Pregnant Women Can Protect Babies from Pertussis Before Birth
Aug 12, 2016

Every Child By Two’s “State of the ImmUnion” campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan.  In this second guest post we hear from a California colleague who has a particular interest in Maternal-Child Health.

Dr. Elizabeth (Betsy) Rosenblum, who is a Professor of Clinical Medicine at UC – San Diego Health System, with joint appointments in the Departments of Family Medicine & Public Health and in Reproductive Medicine, works hard to help protect pregnant women and their babies from pertussis. 

The shattering loss of a child is something no family ever wants to experience. Unfortunately, this year in California, two families have suffered this loss in a particularly devastating manner. These two children, both under six months of age, died from a vaccine-preventable illness: whooping cough.

Whooping cough? Isn’t that a disease from the past, like bubonic plague or smallpox?

The unfortunate answer is no. Whooping cough, or pertussis, is a disease that is still very much with us. It can infect both children and adults. It is most dangerous, however, for young infants. When whooping cough infects babies under two months of age, 90% will be hospitalized, 2-4% will suffer seizures, and 1 in 100 will die from complications of the disease.

How do infants get whooping cough?

Carter was a victim of pertussis at just 7 weeks of age.

The sad fact is, they get it from those around them.  The disease is spread by infectious droplets in the air and is highly contagious. Adults with pertussis infection, who may only have a mild cough, may not realize they have the disease. And, tragically, adults have been shown to be a frequent source of infection to infants with whom they have close contact.

Is there any way to prevent pertussis in infants?

Fortunately, we have a vaccine, called Tdap. We know that when pregnant women are vaccinated during mid-pregnancy, their body has time to pass protective antibodies to their babies. These antibodies can help protect infants from the disease, until they are old enough to mount an immune response to their own pertussis vaccine.

I am a family physician, and care for many pregnant women and young families. I know from experience that some pregnant women are hesitant to get a vaccine, wondering if this might harm their growing baby. I try my best to explain that the opposite is true: that getting Tdap vaccine during pregnancy is far safer for their baby than NOT getting the vaccine. If born without protective antibodies, babies risk getting sick and dying from a potentially preventable disease.

Some of my patients tell me “I’ll get the Tdap vaccine, but I want to wait until after the baby is born.” Certainly, getting the vaccine is better than never getting it. However, this plan offers far less protection. In order for a baby to have protective antibodies circulating in his/her system from the moment of birth, the vaccine must be given at least 3-4 weeks prior to delivery. Currently in the United States, the recommended time of Tdap vaccination for pregnant women is between 27-36 weeks (6-8 months of pregnancy).

I care for some pregnant women whose children are closely spaced in age. When these women reach 27 weeks in a given pregnancy, I recommend Tdap. On occasion, they will tell me “I don’t need it, because I had it last year in my prior pregnancy.” However, in order to protect a newborn from whooping cough, a pregnant woman needs Tdap in each and every pregnancy. It is only when a woman receives the vaccine in a current pregnancy that she sends an abundant and protective amount of antibodies into the baby growing inside of her.

In order to protect infants from whooping cough, do other family members need to be vaccinated?

The answer to this question is a resounding YES! All family members, caregivers, and others who will be around an infant should be certain they are up-to-date with Tdap vaccine. When everyone around a baby is vaccinated, this provides a ‘cocoon’ of protection, greatly minimizing the chances a baby will get sick from the disease.

Children need five DTaP vaccines(the pediatric form of Tdap) at 2, 4, 6, 15 months  and between ages 4-6. They need a Tdap booster at age 11. Adult men only need a single lifetime Tdap. Adult women only need a single lifetime Tdap, unless they are pregnant, in which case they need a Tdap in every pregnancy.

If a murderer was on the loose in California, intent on harming babies, there would be an immense outcry and demand for protection. Well, that murderer is pertussis. And, the best way to protect every infant from this disease is to spread the word of the importance of both maternal Tdap vaccination and vaccination for all members of our communities.

To determine what vaccines are needed before, during and after pregnancy, take a brief Pregnancy and Vaccination Quiz or visit the Pregnancy section of the Vaccinate Your Family website.

Dr. Rosenblum has completed a fellowship in Vaccine Science and Safety through the American Academy of Family Physicians. She chaired the Tdap Working Group in 2010, which coordinated UCSD’s response to the California pertussis epidemic. Her innovative work in designing and implementing a Tdap Cocooning Clinic led to her receiving the APhA Immunization Champion Award in 2011. She was chosen by the CDC to be the Childhood Immunization Champion for the State of California in 2014, in part due to her work in educating pregnant women and their families regarding the importance of childhood immunizations. She currently serves on two Advisory Committee on Immunization Practices (ACIP) work groups; the Tdap Work Group and the Combined Vaccine Work Group. She is also on the Steering Committee of the San Diego Immunization Coalition.