Pertussis has resurged in the United States recently with 10,000 to 50,000 cases reported each year since 2010. More cases were seen in 2012 than in the past 60 years (Centers for Disease Control and Prevention [CDC], 2015). More than half of infants <1 year old with pertussis require hospitalization; those <6 months old are especially vulnerable to serious complications, which may include apnea, pneumonia, and death. No vaccine is available for newborns. Infants are eligible for their primary series of the diphtheria, tetanus, and acellular pertussis vaccine (DTaP) series at 2, 4, and 6 months of age, leaving them without immunity in the first few months of life. Maternal vaccination with tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) during pregnancy, especially when administered between 27 and 36 weeks, confers passive immunity to infants and may help protect them from pertussis infection in their first few months of life (CDC, 2013).
In 2013, the CDC updated recommendations for the Tdap vaccine in pregnancy to include vaccinating women in each pregnancy regardless of prior immunization. This recommendation, endorsed by the American College of Obstetricians and Gynecologists (ACOG, 2013), is based on data indicating that maternal antipertussis antibodies wane quickly over time and that routine Tdap vaccination does not provide sufficient antibody levels to protect newborns (CDC). Other family members and caregivers should also receive the Tdap vaccine at least 2 weeks before any planned contact in order to further protect the infant. This "cocooning" approach provides protection through decreased exposure to the disease (CDC). One study reported that 77% of obstetricians planned to offer Tdap to their pregnant patients after receiving ACOG's immunization toolkits (Jones, Carroll, Hawks, McElwain, & Schulkin, 2016). Although this indicates improvement over earlier data, coverage is likely still suboptimal (Jones et al.). See table for CDC and ACOG recommendations. Given severe morbidity and mortality associated with pertussis in newborns, perinatal nurses can play a central role in improving maternal and infant health by encouraging pregnant women to get the vaccine.
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