Tdap vaccine during pregnancy

I am dismayed to find that a Canadian publication uses recommendations on the use of the acellular pertussis vaccine (Tdap) during pregnancy from an American body, the Advisory Committee on Immunization Practice,¹ rather than those of the Canadian expert body, the National Advisory Committee on Immunization (NACI).

The Canadian Immunization Guide, written by NACI, is the definitive guide for immunization practice in Canada. The following is the guide’s recommendation on the use of Tdap during pregnancy.

[The Advisory Committee on Immunization Practice] in the US has recommended that pregnant women who have not previously been vaccinated against pertussis receive pertussis-containing vaccine in the second half of pregnancy. NACI’s current recommendation for pregnant women who have not previously received Tdap vaccine in adulthood is that Tdap vaccine should be administered immediately post-partum. In particular situations where potential benefits outweigh risks, such as during pertussis outbreaks, acellular pertussis-containing vaccine (Tdap) should be considered for pregnant women in the second half of pregnancy who have not previously received Tdap vaccine in adulthood. Pertussis vaccination in pregnancy is under review by NACI.²

Thus, in the absence of a pertussis outbreak, Tdap is not currently recommended during pregnancy in Canada. In Alberta, there are no pertussis outbreaks at this time, and the public health program, which administers the Tdap vaccine, is not giving it to pregnant women. The Matlow et al¹ article will lead to many physicians referring their pregnant patients to public health services for the Tdap vaccine only to have these patients be turned away; however, on the positive side, this might result in many good discussions between physicians and Medical Officers of Health about the rationale for the Canadian recommendations.

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