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Apr 23 2014

Why I Changed My Mind About the Tdap Vaccine Booster

By at 11:22 am

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I’m entering into my ninth month of pregnancy; I’ve lost all verbal filters that I normally employ and for the most part I either explode or cry. I wasn’t this bad when I was pregnant with the boys (although I was still, admittedly, super crazy) and perhaps it is a combination of managing my 4-year-old’s emotions and chasing after my toddler with fierce hip pain and heartburn, but I want to verbally assault anyone who even looks at me wrong. I’m cranky. So that’s where I’m at.

Around my 27 week prenatal visit my midwives gave me a generic CDC handout offering me a Tdap (Tetanus/Diphtheria/Pertussis) booster. The standard guidelines are for the vaccine to be boostered every 10 years and the sheet also said “or with each pregnancy.” Since I was boostered 18 months ago when my second son was born I felt like it was overkill to do it again. I asked both the midwives and my children’s pediatrician what the rationale behind the “with each pregnancy” was and neither had any convincing talking points. The midwife said, “there may be waning immunity during pregnancy.”

I am not one to decline vaccines. My husband is a doctor and we both have Master of Public Health degrees. But I like to educate myself about the options and make a decision based on current evidence-based research coupled with our personal family circumstances (or, like, just go with the opposite of anything Jenny McCarthy says). The information provided wasn’t compelling enough for me to vaccinate myself again. I had just finished up 20 weeks of painful progesterone injections and have bruised hips to show for it. More needles? No, thanks.

With every visit I’ve had since, I’ve been offered the Tdap and declined it. I was getting so sick of declining the vaccine that I decided to dig around for some literature (or lack thereof) to support my decision.

What I found led to me having a very painful Tdap booster in my deltoid last week.

According to the Centers for Disease Control, in October 2012, the immunization advisory committee recommended that providers, “administer Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant.”

While it is a combination vaccine, the main factor in this recommendation change is with respect to pertussis (whooping cough, a highly contagious respiratory disease) which is on the rise, particularly in areas where community immunity is compromised because of parental refusal of vaccination. Pertussis is particularly life-threatening to infants under 6 months of age, many of which are hospitalized or even die. In many cases, mothers passed pertussis on to their infants because of waning immunity during pregnancy. This part I understood but felt that since I had just been boostered the likeliness was low. HOWEVER, what wasn’t communicated to me was that transplacental transfer (mama-to-baby during pregnancy) of maternal pertussis antibodies provides some protection against pertussis in early life, before infants are able to receive the primary DTaP (at age 2 months). The ideal time to be vaccinated during pregnancy is between 27 and 36 weeks, because it takes about two weeks for maternal antibody levels to peak. This allows enough time for those antibodies to be transferred to the fetus and can continue to be passed in minimal levels through breast milk.

There is some minimal risk to receiving multiple does of the tetanus portion of the vaccine in a 2-year period, but, for me the risks are completely overshadowed by the benefits of passing even some immunity of a life-threatening disease to my unborn child.

Other ways to protect infants from pertussis include encouraging close contacts (grandparents, caregivers) of your infant to be up-to-date with their pertussis vaccine/booster (cocooning) and vaccinating children with DTaP according to the childhood immunization schedule.

The factors that led me to ultimately choose to revaccinate myself where these:

1. I have a child currently in preschool, surrounded by other children whose vaccine or exposure histories I don’t know.

2. I have a toddler who has yet to be fully vaccinated against pertussis (vaccine efficacy is 80 to 85 percent following  three doses of DTaP vaccine) therefore weakening the cocooning effect in our immediate family.

3. The factor that may have pushed me over the edge is that we will be flying across the country with our newborn when she is not yet 7 weeks old.

As vaccinating parents, we sometimes feel we are at the mercy of those who choose not to vaccinate and that can lead to feelings of anger and resentment. I’ve yet to read a civil discussion about vaccines between two opposing parties that resulted in behavior change. But instead of feeling helpless, we can educate ourselves and protect our own children to the best of our ability.

This isn’t a “pro-vax vs. anti-vax” post, everyone needs to make the choice that is right for their family, but I wanted to share the information that resulted in my change of heart. Yes, I am cranky and pregnant but I am glad my provider nagged me about this particular issue because it forced me to seek out the information I needed to make an educated decision for my family. If nothing else I’m encouraging anyone and everyone to ask questions and demand current evidence-based information. Doing something to protect my unborn child feels good and this cranky Mama really needed to feel good about something these days.

DTaP is the vaccine that helps children under 7 develop immunity to diphtheria, tetanus, and pertussis. Tdap is the booster that offers continued protection for adolescents and adults. Information about Tdap for pregnant women can be found at CDC.gov.

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