Effectiveness of prenatal versus postpartum tetanus, diphtheria, and acellular pertussis vaccination in preventing infant pertussis
Open accessAbstract
BACKGROUND: Most severe and fatal cases of pertussis occur in infants <8 weeks of age, before initiation of the primary pertussis vaccine series. Women are recommended to receive tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at the start of the third trimester of each pregnancy to optimize transplacental transfer of antibodies to the fetus. This recommendation was made by the Advisory Committee for Immunization Practices based on immunogenicity data, and no studies in the United States have yet evaluated the effectiveness of this strategy in reducing pertussis incidence in infants. METHODS: We evaluated a cohort of mothers with documented Tdap vaccination histories in the California Immunization Registry to determine whether infants whose mothers received Tdap vaccine at 27-36 weeks gestation had a lower risk of pertussis at <8 weeks of age than infants born to women who received Tdap vaccine within 14 days post partum. RESULTS: Tdap vaccination received at 27-36 weeks gestation was found to be 85% (95% confidence interval, 33%-98%) more effective than postpartum Tdap vaccination at preventing pertussis in infants <8 weeks of age . Vaccination at 27-36 weeks gestation was more effective at preventing pertussis in infant than vaccination during the second trimester. CONCLUSIONS: Tdap vaccination at 27-36 weeks gestation was 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age. Efforts should be made by prenatal care providers to provide Tdap vaccine to pregnant women during routine prenatal visits at the earliest opportunity between 27 and 36 weeks gestation.
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Maternal vaccination with a pertussis-containing vaccine results in high concentrations of antibody in the infant over the first 2 months of life.
“Maternal vaccination with a pertussis-containing vaccine is now routinely recommended in several countries and has been shown to be safe and to result in high concentrations of antibody in the infant over the first 2 months of life (18–21).”
From Factors Affecting the FcRn-Mediated Transplacental Transfer of Antibodies and Implications for Vaccination in Pregnancy (2017) · cites this paper as [20]
The Discussion reports high anti-pertussis-toxin antibody concentrations in infants whose mothers were vaccinated at 26–33 weeks’ gestation. It does not establish that concentrations remain high throughout the first two months of life; the paper’s <8-week results concern pertussis risk, not antibody levels. (LLM, conf=0.85)
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- Authors
- Winter, K., Nickell, S., Powell, M., & Harriman, K.
- Affiliations
- California Department of Public Health (US)
- Corresponding author
- Winter, Kathleen
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-09-13
- Volume
- 64
- Issue
- 1
- Pages
- 3-8
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2520614282
- Cited by
- 178
- References
- 15
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 10 · 2023: 13 · 2022: 13 · 2021: 32 · 2020: 18 · 2019: 23 · 2018: 28 · 2017: 27
- FWCI
- 26.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- California Department of Public Health
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Diphtheria, Corynebacterium, and Tetanus
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- Tdap vaccine, pertussis prevention, infant pertussis, prenatal vaccination, postpartum vaccination, transplacental antibody transfer, maternal immunization, vaccine effectiveness
- MeSH terms
- Adult, California, Female, Humans, Infant, Infant, Newborn, Male, Postnatal Care, Pregnancy, Prenatal Care, Registries, Risk Factors, Time Factors, Vaccination, Whooping Cough, Outcome Assessment, Health Care, Diphtheria-Tetanus-acellular Pertussis Vaccines, Young Adult
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