Reviewed by Elizabeth Salas, MPH

Are you currently pregnant? Are you aware of the risk of pertussis to your baby?

Pertussis, also known as whooping cough, is a serious problem throughout California. Public health officials confirm our state is currently experiencing a pertussis epidemic. In 2010, there were more pertussis cases in California than had been reported in over 60 years with approximately 9,000 cases including 10 infant deaths. In 2014 10,831 cases were reported. The California Department of Public Health (CDPH) January 7, 2015 Pertussis Report states that of the 376 cases requiring hospitalization, 227 (60%) were babies less than 4 months of age. The two deaths reported in 2014 were babies less than 6 weeks of age. Unfortunately, babies are among the most vulnerable, but there are things you can do to protect your baby.

What Every Pregnant Woman Should Know About Pertussis

What is Pertussis?

Pertussis is a bacterial infection caused by the bacterium bordetella pertussis. This germ can be transferred from an infected person to an uninfected person through coughing, sneezing, or having close contact with someone infected. Pertussis is very contagious and can cause serious illness. It can affect any person at any age, but is more commonly reported in infants and the elderly.

At first pertussis may resemble a cold, but the symptoms change over time. Within 1-3 weeks after being infected, the person will have a rapid cough leading to difficulties in breathing. After coughing for seconds to minutes, they will make a “whooping” sound as they try to catch their breath. It can take weeks or even months before a person recovers from this infection. However, this infection may be prevented by vaccinating.

Why is pertussis a concern for newborns?

Newborns are at a higher risk of getting pertussis because their immune systems are weaker and not as capable of fighting off infections. In addition, they cannot receive their first pertussis vaccine until they are at least 6 weeks of age. Newborns infected with pertussis are at risk of being hospitalized, depending on the severity of the illness and can experience life-threatening symptoms. According to the CDC, in babies who are hospitalized for pertussis, studies suggest that 1 in 4 of these babies get pneumonia, 2 in 3 will experience apnea (slowed or stopped breathing), 1-2 per 100 will have convulsions, 1 in 300 experience encephalopathy (disease of the brain), and 1-2 per 100 babies hospitalized will die.

What can a pregnant woman do to protect her newborn?

Vaccinating during pregnancy is the best tool we have to protect moms and babies against pertussis. When mom receives the vaccine during pregnancy, it provides protection for the newborn. Mom can transfer protective antibodies (proteins that protect against pertussis) to the baby during pregnancy, which helps protect the newborn in the first 6-8 weeks when they are too young to get vaccinated. This vaccine will also help the mother by keeping her healthy and decreasing the chances of her spreading pertussis to her infant. It is important to get vaccinated during every pregnancy because over time levels of antibodies will start to decrease. In order to transfer the highest levels of antibodies to your baby, vaccination late in pregnancy is ideal.

It is also very important that new moms vaccinate their newborns against pertussis at 6-8 weeks rather than delaying vaccination. The longer mom waits to vaccinate, the longer her baby is vulnerable.

Is this vaccine safe during pregnancy?

The Tdap vaccine is an inactivated vaccine. This means the vaccine is made of particles of killed bacteria. It does not contain a live virus. There is no risk of contracting the infection from the vaccine, unlike vaccines that contain live viruses or bacteria. Currently the published information on vaccination against pertussis in pregnancy has not found an increased risk for problems in pregnancy or for the newborn. In every pregnancy, there is a 3-5% chance of having a baby with a birth defect regardless of exposures in pregnancy. This is known as the background risk. Vaccination against pertussis during pregnancy has not been shown to increase the risk of birth defects above the background risk that already exists in every pregnancy.

In 2011, the Centers for Disease Control and Prevention recommended the pertussis vaccine for pregnant women. The update in October of 2012, recommended that pregnant women, regardless of vaccination history, should receive the Tdap vaccine in every pregnancy. The optimal time to administer the vaccine is between 27-36 weeks gestation to maximize benefits to mom and baby. The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice also supports the recommendations.

What can family and friends do to help protect a newborn?

