Tdap vaccine while pregnant???

[jkl]

I am almost 35 weeks pregnant, and my ob is advising me to get this now. Anyone have any thoughts on this? I am torn...I did get a flu shot this year, even though I felt nervous about it. But this..... Dh had a booster not long ago, and our other kids are on fully caught up on their vaccines. Hmmm......

 

ETA: I did a search on this topic and didn't find anything recent, but in case there was a recent similar thread I missed, please let me know ;)

[Susan C.]

If it were me I would wait. I had to take Rhogam shots with both (Rh neg.) and that shot has tons of mercury in it.... Both dc have the strangest allergies.... who knows if that caused it, but still.

[Anne]

I would evaluate your risk for these things.  When was your last tetanus vaccine?  Do you hang out with lots of rusty nails???    Is there a lot of pertussis in your area now?  Amongst your friends or people you might encounter?

 

Unless there is some real risk, I would wait.  

 

I am not particularly anti-vaccine, although I did delay my dc's vaccines considerably. 

 

Anne

 

[JessReplanted]

I chose to wait, and then I got it in the hospital after the baby was born.

[prairiewindmomma]

Pertussis is in our area; I'd do it in the hopes of providing protection to baby.

[T'smom]

Pertussis is a big deal. I am going to get the Tdap when I go to do my glucose test. My ob recommends it for everyone.

[Rubix]

The thought on getting the vaccine now while you are pregnant is that it will protect the baby from pertussis before it is old enough to receive it's own vaccinations.  If baby will be exposed to pertussis in the first 6 months (as in any one who has not had a Tdap booster, or out in the community) it is recommended. 

 

I didn't do the flu shot, but I did get this booster, and I am just about as far along as you are (34 1/2 weeks).  Being due in February, my personal decision was to either not expose the baby to anyone, visitors who didn't have a booster or the public until the winter/spring sicknesses were over, or get the vaccine.  Realistically, needing Dr. visits for baby, and errands, people who want to visit, etc, I decided to go with the vaccine, and we will still take precautions with not having sick visitors, washing hands, etc. 

[OH_Homeschooler]

During my last pregnancy a few years ago my OB recommended I wait until right after the baby was born. Then I remembered I'd had a booster a couple years before that so it ended up not being an issue at all. She did recommend the flu shot for me while pregnant though, and I got that.

[alef]

I would get it, and I would have any other adults or teens in the household who are due for a booster get one as well. Pertussis is worth protecting against.

[momto10blessings]

My dr advised I receive the shot during my last pregnancy to pass the immunity of pertussis on to my baby. He did say it had to be done a certain amount of weeks before delivery (sorry, can't remember how many wks) so if you want to get it, I would do it now. Especially if you have a history of early deliveries.

[carriede]

I just have birth in December and I got a Tdap booster while still in the hospital. My OB did not mention it before then. But then, prutessis isn't around here at the moment. I did it anyway. Don't think my DH has had a Tdap... The kids are up to date on vaccines so they're covered.

[ErinE]

For the current pregnancy, I was advised to get the Tdap even though I'm current. I asked the doctor why as I had a baby less than a year ago and was told nothing. He said that pertussis infections are on the rise from people declining vaccinations. Pregnant women are asked to get the Tdap to protect the newborn from infection before the first round of shots at six weeks.

[lavender's green]

IIRC my midwives said to get it during pregnancy because they're finding that pregnant women lose immunity faster.  They're don't recommend "extras" like this lightly, and pertussis is on the rise in my area, so I just went ahead and got it.

[jkl]

Thanks for your opinions, everyone. You all are split, just like I am in my own mind! From reading the info on the CDC's website, it seems like there is some uncertainty about if immunity actually passes through to the baby. There is also a question of, if some immunity does pass through, does that somehow interfere when the baby gets his actual vaccination at 2 months. (at least that how I'm reading it.. http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm ) Still torn.....

[mmeblue]

I am 28 weeks and was told at my appointment last week that they are now recommending it with every pregnancy, even if you've had it recently enough otherwise, because it will pass the pertussis immunity along to the baby.  I didn't get it that day because I wanted to confirm that it doesn't have egg as a vaccine component (I'm allergic), but I will probably get it when I go back at 31 weeks.  

[KungFuPanda]

Did you see this map/article?

 

http://touch.latimes.com/#section/-1/article/p2p-78971408/

[mamaraby]

Pertussis and infants is not something to mess around with - the majority of complications with Pertussis occur in the 0-6mo age range (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf). Also, none of the versions of TdaP contain a preservative, though they do contain an adjuvant because without them they don't work. Immunity for the baby aside, just making sure you're up to date is a wise plan - especially when you consider it's airborn and just how often you and baby will be near each other.

