USE OF PERTUSSIS/TETANUS/DIPHTHERIA/POLIO VACCINES IN PREGNANCY

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(Date of issue: November 2016, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on pertussis booster vaccine use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

The Joint Committee on Vaccination and Immunisation recommends that all pregnant women in the UK are vaccinated with Boostrix IPV® (a combined, inactivated tetanus/diphtheria/acellular pertussis/polio (Tdap-IPV) vaccine) between 16 and 32 weeks of gestation.
 
Infants under the age of three months are at increased risk of severe complications of pertussis infection, including death. Maternal vaccination between 16 and 32 weeks of pregnancy is thought to optimise the transfer of maternal anti-pertussis antibodies to the fetus, thereby improving immunity in the infant until infant vaccination against pertussis is offered at two months. Women may still be immunised after week 32 of pregnancy until delivery, but this may not offer as high a level of passive protection to the infant. The Department of Health states that women who also require vaccination against diphtheria/tetanus/polio after 16 gestational weeks (such as those with unknown/incomplete vaccination status) can receive a dose of Tdap-IPV in place of Td-IPV, with Td-IPV then used for any remaining doses required to complete the primary schedule.

Risk of congenital malformation or spontaneous abortion following first trimester exposure is undetermined, as vaccination during this stage of pregnancy is uncommon. Since most fetal organs are structurally formed by the end of the first trimester, maternal vaccination after 16 weeks of pregnancy is not expected to increase the risk of congenital malformation in the infant. Data on rates of stillbirth, low birth weight/intrauterine growth restriction, and reduced gestational length following exposure to pertussis vaccine in utero, do not provide any evidence of increased risk of these outcomes. Although data are too limited to rule out fetal risk from vaccination, the risk of neonatal pertussis infection is well-established and there is evidence to support the effectiveness of the maternal pertussis vaccination campaign in reducing rates of neonatal pertussis infection.  

Exposure to pertussis vaccine at any stage in pregnancy would not be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

For information on use of the tetanus/diphtheria/polio vaccine (Td-IPV) in pregnancy please refer to the separate monograph.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.