In February of 2018, the National Advisory Committee on Immunization issued updated guidelines for pertussis vaccination in pregnancy.
Tdap in Pregnancy:
- Immunization with Tdap vaccine should be offered in every pregnancy at 27-32 weeks of gestation, regardless of previous Tdap immunization history.
- Tdap immunization in pregnancy has been shown to protect infants against pertussis in the first three months of life. The safety of the Tdap vaccine during pregnancy is well established.
- Based on safety and effectiveness data, the ideal timing for immunization is 27-32 weeks of gestation. Immunization between 22-26 weeks may be considered for specific clinical or operational reasons, e.g. increased risk of preterm delivery. Although NACI supports immunization between 13-26 weeks, 22-26 weeks covers most preterm babies.
- Immunization until the end of pregnancy should be considered as it has the potential to provide partial protection (four weeks are required for optimal transfer of antibodies and direct protection of the infant against pertussis). In addition, there may be indirect protection through breast milk.
- Women who were not immunized during pregnancy should receive Tdap as soon as possible after birth to protect the baby from coming into contact with pertussis. Immunization is particularly important if the baby is preterm.
- If Tdap immunization was provided early in pregnancy (e.g. prior to recognition of pregnancy), it is not necessary to re-immunize after 13 weeks of gestation.
In addition, all caregivers and close contacts, both children and adults, should be up to date with their pertussis immunization. The Nova Scotia Routine Immunization schedule is available here:
Infants and young children are at particular risk of contracting pertussis until they have completed their primary immunization series. For maximum protection, children need a primary series of pertussis-containing vaccine at two, four, and six months followed by booster doses at 18 months, between four to six years of age, and again as part of the school-based immunization program, which in Nova Scotia, occurs in Grade 7.
The best way to prevent mortality and significant morbidity from pertussis is for health care providers to:
- offer one dose of pertussis containing vaccine (Tdap) to all pregnant women, ideally at 27-32 weeks of gestation. An earlier gestation may be chosen in some circumstances;
- ensure that infants and young children are immunized according to the recommended schedule; and
- recommend that caregivers and close contacts of infants and young children receive a pertussis immunization.