Staying up to date with pertussis vaccination is important, especially since adults may not know they are infected or may confuse pertussis with a common cold. “Cocooning” is a strategy recommended to protect the newborn. “Cocooning” refers to the vaccination of those who will be in close contact with the baby (dad, siblings, grandparents, and caretakers) in order to reduce the chance baby will be exposed to pertussis. Newborns are more likely to get pertussis from a family member or by having close contact with an infected person, especially when that person has not been vaccinated. Anyone not up to date with pertussis vaccines should be vaccinated at least 2 weeks before coming in contact with the infant to ensure their bodies have had enough time to develop immunity.

The Bottom Line for Expecting Moms and Their Families

Getting the vaccine does not necessarily mean that you or your baby are not at risk of being infected. While adults, who have been vaccinated, can still get pertussis, the infection is usually less severe. Vaccinating can reduce the chances you and your baby will get pertussis. Contact your doctor for more information about getting vaccinated. According to the Immunization Branch of the CDPH, even a single dose of the DTaPvaccine may provide some protection against severe pertussis disease in babies.

Elizabeth Salas is the Lead Teratology Information Specialist for MotherToBaby California, a non-profit that provides information to healthcare providers and the general public about medications and more during pregnancy and breastfeeding. She is based at the University of California, San Diego, and is passionate about the work MotherToBaby is doing to promote healthy moms, healthy pregnancies and healthy babies.

Download the Tetanus, diphtheria and pertussis and Tdap Vaccine and Pregnancy fact sheet and other fact sheets by MotherToBaby (also available in Spanish) at

http://www.mothertobabyca.org/resources/fact-sheets/

For the latest information on pertussis in California, visit the California Department of Public Health Pertussis Summary Reports at http://www.cdph.ca.gov/programs/immunize/Pages/PertussisSummaryReports.aspx

Additional information about pertussis is available at the following Centers for Disease Control and Prevention link at http://www.cdc.gov/pertussis/materials/pregnant.html

References:

1. Committee Opinion Number 566 June 2013, The American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Web. 21 January 2015. <http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Update-on-Immunization-and-Pregnancy-Tetanus-Diphtheria-and-Pertussis-Vaccination>
2. “Pertussis Summary Report 2015-1-7.” California Department of Public Health, Pertussis Summary Reports, 7 January 2015. Web. 21 January 2015. <http://www.cdph.ca.gov/programs/immunize/Pages/PertussisSummaryReports.aspx>
3. “Pertussis (Whooping Cough).” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 15 Jan. 2013. Web. 04 June 2014. <http://www.cdc.gov/pertussis/about/complications.html>.
4. “Prevention.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 13 Feb. 2014. Web. 04 June 2014. <http://www.cdc.gov/pertussis/about/prevention/index.html>.
5. “Protect Babies from Whooping Cough (Pertussis).” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 10 Feb. 2014. Web. 04 June 2014. <http://www.cdc.gov/features/pertussis>.

The post How You Can Protect Your Baby from Pertussis “Whooping Cough” Before and After Birth appeared first on MotherToBaby.

“I’m very confused” said the pregnant caller. “I’ve heard different things about whether I should get the vaccine against whooping cough now or after I deliver. Maybe I should just wait?” As a teratogen information specialist who talks to women and health professionals daily regarding the recommended vaccines for pregnancy, it concerns me that pregnant women are not receiving a clear message about the recommendations for vaccination against pertussis during pregnancy. How can pregnant women make informed decisions when they are not getting the correct information?

When it comes to understanding and preventing illness and injury to their children, a parent’s job starts before they hold the baby in their arms and continues for many years afterward. Before birth, parents research toys, car seats, bedding, and a number of other potential threats. High on the radar should also be preventable diseases such as pertussis, which we are hearing about much more frequently these days.

Pertussis, commonly known as “whooping cough,” is a disease caused by a bacteria, bordetella pertussis, that can spread easily through the air in infectious droplets, for example from a cough or sneeze. Although pertussis is not something that most Americans of childbearing age remember from their own childhood, pertussis harmed many children in the years before a vaccine was discovered. In the early 1900’s, 1 out of 10 children with pertussis died. When pertussis became a reportable disease in 1922, more than 100,000 cases of pertussis were reported each year.

