CDC recommends Tdap during each pregnancy                                        Sarah S. Long                            ...
Volume 34 • Number 2                                                                                                      ...
immunogenic in pregnancy and transplacental passage of antibodies             infant’s response to DTaP, but limited recen...
CDC recommends Tdap during each pregnancy                                      Sarah S. Long                              ...
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Tdap en embarazadas recomendaciones aap news-2013-long-8

  1. 1. CDC recommends Tdap during each pregnancy Sarah S. Long AAP News 2013;34;8 DOI: 10.1542/aapnews.2013342-8The online version of this article, along with updated information and services, is located on the World Wide Web at: AAP News is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. AAP News is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2013 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397. Downloaded from by Trisha Korioth on February 13, 2013
  2. 2. Volume 34 • Number 2 February 2013 www.aapnews.orgCDC recommends Tdap during each pregnancyby Sarah S. Long, M.D., FAAP The Centers for Disease Control and Prevention now recommendstetanus, diphtheria and acellular pertussis vaccine (Tdap) for pregnantadolescents and adults during each pregnancy. The recommendationis included in the 2013 immunization schedule (see page 17). This approach was in response to increasing cases of pertussisnationally and a recognition that the greatest burden of disease,morbidity and mortality occurs in infants before they can achieveprotection from their primary series with diphtheria and tetanustoxoids and acellular pertussis vaccine (DTaP). Data on the safetyand efficacy of multiple Tdap doses are limited. The AAP Committee on Infectious Diseases agrees that adolescentsand young adults who received Tdap prior to their pregnancy shouldreceive a second dose during pregnancy regardless of the interval With the increase in pertussis cases, one of the changes in the 2013since the first dose. This includes pregnant adolescents who received immunization schedule is a recommendation to administer tetanus,Tdap during a prior pregnancy, postpartum or as part of the ado- diphtheria and acellular pertussis (Tdap) vaccine to pregnant adoles-lescent immunization schedule. cents and adults during each pregnancy. In 2010, the 27,555 U.S. Optimal timing for Tdap administration is between 27 and 36 cases of pertussis were the highest in the preceding five years.weeks’ gestation to maximize antibody passively transferred beforebirth. However, Tdap is safe in all trimesters and can be given atany time during pregnancy. If not administered during pregnancy, added to universal Tdap recommendations. All persons in the UnitedTdap should be administered immediately postpartum. Additional States 11 years of age and older who have not received Tdap shouldTdap doses for subsequent pregnancies will be addressed in a future receive it now; they should not wait to replace Tdap for the decennialAAP policy statement and in the 2014 immunization schedule. tetanus-diphtheria vaccine (Td). Protecting young infants by neonatal dosing of DTaP productsBurden of disease is not an option as this appears to interfere with subsequent response Pertussis has increased in the United States in recent years. The to other vaccines routinely administered in infancy. The burden of27,555 cases reported in 2010 were the highest number in the pre- pertussis in young infants has risen despite cocooning policies inceding five years. In 2012, at least 34 states reported surges, with place since 2006 that target single doses of Tdap. Such recommen-final numbers likely to exceed 35,000 cases and 20 infant deaths. dations included Tdap immunization for all adolescents (AAP, 2006) Incidence is highest among infants younger than 3 months (who and cocooning strategy preferring immediate postpartum maternalare too young to be protected by infant DTaP) and 7- to 10-year- immunization (CDC, 2006). In 2011, the CDC revised its recom-olds (who have waning immunity). mendation, preferring immunization of pregnant women during The threat of loss of control of pertussis in the United States is the second or third trimester. By 2012, fewer than 3% of pregnantreal. Despite recommendations for universal administration, Tdap women had received Tdap, and cocooning through immunizationcoverage among adolescents was only 78% in 2011, and only 8% of infant contacts was abysmally low.of adults had received Tdap in 2010. The 2013 CDC recommendation for Tdap during each pregnancy will remove real and perceived barriers to maternal immunization.Changing recommendations Recommendations for Tdap usage have expanded incrementally AAP involvement in recommendationas the burden of pertussis and safety data on the vaccine increased The Academy has participated in the CDC’s Tdap Workingover the last five years. Some practitioners, however, may not be Group, which evaluates all available data to inform decision-aware of these changing recommendations. making by the Advisory Committee on Immunization Practices. In 2012, the last age group, i.e., those 65 years and older, were Published and preliminary data indicate that while Tdap is©Copyright 2013 AAP News Downloaded from by Trisha Korioth on February 13, 2013
  3. 3. immunogenic in pregnancy and transplacental passage of antibodies infant’s response to DTaP, but limited recent data are reassuring thatis adequate, there is rapid fall of antibody to pertussis toxin after this appears to be transient.immunization and rapid decay of transplacentally acquired anti- In sum, the CDC and Academy consider the benefits of Tdap re-body postnatally. A second dose of Tdap is immunogenic in non- vaccination in pregnancy to outweigh theoretical risks. The Vaccinepregnant adults. Adverse Event Reporting System and the Vaccine Safety Datalink The working group concluded that a single dose of Tdap in one will be used to monitor the safety of Tdap in pregnant women.pregnancy likely is insufficient to protect offspring of subsequent Pertussis likely will remain a perpetual, perplexing problem. Thepregnancies. Therefore, a repeated dose, especially during the latter CDC and Academy will consider changes in DTaP and Tdap sched-part of pregnancy, would bolster antibody levels. ules as well as second doses of Tdap for health care personnel and Tdap is licensed by the Food and Drug Administration for a single the public as additional safety, efficacy and cost-effectiveness datalifetime dose. The working group concluded, however, that data become available.and experience with tetanus toxoid-containing vaccines in pregnancysuggest no increased risk of adverse events if a second dose is admin- Dr. Long is an ex officio member of the AAP Committeeistered. Extensive safety data with nonpregnant persons do not show on Infectious Diseases and associate editor of the AAPincreased reactogenicity of Tdap compared with Td, and smaller Red Book.studies of second doses of Tdap in nonpregnant persons in Canadaand Finland do not show increased reactogenicity compared withadministration to Tdap-naive persons. Prior studies suggested a pos-sible blunting effect of high pre-vaccine antibody levels on the©Copyright 2013 AAP News Downloaded from by Trisha Korioth on February 13, 2013
  4. 4. CDC recommends Tdap during each pregnancy Sarah S. Long AAP News 2013;34;8 DOI: 10.1542/aapnews.2013342-8Updated Information & including high resolution figures, can be found at:Services & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtmlReprints Information about ordering reprints can be found online: /site/misc/reprints.xhtml Downloaded from by Trisha Korioth on February 13, 2013