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Summary for primary care

Pertussis Vaccination Programme for Pregnant Women: Information for Healthcare Practitioners

Latest Guidance Updates:

6 September 2021: new guidance and information on COVID-19 and dTaP/IPV vaccines

Overview

This Guidelines summary covers guidance on the pertussis (whooping cough) vaccination programme for pregnant women, which commenced on 1 October 2012. This summary includes guidance on:

  • the aim of the pertussis vaccination programme for pregnant women
  • recommended vaccine for the programme
  • vaccine administration
  • inadvertent vaccine administration errors
  • further information sources
For more information, see the full guideline.

Reflecting on your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Pertussis Vaccination Programme for Pregnant Women

Aim of the Programme

  • To protect infants by boosting pertussis immunity in pregnant women. Although most women will have been vaccinated or exposed to natural whooping cough in childhood, if they are given pertussis containing vaccine from week 16 of pregnancy, the vaccine will temporarily boost their antibody levels. This enables the mother to transfer a high level of pertussis antibodies across the placenta to her unborn child which should passively protect her infant against pertussis until he/she is due the first dose of primary immunisations at 8 weeks of age
  • Although it is recommended that women are offered the vaccine between weeks 16­–32 of pregnancy, women may still be immunised after week 32 of pregnancy until delivery. However, this may not offer as high a level of passive protection to the baby, particularly if they are born pre-term.

Safety of Vaccine Administration During Pregnancy

  • There are no concerns about the safety of pertussis containing inactivated vaccine at any stage in pregnancy. Inactivated vaccines contain no live organisms, cannot replicate and therefore cannot cause infection in either the mother or the fetus.

Women Beyond 32 Weeks of Pregnancy

  • If the woman reaches 38 weeks of pregnancy and has not received the vaccine, it should still be offered. Although immunisation after week 38 of pregnancy may not provide passive protection to the infant, it would potentially protect the mother from pertussis infection and reduce the risk of her becoming a source of infection to her infant
  • If the pregnant woman has not had the vaccine by the time she goes into labour, it can still be offered, but as antibody levels in adults peak about 2 weeks after a pertussis booster, there would be insufficient time for the mother to make a good response and have antibodies to pass across the placenta.

Postnatal Vaccination

  • Women who did not receive pertussis-containing vaccine during pregnancy can be offered it in the 2 months following birth (up until their child receives their first dose of pertussis-containing vaccine). This will protect the woman and may prevent her from becoming a source of infection for the infant, but will not provide direct protection for the infant.

Pregnant Women and Women Presenting Shortly After Giving Birth with an Incomplete or Unknown Vaccination History (Primary Vaccination Against Diphtheria, Tetanus and Polio)

  • Women who have not completed a primary course of three doses of tetanus, diphtheria, and polio-containing vaccines may be offered these while they are pregnant. The relevant chapters of the Green Book (Immunisation against infectious disease) advise that tetanus, diphtheria and polio-containing vaccines ‘may be given to pregnant women when the need for protection is required without delay’
  • There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Chapter 6: contraindications and special considerations)
  • If a course of tetanus-, diphtheria-, and polio-containing vaccination is commenced before week 16 of pregnancy, a 4-week interval should be left between each dose
  • Once the woman reaches 16 weeks of pregnancy or around the time of her fetal anomaly scan, she should be offered a dose of diphtheria, tetanus, and pertussis/inactivated poliovirus vaccine (dTap/IPV), preferably 4 weeks after any tetanus, diphtheria, and inactivated poliovirus vaccine (Td/IPV) dose that has been given. The dose of dTaP/IPV offered should be counted as one of the three primary doses of tetanus, diphtheria, and polio vaccines if this primary course has not been completed
  • Women who have not completed their primary course of Td/IPV-containing vaccinations by the end of their pregnancy should be offered any outstanding doses
  • The dTaP/IPV they received in pregnancy should be counted as one of their primary doses and any outstanding doses should be given as Td/IPV vaccine. See Vaccination of individuals with uncertain or incomplete immunisation status
  • Any other outstanding vaccines should also be offered as appropriate. As the measles, mumps, and rubella vaccine is a live vaccine, and live vaccines are contraindicated during pregnancy, any woman who has not completed a two-dose course prior to their pregnancy should receive it after the baby is born (which may be at the 6–8 week check if it has not been possible to offer it before this).

Breastfeeding Mothers

  • dTaP/IPV vaccine can be given to women who plan to breastfeed.
  • Low-dose diphtheria, tetanus, pertussis (acellular component) and poliomyelitis (inactivated) vaccine (dTaP/IPV) should be used for this programme
  • dTaP/IPV vaccine is a prescription-only medicine and immunisers should refer to the Pertussis vaccination in pregnancy, dTaP/IPV patient group directions for full information on the supply and administration of it.

Vaccine Supply for this Programme

  • Boostrix-IPV vaccine is the main supply for this programme. This has recently changed from Repevax. Both Boostrix-IPV and Repevax vaccines are equivalent and either of these vaccines can be used for this vaccination programme
  • Vaccines can be ordered via Immform and are provided free of charge for this programme.

Single-antigen Pertussis Vaccine

  • Monovalent pertussis vaccines are not available. Pregnant women requesting monovalent vaccine should be reassured of the safety and efficacy of dTaP/IPV vaccine during pregnancy.

Vaccine Administration

  • dTaP/IPV is supplied as a 0.5 ml dose in a prefilled syringe and should be administered as a single intramusclar injection into deltoid region of the upper arm
  • Healthcare professionals are encouraged to read the patient group directions and the summary of product characteristics prior to administration to familiarise themselves with the product.