Introduced in the late 1940’s, the pertussis vaccine has improved the health of children tremendously. The wide distribution of the vaccine since first developed meant that the numbers of infections (and deaths) from pertussis dropped dramatically. By the 1970’s, vaccination programs had been so successful that U.S. cases totaled only about 1,000 per year. Unfortunately, those historic declines have been reversed and in the past 20 years, we have seen an increase in cases rather than a decline. In 2012, over 48,000 cases of pertussis infection were reported in the U.S. which was a 60-year record high. Experts are trying to understand why the numbers of reported cases have increased. Is it due to a decrease in vaccination of children, or another reason?

Currently the pertussis vaccine comes in two forms – DTaP (Diphtheria Tetanus and Pertussis), which is the vaccine that is given in five doses to infants and children, and Tdap (Tetanus, Diphtheria and Pertussis), which is a vaccine that acts as a booster for adults and pregnant women. DTaP and Tdap are inactive vaccines and there is no chance of “catching” pertussis from the vaccination since neither contains live bacteria. While the earliest pertussis vaccines developed in the 1940’s had risks of injection site reactions such as redness and swelling, the newer forms in use today are purified (acellular) and have fewer reported side effects.

The most successful strategy for preventing pertussis in infants and children is consistent and timely vaccination of all children and adults. The Centers for Disease Control has added to this strategy by recommending that all pregnant women be vaccinated in their third trimester of pregnancy, between 27 and 36 weeks of pregnancy. Studies have shown that when women receive Tdap vaccination during the recommended time period in pregnancy, the newborn baby develops immunity through the mom’s vaccination that lasts for about two months after birth. Newborn infants are particularly vulnerable to pertussis, therefore smart vaccination interventions are needed to curb the risk to the baby.

Results of a randomized, double-blind, placebo controlled clinical trial were published in May of 2014 by Munoz, et al. The trial included 48 pregnant women who received the Tdap vaccine (33) or a placebo (15). All women received either shot at 30-32 weeks of pregnancy. The goal was to evaluate the safety of Tdap for the woman and her pregnancy as well as to determine if the vaccine would interfere with the infant’s response to the DTaP when given later in infancy. The authors found no Tdap related side effects and no other complications for mother or baby during pregnancy. Infants in both groups had similar growth and development, and reassuringly, being exposed to Tdap prior to birth did not interfere with the baby’s immune response to the DTaP series.

August is National Immunization Awareness Month and although immunizations take place daily across the country, having a specific month dedicated to vaccines gives all of us a reason to educate ourselves and others about the importance of timely vaccination and the work that is being done to understand the health benefits and any potential risks from vaccination of any group, including pregnant women. The research published to date on vaccination of pregnant women with Tdap and other vaccines including the flu shot has been reassuring and no adverse effects have been identified for either mom or the baby. Additional studies can contribute to the pool of information that is already available. MotherToBaby is conducting such a study to further understand the effects of Tdap on pregnancy. Click here to learn more.

Preventing pertussis through vaccination is similar to adding safety equipment to a pool that your own children use – as well as any neighbor children that visit. Vaccination with Tdap, particularly if you are pregnant or will be around any children, is key to preventing the damage done by this potentially fatal disease. So, just as you would talk about swimming safety with others, don’t hold your breath about pertussis. It’s air well spent to help us all breathe a bit easier!

Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, vaccines, beauty products, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.

References

Clark, Thomas A. (2014). Changing Pertussis Epidemiology: Everything Old is New Again. Journal of Infectious Diseases, 209;978-981. doi:10.1093/infdis/jiu001

Munoz M. Flor, MD, Bond Nanette H. PAC, Maccato Maurizio, MD, et al (2014). Safety and Immunogenity of Tetanus Diphtheria and acellular Pertussis (Tdap) Immunization during pregnancy in Mothers and Infants. JAMA, 311(17), 1760-1769. doi:10.1001/jama.2014.3633

Hirtle, P. B. (2008, July-August). Copyright renewal, copyright restoration, and the difficulty of determining copyright status. D-Lib Magazine, 14(7/8). doi:10.1045/july2008-hirtle

Centers for Disease Control and Prevention, Pertussis (Whooping Cough) http://www.cdc.gov/pertussis/about/index.html

The History of Vaccines, A Project of The College of Physicians of Philadelphia. http://www.historyofvaccines.org/content/articles/pertussis-whooping-cough

The post Should I Get The Pertussis Vaccine During Pregnancy? appeared first on MotherToBaby.