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Overview

This Guidelines summary covers guidance on the pertussis (whooping cough) vaccination programme for pregnant women, including:

  • recommended vaccine for the programme
  • vaccine administration
  • inadvertent vaccine administration errors
  • further information sources.

For more information, see the full guideline.

This summary has been abridged for print. View the full summary at guidelines.co.uk/455523.article.

Pertussis vaccination programme for pregnant women

Aim of the programme

The aim of the programme is 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 foetus.

Women beyond 32 weeks of pregnancy

The vaccine can be offered to pregnant women up until they go into labour. However, this is not the optimal time for immunisation since antibody levels in adults peak about 2 weeks after a pertussis booster. A vaccine administered shortly before labour may mean that there is insufficient time for the mother to make a good response and have antibodies to pass across the placenta.

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.

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 3 doses of tetanus, diphtheria and polio containing vaccines may be offered these whilst 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 foetal anomaly scan, she should be offered a dose of dTaP/IPV vaccine, preferably 4 weeks after any Td/IPV dose that has been given. The dose of dTaP/IPV offered should be counted as one of the 3 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 tetanus, diphtheria and polio (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 PHE Vaccination of individuals with uncertain or incomplete immunisation status.

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 PGD for full information on the supply and administration of it.

Since 1 July 2014, the recommended vaccine for the programme has been Boostrix-IPV (dTaP/IPV), which is licensed as a booster from 4 years of age and contains low dose diphtheria suitable for adults. Repevax (dTaP/IPV) vaccine may be used as an alternative if Boostrix vaccine is not available.

Boostrix-IPV and Repevax can be ordered via Immform and are provided free of charge for this programme.

Repevax (dTaP/IPV) vaccine as an alternative to Boostrix-IPV (dTaP/IPV)

Although Boostrix-IPV replaced Repevax (dTaP/IPV) From 1 July 2014 as the recommended vaccine for this programme, either vaccine is suitable for the vaccination of pregnant women to protect their unborn babies from pertussis.

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 pre-filled syringe and should be administered as a single intramusclar injection into deltoid region of the upper arm.

Healthcare professionals are encouraged to read the PGD and the Summary of Product Characteristics (SmPC) prior to administration to familiarise themselves with the product.

Vaccine contraindications

There are few individuals who cannot receive pertussis containing vaccines. The vaccines should not be administered to those who have had:

  • a confirmed anaphylactic reaction to a previous dose of pertussis containing vaccine or
  • a 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 week 16 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 foetal 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.

dTaP/IPV following administration of a Td/IPV (Revaxis) vaccine

Please also refer to Pregnant women and women presenting shortly after giving birth with an incomplete or unknown vaccination history (primary vaccination against diphtheria, tetanus and polio).

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 foetal 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.

Infanrix hexa (DTaP/IPV/Hib Hep B) vaccine administered in error

Women who have inadvertently received Infanrix hexa (DTaP/IPV/Hib/HepB) 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.

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.

Menitorix (Hib/MenC) 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 2 vaccines so that vaccine errors do not occur. Please 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, which means that it doesn’t contain any live organisms. Since inactivated vaccines cannot replicate, they cannot cause infection in either the mother or her baby.

There is no known risk associated with giving inactivated vaccines at any stage of pregnancy. As Menitorix (Hib/Men C) 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 benefited 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. The first set of primary immunisations can be given from 6 weeks of age if required in certain circumstances such as travel to an endemic country.

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.’

The schedule has been designed to provide optimum protection for infants at the earliest opportunity. Administering vaccines early may have a negative impact on the immune response that the infant makes.

Once a baby starts their routine vaccination schedule, it is important that they have all their vaccines at the recommended time.

Further information

© Crown copyright 2020 Public Health England. Vaccination against pertussis (whooping cough) for pregnant women. Available from: www.gov.uk/government/publications/vaccination-against-pertussis-whooping-cough-for-pregnant-women

Contains public sector information licensed under the Open Government Licence v3.0.

Published date: 24 June 2014.

Last updated: 2 July 2020.