Safety of pertussis vaccination in pregnant women in UK: observational study

Donegan, Katherine; King, Bridget; Bryan, Phil

doi:10.1136/bmj.g4219

Cited by 253 publications

(197 citation statements)

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“…The available scientific evidence indicates that maternal pertussis vaccination with Tdap is safe among pregnant women, their fetus and the newborn [10,15]. In a clinical trial with crossover design assessing the safety and immunogenicity of Tdap, local reactions were reported during pregnancy in 79% of vaccinated women, versus 80% after pregnancy.…”

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confidence: 99%

“…Some countries have recommended only the cocooning strategy; however, this option has proven challenging to implement [14], requiring significant resources in order to vaccinate multiple family contacts. Other strategies have been considered, such as adolescent vaccination; however, this one is unlikely to show clear benefits to infants by itself [1].The available scientific evidence indicates that maternal pertussis vaccination with Tdap is safe among pregnant women, their fetus and the newborn [10,15]. In a clinical trial with crossover design assessing the safety and immunogenicity of Tdap, local reactions were reported during pregnancy in 79% of vaccinated women, versus 80% after pregnancy.…”

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Protecting newborns against pertussis: the value of vaccinating during pregnancy

Vilajeliu

García‐Basteiro

Bayas

2015

Expert Review of Vaccines

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Resurgence of pertussis has recently been reported in several countries with long-standing pertussis immunization and high vaccination coverage. This situation requires consideration of alternative immunization strategies to protect newborns. In the absence of a vaccine that confers long-lasting immunity, maternal vaccination for pertussis during pregnancy seems to be a safe, immunogenic, effective and accepted strategy to protect infants during the first weeks of life. The existing scientific evidence provides the grounds for pregnant women and healthcare workers to make informed decisions regarding this measure as well as for countries with high pertussis-related infant morbidity and mortality that should consider implementation. Furthermore, this could be a promising strategy to address other vaccine-preventable diseases of pregnancy and the neonatal period.Pertussis is currently a major cause of infant morbidity and mortality worldwide and an emerging public health concern. A resurgence of pertussis cases has recently been reported in several countries with long-standing pertussis immunization and high vaccination coverage such as Spain [1], the USA [2] and the UK [3]. Although the reasons have not been fully elucidated, the improved availability of methods to confirm diagnoses (e.g., PCR), the increased awareness for diagnosis and reporting among health professionals, the different efficacy against disease and infection between whole cell and acellular vaccine, the pathogen adaptation or waning of natural or vaccine immunity during periods of low pertussis activity are thought to play an important role in the current trends of the disease [4]. Neither pertussis natural infection nor vaccination induces lifelong immunity; it has been estimated that only 10% of children will be protected 8.5 years after last dose of Tdap [5]. However, vaccination is the most effective way to combat whooping cough epidemics.Cases increased in several countries in 2011, including high incidence in adulthood. Severe morbidity and mortality from pertussis are concentrated in infants aged <3 months. For example, in 2010, California reported an incidence of 445.9 per 100,000 infants <6 months of age [2], and in 2011, Spain reported an incidence of clinically reported cases higher than 500 cases per 100,000 infants <3 months of age. In the period between 2007 and 2010, there was an increase in infant mortality due to pertussis, being 3.75 deaths per year, compared to 1 death per year in the period 1997-2007 [1]. In UK, 48 deaths in infants under 1 year of age were identified between 2001 and 2011 [3]. In adolescents and adults, pertussis almost always presents as persistent cough, often of undiagnosed cause, and these cases (mainly the parents) are the main sources of infection to susceptible children [1].The current situation requires consideration of alternative immunization strategies to protect newborns. Editorial provided an opportunity of global review of pertussis epidemiology, as well as newly available data on effectiveness...

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Protecting newborns against pertussis: the value of vaccinating during pregnancy

Vilajeliu

García‐Basteiro

Bayas

2015

Expert Review of Vaccines

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“…La vacuna dTpa se ha utilizado en el embarazo y ha sido bien tolerada y no se ha asociado a complicaciones en la gestación, en el feto 29 , o el recién nacido [30][31][32][33] . Asimismo, en los seguimientos de lactantes hijos de madres vacunadas no se han observado trastornos del desarrollo psicomotor o del crecimiento de los niños [30][31][32][33][34] .…”

Section: Estrategias Propuestasunclassified

Estrategias para proteger al recién nacido y lactante menor de 6 meses de la coqueluche: Posición del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología (CCI)

Potı́n¹,

Fíca²,

Véliz³

et al. 2016

Rev. chil. infectol.