 

I would definitely get it and make sure all adults/children in the family are current on their pertussis before I'd let them around the baby (and yes, I'd still take necessary, common sense precautions re: hand-washing and the like).

[Heather in OK]

Ask your doctor for the package insert.  Read it.  Has it been tested on pregnant women and/or fetuses?  Is it safe and effective for pregnant women?  If it has not, are you still comfortable taking that vaccine?

 

 

 

[KungFuPanda]

Ask your doctor for the package insert.  Read it.  Has it been tested on pregnant women and/or fetuses?  Is it safe and effective for pregnant women?  If it has not, are you still comfortable taking that vaccine?

 

I'm willing to bet that there has never been a drug trial where pregnant women or fetuses lined up to participate.

[Whereneverever]

The CDC has a great page on this. http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

[Mergath]

I would get it.  My dd had whooping cough when she was about three, and it was so scary.  She coughed all night long until she threw up, sobbing in between coughing fits.  And she was older.  Going through that with an infant would be absolutely terrifying, and something I'd try to prevent if at all possible.

[JumpyTheFrog]

http://t.nbcnews.com/health/whooping-cough-vaccine-may-not-halt-spread-illness-2D11655363

 

This article says that the pertussis vaccine was changed in the 1990s to reduce side effects. It seems that the new vaccine isn't as effective and may be the main cause of the increase in cases. In baboon studies, vaccinated infant baboons exposed to pertussis didn't get sick, but had high enough bacteria levels that they were probably contagious for five weeks. The ones given the old vaccine high much lower bacteria levels at only two weeks.

 

It seems like I read somewhere a few months ago that the strain of whooping cough circulating doesn't match the vaccine as well as it used to.

[JumpyTheFrog]

http://www.cbsnews.com/news/possibly-vaccine-resistant-whooping-cough-strain-found-in-us/

 

14% of whooping cough cases in France are a vaccine-resistant strain.

[JessReplanted]

Thanks for your opinions, everyone. You all are split, just like I am in my own mind! From reading the info on the CDC's website, it seems like there is some uncertainty about if immunity actually passes through to the baby. There is also a question of, if some immunity does pass through, does that somehow interfere when the baby gets his actual vaccination at 2 months. (at least that how I'm reading it.. http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm ) Still torn.....

 

This is why I waited. It seems like they are just *hoping* immunity will be passed on to the baby, as there have not been any conclusive studies done.

[xixstar]

I am too conservative in interventions to take a vaccination while pregnant, especially if it's a vaccine that generally considered unsafe for a new infant either.

 

 

[Heather in OK]

Each week you can also look up the number of cases in your state via the Morbidity Mortality Weekly Report.  Here is the report for the week ending on 1/18:  http://www.cdc.gov/mmwr/pdf/wk/mm6303md.pdf 

 

Look at the actual numbers for your state.  Is it really that much of a threat?  If you feel it is (and if you are ok with what the package label says about testing being done on pregnant women and fetuses), then you can make a better informed decision about this vaccination.  

[mamaraby]

http://www.cbsnews.com/news/possibly-vaccine-resistant-whooping-cough-strain-found-in-us/

 

14% of whooping cough cases in France are a vaccine-resistant strain.

From the linked article:

In a small, soon-to-be published study, French researchers found the vaccine seemed to lower the risk of severe disease from the new strain in infants. But it didn't prevent illness completely, said Nicole Guiso of the Pasteur Institute, one of the researchers.

So in other words, even if it didn't completely prevent infection, it did lower the risk of serious complications which when we're talking 0-6 mos is a very good thing.

[LMV]

Ultimately you will need to decide what is the right decision for you and your unborn child, however, I personally would (and did in September 2012 before giving birth to our youngest seven weeks later) receive the vaccine.  At that time ACIP hadn't officially recommended (they would a later in 2012) but both my OB and our other kids' pediatrician were recommending this approach.  The idea behind giving Tdap during the first part of the third trimester is to maximize passive antibody transfer to the baby in the hopes of protecting them through the most risky period for pertussis infection (birth through three months) and before there is another good option for this (as DTaP can't be given before six weeks of age).  There have been studies which have showed that this is efficacious.  It is also recommended that all individuals who are going to have close contact with infants <1 year are vaccinated.  So ideally dads and adolescent older siblings would be receiving Tdap as well.  There is less strength of evidence for this recommendation but some of this is because immunization rates in some of these groups have been less than would be ideal (ie.. statistical power limitation issue).

 

As far as safety with TdaP during pregnancy it is true that there are only a few small studies looking at this specifically but there is also post immunization surveillance of this group via VAERS and this hasn't shown harm.  Additionally as the vaccine is recommended to be given during the third trimester it is beyond the gestational period for great teratogenic concerns.

