When I approach the subject of pertussis vaccination with my pregnant patients, I am often met with blank stares. For better or for worse, everyone talks about the flu shot, but many have not even heard of Tdap. However, in the last 10 years the US had the largest outbreaks of pertussis since the invention of the vaccine in the 1930’s, and sadly, newborn babies are the most vulnerable to the disease. The vaccine is safe and effective in pregnancy, and giving it in the third trimester can help prevent both the mom and her baby from getting sick.
What is pertussis, and why is it so bad for babies?
Pertussis, also known as whooping cough, is a highly contagious bacterial infection that causes a respiratory illness. The bacteria infect the lungs and specifically destroy the cilia, which are the tiny hairs that line the respiratory tract that help remove mucous and debris. As the name so fittingly implies, whooping cough causes a long standing, obnoxious sounding cough. As they gasp for breath in between prolonged coughs, infected people will often make the characteristic “whooping” noise. The coughing spells are so severe, that they will sometimes be followed by vomiting. In adults, the infection rarely requires hospitalization, but the cough can last up to 100 days, which is pretty darn annoying.
Babies on the other hand, really need their cilia to help clear their lungs. Pertussis doesn’t just cause an annoying cough in little ones, it can lead to pneumonia, respiratory failure and even death. Babies are most susceptible to the disease in the first 6 months of life, with most deaths reported in the first 2 months.
Why is pertussis on the rise in the US?
The vaccination you get in childhood does not provide lifelong immunity, so most adults who haven’t had a booster are susceptible to the disease. In adults the initial illness is very similar to a cold, and highly contagious. By the time an adult realizes they actually have pertussis, they have already infected 40% of people around them. Increased rates of non-vaccinated children also likely play a role.
The current childhood vaccine series recommends multiple doses starting at 2 months to be effective. A middle school booster is also recommended at age 10 and the adult booster is good for about 10 years.
Why vaccinate in pregnancy?
Since 50% of babies who get pertussis are infected by their mothers, the CDC recommends that pregnant women receive the Tdap vaccine each pregnancy, ideally between 27-36 weeks. Not only will vaccination in pregnancy prevent the mother from getting pertussis and accidentally spreading it to her new born, but most importantly, when the mom gets the vaccine, she forms antibodies that then cross the placenta and helps protect the baby from infection in those first pivotal months.
While pertussis is on the rise in the US, the good news is that it is preventable by vaccine, and there are steps that we can take to protect our babies. Pregnant women should get the vaccine in the third trimester of each pregnancy. If they don’t get it in pregnancy, they can at least get it postpartum. Additionally, the dads, grandparents and health care workers are also recommended to receive the vaccine in order to create a cocooning effect around the baby.
Dr. Heather Rupe 