaccination during pregnancy to prevent infant pertussis.Pediatrics. 2017; 139https://doi.org/10.1542/peds.2016-4091
- Pertussis vaccination during pregnancy: Antibody persistence in infants.Vaccine. 2016; 34: 3719-3722https://doi.org/10.1016/j.vaccine.2016.05.051
- A review of uses of health care utilization databases for epidemiologic research on therapeutics.J Clin Epidemiol. 2005; 58: 323-337https://doi.org/10.1016/j.jclinepi.2004.10.012
Article info
Publication history
Published online: June 14, 2018
This activity is available for CME credit. See page A3 for information.Identification
Copyright
© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