 

 

 

[kubiac]

After reading this frightening article, I got the TDAP shot and insisted that all caregivers (husband, grandparents) get it as well.

 

I know whooping cough could hurt or kill a newborn, and I think the idea of "vaccine injury" is mass hysteria at its worst, so for me it was an easy decision. YMMV.

[StaceyinLA]

I think the idea of huge pertussis outbreaks caused by unvaccinated people is mass hysteria, and an attempt to keep people from realizing that the pertussis vaccine isn't as effective or long-lasting as it is proclaimed to be. When the outbreak in Washington (I believe it was - could've been Oregon) happened, it was mostly vaccinated children around age 7 or 8 contracting the disease. The problem is, from what I read at the time, that pertussis immunity doesn't last nearly as long as the tetanus and diphtheria immunities, but you can't be boostered for it because it isn't offered in a single vaccine (and you can't give the D or T booster until 10 years after initial series). This isn't even taking into consideration the percentage of time where the vaccine isn't effective, nor the new strains developing that the vaccine doesn't cover.

 

We have a vaccine that gives a false sense of security, and the issues with it need to be addressed.

 

Fwiw, I'm for delayed and selective vaccines for babies, but I did have my Tdap before my grandchildren arrived.

[StaceyinLA]

After reading this frightening article, I got the TDAP shot and insisted that all caregivers (husband, grandparents) get it as well.

 

I know whooping cough could hurt or kill a newborn, and I think the idea of "vaccine injury" is mass hysteria at its worst, so for me it was an easy decision. YMMV.

And in that article, it states, "But immunity to whooping cough can begin fading 5 years after an inoculation." This is the problem. By the time a child is 6-7, they can be losing their immunities already, and cannot be revaccinated for another 4-5 years. Huge issue for younger siblings; probably more of an issue than an unvaccinated child since you wouldn't consider a vaccinated child a potential threat if they got sick.

[LMV]

After reading this frightening article, I got the TDAP shot and insisted that all caregivers (husband, grandparents) get it as well.

 

I know whooping cough could hurt or kill a newborn, and I think the idea of "vaccine injury" is mass hysteria at its worst, so for me it was an easy decision. YMMV.

 

I’ve intubated two infants (who were later confirmed to be infected)with B. pertussis during ED shifts in the past year.  One of them ultimately did reasonably well eventually, the other one I truly believe we did everything we could (including shipping the baby to another hospital where ECMO was possible).  In one case our daughter was still very young and I think because of that it hit me harder because she was close in age and also because I was still a little afraid of potentially bringing something home to her.  I’m usually a very judicious antibiotic prescriber in the ED and expect the same from physicians treating family members but I did take prophylactic Azithromycin because I decided that ultimately I just couldn’t take the risk with our kids.  

 

 

[LMV]

And in that article, it states, "But immunity to whooping cough can begin fading 5 years after an inoculation." This is the problem. By the time a child is 6-7, they can be losing their immunities already, and cannot be revaccinated for another 4-5 years. Huge issue for younger siblings; probably more of an issue than an unvaccinated child since you wouldn't consider a vaccinated child a potential threat if they got sick.

 

I’m not sure why you have concluded this.  The primary DTaP series is 5 doses.  If a child completes a standard schedule primary series then they will receive their final primary dose at age 5.  If you follow FDA labeling Tdap can be given as early as age 10.  If you follow a standard schedule the Tdap booster is recommended around age 11.  I’m not arguing that DTaP/TdaP offer full coverage/lifelong protection.  There is evidence that they don’t (although I think with the changes to the immunization guidelines and with some possible vaccine modifications in the works we will see increased vaccine efficacy going forward), however, from my perspective as a physician and as a mom, there is still benefit to using them.  It is hard to logically conclude that something which reduces the likelihood of infection (albeit not to zero) and thus potential transmission to vulnerable siblings is more dangerous than having siblings without any infection risk reduction.  As far as false security, I think most prudent US physicians consider pertussis infection in immunized children if the clinical scenario suggests it.  I know I do.  I know our kids’ pediatrician does.  In general I feel Azithromycin can be an overused and misused antibiotic but I make an exception for confirmed and strongly suspected pertussis, especially in high complication risk populations, or in individuals who may transmit to those populations.  

 

 

 

[momto10blessings]

After reading this frightening article, I got the TDAP shot and insisted that all caregivers (husband, grandparents) get it as well.

 

I know whooping cough could hurt or kill a newborn, and I think the idea of "vaccine injury" is mass hysteria at its worst, so for me it was an easy decision. YMMV.

I have two family members who have had terrible life altering reaction to the pertussis vaccine. They went from healthy babies to a lifetime of never be able to do anything for themselves. I do understand that whooping cough is a terrible disease, but there are people who have terrible reactions.