Vaccine Contraindications

  • Vaccines should not be administered to those who have had:
    • confirmed anaphylactic reaction to a previous dose of pertussis containing vaccine or
    • confirmed anaphylactic reaction to any component of the vaccine, including neomycin or polymyxin.

Administering dTaP/IPV Vaccine at the Same Time as Anti-D Treatment

  • dTaP/IPV is an inactivated vaccine which will not be affected by, nor interfere with, anti-D treatment. The administration of TdaP/IPV vaccine should not be delayed due to the individual receiving anti-D treatment.

Pregnant Women Previously Vaccinated Against Pertussis

  • If a pregnant woman received a pertussis-containing vaccine before week16 of her pregnancy, either in error or for occupational or contact reasons, then she should be offered a second dose when she reaches 16 weeks of pregnancy or around the time of her antenatal fetal anomaly scan
  • The dose should be repeated to maximise the antibodies she can transfer across the placenta to her unborn baby. If a repeat dose is required, there should be an interval of at least 4 weeks from the previous dose to minimise the risk of local reaction
  • If a pregnant woman has received a dose of pertussis-containing vaccine after week 16 of pregnancy for occupational or contact reasons, this should be counted as a valid dose and she would not need a repeat dose.

Influenza Vaccine and dTaP/IPV Vaccines

  • The seasonal influenza vaccine should be offered to women at any stage of pregnancy during ‘flu season’, which is usually from September each year. dTaP/IPV should be offered to women from 16 weeks of pregnancy regardless of the time of year
  • Both vaccines are inactivated vaccines containing different antigens and therefore may be administered at the same time or at any interval from each other. No minimum interval needs to be observed between these vaccines
  • Both vaccines should be given at the recommended time and vaccination should not be delayed, to reduce the number of appointments required.

COVID-19 Vaccine and dTaP/IPV Vaccines

  • Because of wider experience with the Pfizer BioNTech and Moderna vaccines, these two vaccines are the preferred vaccines to offer to pregnant women aged 18 years and over. Pfizer vaccine is recommended for use in those under the age of 18 years
  • Clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the limited evidence of safety for the vaccine in pregnancy. Further information on the COVID-19 vaccination programme can be found in chapter 14a of the Green Book and COVID-19 vaccination: information for healthcare practitioners.

dTaP/IPV Following Administration of a Td/IPV (Revaxis) Vaccine

  • Please also refer to the section, Pregnant Women and Women Presenting Shortly After Giving Birth with an Incomplete or Unknown Vaccination History (Primary Vaccination Against Diphtheria, Tetanus, and Polio) in the section, Pertussis Vaccination Programme for Pregnant Women
  • If Td/IPV vaccine has been given as part of a primary course, a 4-week minimum interval period is normally recommended to be observed before dTaP/IPV is given to ensure an adequate response. There is good evidence to suggest that dTaP/IPV may be administered to adults as soon as 1 month after Td/IPV (Revaxis) without significantly increasing the frequency or severity of side effects.

Inadvertent Vaccine Administration Errors

DTaP/IPV Administered Before 16 Weeks of Pregnancy

  • If the dose was given before 16 weeks of pregnancy, it should be repeated once the woman reaches 16 weeks of pregnancy or around the time of her fetal anomaly scan. A minimum interval of 4 weeks between doses should be observed to reduce the risk of a local reaction. Repeating the dose will ensure that the unborn baby benefits from optimal transfer of maternal antibodies.

DTaP/IPV/Hib Hep B (Infanrix Hexa) Vaccine Administered in Error

  • Women who have inadvertently received DTaP/IPV/Hib Hep B (Infanrix hexa) instead of the recommended dTap/IPV vaccine should be reassured that Infanrix hexa does offer protection against pertussis and that no further action is required
  • Such women should also be advised that Infanrix hexa contains a high dose of diphtheria that is not normally given to adults because it is more likely to cause a localised reaction. Women who have inadvertently received Infanrix hexa should be informed of the higher risk of localised reactions
  • Healthcare professionals should report the administration error via their local governance system(s), so that the appropriate action can be taken, lessons can be learned, and the risk of future errors minimised.

Td/IPV (Revaxis) Vaccine Administered in Error

  • As Td/IPV vaccine (Revaxis) does not protect against pertussis, a dose of dTaP/IPV should be given as soon as possible after the error is realised
  • Healthcare professionals should report the administration error via their local governance system(s), so that the appropriate action can be taken, lessons can be learned, and the risk of future errors minimised.

Hib/MenC (Menitorix) Vaccine Administered in Error

  • Due to the packaging similarities between one of the dTaP/IPV vaccines (Boostrix-IPV) and Menitorix, healthcare professionals are encouraged to familiarise themselves with the two vaccines so that vaccine errors do not occur. See page 8 of Vaccine Update April 2014 and the visual guide to vaccines poster
  • Women who have inadvertently received Menitorix instead of the recommended Boostrix-IPV should be reassured that there is no known risk as this is an inactivated vaccine
  • There is no known risk associated with giving inactivated vaccines at any stage of pregnancy. As Menitorix does not protect against pertussis, a dose of dTaP/IPV vaccine should be administered as soon as possible after the error is realised
  • Healthcare professionals should report the administration error via their local governance system(s) so that the appropriate action can be taken, lessons can be learned and the risk of future errors minimised.

Primary Vaccination of Infants whose Mother Did Not Receive Pertussis Vaccine During Pregnancy

  • The best way to protect newborn babies from pertussis is to make sure that the baby has benefitted from the transfer of maternal antibodies before it was born
  • The Green Book (chapter 11) advises that immunisations should not be given before the scheduled age unless there is a clear clinical indication for this
  • Administering the first set of primary immunisations before 6 weeks of age is not recommended, as it may result in a sub-optimal response to the vaccine which could undermine good control.

Further Information


References


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