ACOG committee update on Immunization in Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) has released updated guidelines for Tetanus, Diphtheria, and Pertussis Vaccination (Tdap) in pregnancy.

The Committee Opinion No. 718 was published in September issue of Journal of Obstetrics and Gynecology.

This update is especially important to reduce pertussis infection in newborn through passive immunization. Infants 3 months and younger face high risk of pertussis infection and the earliest possible shot they can receive is at 6 weeks of age, thereby leaving a window when they are vulnerable for infection from close family itself.

Increasing research and study data available since 2013, have shown that if mother receives Tdap during the late second or early third trimester (with at least 2 weeks from the time of vaccination to delivery), it is   highly effective in protecting the infant against neonatal pertussis.

The recommendations state that:

1) All pregnant women should be vaccinated with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap)during each pregnancy between 27–36-weeks-of-gestation period if possible.

2) All pregnant women should be reassured about safety of vaccine during each pregnancy, so that the newborn can be protected against pertussis till he starts with his own vaccination series.

3) All obstetric health care provider should carry the vaccine and administer it to the women during prenatal visits.

4) All family members, caregivers should also be offered the vaccination if not already received. The ideal time for them to receive the vaccine is 2 weeks before the expected arrival of the baby.

5) If not received during pregnancy the women should be vaccinated postpartum, if she has not received Tdap as adolescent, adult or during the previous pregnancy.

6) In certain circumstances, the women can be given the vaccine outside the 27–36 weeks of gestation window like pertussis outbreak in the community or managing a wound.

7) If she receives the vaccine outside the 27–36 weeks of gestation window, she need not be again given a second dose during 27–36 weeks.

Full Text of Committee Opinion.