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LetterLetters

Response

Meghan Gilley and Ran D. Goldman
Canadian Family Physician June 2014, 60 (6) 521-522;
Meghan Gilley
Vancouver, BC
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Ran D. Goldman
Vancouver, BC
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We thank Dr Warshawsky for the update on the National Advisory Committee on Immunization position on tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination in pregnancy in response to our article.1 Dr Warshawsky is correct that there are no data on how maternal vaccination during pregnancy affects infants’ immunologic response to the regularly scheduled acellular pertussis vaccinations at 2 months, 4 months, 6 months, and 18 months. Despite that, since 2012, the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices has recommended that women receive Tdap boosters with every pregnancy. They recommend vaccination between 27 and 36 weeks, which is the optimal time for antibody transfer.2 The Advisory Committee on Immunization Practices determined that cocooning alone (vaccination of household members and close contacts) was not sufficient to reduce the number of infant pertussis cases given the severity of the disease in this age group.3

A cost-effectiveness model analysis by Terranella et al found that maternal vaccination during pregnancy would prevent more infections, hospitalizations, and infant deaths compared with the postpartum model for 2 reasons: earlier protection of the mother from pertussis, which prevents transmission to the infant; and transfer of maternal antibodies to the infant.4

The differences in practices and recommendations between the National Advisory Committee on Immunization and the Centers for Disease Control and Prevention illustrate the subtle differences between Canadian and American practices. That being said, both organizations agree that a pregnant woman should receive a Tdap booster in her late second to third trimester if she has not already received one in adulthood.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Gilley M,
    2. Goldman RD
    . Protecting infants from pertussis. Can Fam Physician 2014;60:138-40. (Eng), e101–3 (Fr).
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    Centers for Disease Control and Prevention [website]. Tdap for pregnant women: information for providers. Atlanta, GA: Centers for Disease Control and Prevention; 2014. Available from: www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm. Accessed 2014 Apr 18.
  3. 3.↵
    Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep 2011;60(41):1424-6.
    OpenUrlPubMed
  4. 4.↵
    1. Terranella A,
    2. Beeler Asay GR,
    3. Messonnier ML,
    4. Clark TA,
    5. Liang JL
    . Pregnancy dose Tdap and postpartum cocooning to prevent infant pertussis: a decision analysis. Pediatrics 2013;131(6):e1748-56. Epub 2013 May 27.
    OpenUrlAbstract/FREE Full Text
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Canadian Family Physician: 60 (6)
Canadian Family Physician
Vol. 60, Issue 6
1 Jun 2014
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Canadian Family Physician Jun 2014, 60 (6) 521-522;

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Canadian Family Physician Jun 2014, 60 (6) 521-522;
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