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Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S.
Am J Prev Med. 2018 08; 55(2):159-166.AJ

Abstract

INTRODUCTION

It is recommended that all pregnant women in the U.S. receive tetanus, diphtheria, acellular pertussis (Tdap) immunization to prevent infant pertussis. This study's objective was to examine the clinical effectiveness of prenatal Tdap, and whether effectiveness varies by gestational age at immunization.

METHODS

A nationwide cohort study of pregnant women with deliveries in 2010-2014 and their infants was performed. Commercial insurance claims data were analyzed in 2016-2017 to identify Tdap receipt by the pregnant women, and hospitalizations and outpatient visits for pertussis in their infants until the infants reached 18 months of age. Pertussis occurrence was compared between infants of mothers who received prenatal Tdap (overall and stratified by gestational age at administration) and infants of unvaccinated mothers.

RESULTS

There were 675,167 mother-infant pairs in the cohort. Among infants whose mothers received prenatal Tdap, the rate of pertussis was 43% lower (hazard ratio=0.57, 95% CI=0.35, 0.92) than infants whose mothers did not receive prenatal or postpartum Tdap; this reduction was consistent across pertussis definitions (hazard ratio for inpatient-only pertussis=0.32, 95% CI=0.11, 0.91). Pertussis rates were also lower for infants whose mothers received Tdap during the third trimester. Infants whose mothers received Tdap at <27 weeks of gestation did not experience reductions in pertussis rates (hazard ratio for pertussis=1.10, 95% CI=0.54, 2.25).

CONCLUSIONS

Infants of mothers who received prenatal Tdap experienced half the rate of pertussis as compared with infants of unimmunized mothers. These results do not provide evidence to support changing the currently recommended timing of Tdap administration in pregnancy.

Authors+Show Affiliations

Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: sbd@unc.edu.Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.NoviSci, LLC, Durham, North Carolina.Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI Health Solutions, Research Triangle Park, North Carolina.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29910115

Citation

Becker-Dreps, Sylvia, et al. "Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S." American Journal of Preventive Medicine, vol. 55, no. 2, 2018, pp. 159-166.
Becker-Dreps S, Butler AM, McGrath LJ, et al. Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S. Am J Prev Med. 2018;55(2):159-166.
Becker-Dreps, S., Butler, A. M., McGrath, L. J., Boggess, K. A., Weber, D. J., Li, D., Hudgens, M. G., & Layton, J. B. (2018). Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S. American Journal of Preventive Medicine, 55(2), 159-166. https://doi.org/10.1016/j.amepre.2018.04.013
Becker-Dreps S, et al. Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S. Am J Prev Med. 2018;55(2):159-166. PubMed PMID: 29910115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S. AU - Becker-Dreps,Sylvia, AU - Butler,Anne M, AU - McGrath,Leah J, AU - Boggess,Kim A, AU - Weber,David J, AU - Li,Dongmei, AU - Hudgens,Michael G, AU - Layton,J Bradley, Y1 - 2018/06/14/ PY - 2017/09/01/received PY - 2018/03/13/revised PY - 2018/04/06/accepted PY - 2018/6/19/pubmed PY - 2019/10/8/medline PY - 2018/6/19/entrez SP - 159 EP - 166 JF - American journal of preventive medicine JO - Am J Prev Med VL - 55 IS - 2 N2 - INTRODUCTION: It is recommended that all pregnant women in the U.S. receive tetanus, diphtheria, acellular pertussis (Tdap) immunization to prevent infant pertussis. This study's objective was to examine the clinical effectiveness of prenatal Tdap, and whether effectiveness varies by gestational age at immunization. METHODS: A nationwide cohort study of pregnant women with deliveries in 2010-2014 and their infants was performed. Commercial insurance claims data were analyzed in 2016-2017 to identify Tdap receipt by the pregnant women, and hospitalizations and outpatient visits for pertussis in their infants until the infants reached 18 months of age. Pertussis occurrence was compared between infants of mothers who received prenatal Tdap (overall and stratified by gestational age at administration) and infants of unvaccinated mothers. RESULTS: There were 675,167 mother-infant pairs in the cohort. Among infants whose mothers received prenatal Tdap, the rate of pertussis was 43% lower (hazard ratio=0.57, 95% CI=0.35, 0.92) than infants whose mothers did not receive prenatal or postpartum Tdap; this reduction was consistent across pertussis definitions (hazard ratio for inpatient-only pertussis=0.32, 95% CI=0.11, 0.91). Pertussis rates were also lower for infants whose mothers received Tdap during the third trimester. Infants whose mothers received Tdap at <27 weeks of gestation did not experience reductions in pertussis rates (hazard ratio for pertussis=1.10, 95% CI=0.54, 2.25). CONCLUSIONS: Infants of mothers who received prenatal Tdap experienced half the rate of pertussis as compared with infants of unimmunized mothers. These results do not provide evidence to support changing the currently recommended timing of Tdap administration in pregnancy. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/29910115/Effectiveness_of_Prenatal_Tetanus_Diphtheria_Acellular_Pertussis_Vaccination_in_the_Prevention_of_Infant_Pertussis_in_the_U_S_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(18)31696-9 DB - PRIME DP - Unbound Medicine ER -