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, en representación del CCI Strategies to protect the newborn and infants under 6 months of age against pertussis. Statement of the Advisory Committee for Immunizations of the Chilean Infectious Diseases SocietyIn recent years there have been Pertussis outbreaks not seen in the last 50 years affecting adults, adolescents and children and causing deaths in young unvaccinated infants. In Chile an outbreak of Pertussis started in year 2011, leaving 16 infants less than 3 months dead during this year, twice the number seen in a non epidemic year. These children were infected before receiving the programmatic vaccines indicated at 2, 4 and 6 months of age, usually from close contacts, especially their mothers. Pertussis control has not been possible for several reasons, such as limited immunity duration of available vaccines and their poor impact on nasopharyngeal carriage, situation that keeps the agent's circulation and transmission, condition often asymptomatic or unrecognized. Additionally, the use of acellular vaccines appears to be a determining factor because they induce an immune response with poor immune memory and consequently a short time duration. The acellular vaccines with reduced antigen content, available for adolescents and adults, has allowed the evaluation of various strategies but none has succeeded in reducing infant mortality. Recently a new strategy of vaccinating pregnant women against Pertussis in the second or third semester has shown remarkable results reducing up to 90% infant deaths due to Pertussis infection. This strategy prevents mother´s infection avoiding child infection through respiratory droplets and also provides the child with antibodies from placental transmission. Improved pertussis vaccines are required, in the meantime the Committee considers that the pregnant immunization strategy, between the 27 and 36 weeks, with acellular pertussis vaccine should be included in our national vaccine program.Key words: Pertussis infection, whooping cough, maternal immunization. Palabras clave: Coqueluche, tos ferina, vacunación materna. Situación epidemiológicaL a coqueluche o tos convulsiva, constituye junto al sarampión, una de las dos enfermedades inmunoprevenibles de mayor transmisibilidad, siendo cada una de ellas capaz de enfermar cerca de 12 a 17 personas susceptibles. A pesar del uso de vacunas eficaces por más de 60 años, la coqueluche continúa siendo un problema de salud pública provocando anualmente unas 200.000 muertes de lactantes en el mundo 1 . En forma cíclica, cada dos a cinco años ocurren brotes epidémicos, incluso en países con altas coberturas de vacunación y entre los años 2010 y 2012 se alcanzaron las incidencias más altas de los últimos 20 a 50 años en países desarrollados como E.U.A. . Estos aumentos de la incidencia afectan a lactantes bajo 6 meses de edad, que por su edad no han iniciado la vacunación o no la han completado o tampoco poseen ya inmunidad pasiva transferida desde la madre. Los brotes también afectan a escolares o adolescentes y adultos, en los que ...

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“…41,43 Both randomized clinical trials and cohort studies also support the safety of pertussis vaccination in pregnancy, finding no increase in pregnancy complications, 42 46 or stillbirth. 45 One cohort study identified a slight increase in chorioamnionitis following pertussis vaccination during pregnancy. 47 A subsequent review of the VAERS system for all reports of chorioamnionitis showed that the condition is uncommonly reported following vaccination during pregnancy and 58% of women who report chorioamnionitis had at least one risk factor predisposing them to the condition.…”

Section: Acellular Pertussis Vaccinementioning

confidence: 99%

The safety of maternal immunization

Regan

2016

Human Vaccines & Immunotherapeutics

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Maternal vaccination offers the opportunity to protect pregnant women and their infants against potentially serious disease. As both pregnant women and their newborns are vulnerable to severe illness, the potential public health impact of mass maternal vaccination programs is remarkable. Several highincome countries recommend seasonal influenza and acellular pertussis vaccines, and many developing countries recommend immunization against tetanus during pregnancy. There is a significant amount of literature supporting the safety of vaccination during pregnancy. As other vaccines are newly introduced for pregnant women, routine systems for monitoring vaccine safety in pregnant women are needed. To facilitate meta-analyses and comparison across systems and studies, future research and surveillance initiatives should utilize the same criteria for defining adverse events following immunization among pregnant women. At least 2 areas require further exploration: 1) identification of pregnancy outcomes associated with concomitant and closely spaced vaccines; 2) evaluation of possible improvement in birth outcomes associated with maternal vaccination. Given the public health impact of maternal vaccination, the existing evidence supporting the safety of vaccination during pregnancy should be used to reassure pregnant women and their providers and improve vaccine uptake in pregnancy.

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Safety of pertussis vaccination in pregnant women in UK: observational study

Cited by 253 publications

References 10 publications

Protecting newborns against pertussis: the value of vaccinating during pregnancy

Protecting newborns against pertussis: the value of vaccinating during pregnancy

Estrategias para proteger al recién nacido y lactante menor de 6 meses de la coqueluche: Posición del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología (CCI)

The safety of maternal immunization

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