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.
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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.
