Ask the Experts: Tetanus: Tdap and Pregnancy

Results (11)

Yes. Tdap vaccination is routinely recommended to be given at 27 through 36 weeks’ gestation during every pregnancy. This CDC recommendation is endorsed by the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Tdap given during one pregnancy will not provide sufficient protection for subsequent pregnancies. In June 2011 ACIP first voted to recommend that pregnant people who have never received the Tdap vaccine be vaccinated to optimize the concentration of maternal antibodies transferred to the fetus. ACIP made this recommendation with the goal of protecting newborns with maternal antibodies and decreasing the risk of transmission of pertussis to infants shortly after birth. In October 2016, ACIP voted to recommend administering Tdap vaccination early in the 27- through 36-week “window” to maximize passive antibody transfer to the infant. Mothers who have never received Tdap and who do not receive it during pregnancy should receive it immediately postpartum.

Fewer babies are hospitalized for pertussis when Tdap is given during pregnancy rather than during the postpartum period. A large U.S. study found an 85% reduction in the risk of pertussis in infants under 2 months of age whose mothers were vaccinated with Tdap at 27 through 36 weeks’ gestation, compared to infants whose mothers were vaccinated in the hospital immediately following delivery.

When a mother gets Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, protecting the baby against pertussis in early life, before the baby is old enough to have received vaccination with DTaP. Tdap also protects the mother, making it less likely that she will get infected with pertussis during or after pregnancy.

Recommendations for the use of Tdap in pregnancy are covered in detail here: www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

A CDC evaluation found Tdap vaccination during the third trimester of pregnancy prevents 78% of pertussis cases in infants younger than 2 months of age. These findings are similar to other studies from the United Kingdom and the United States that suggest that vaccinating the mother during pregnancy is highly effective at protecting infants against pertussis.

When infants do get pertussis, their infection is less severe if their mother received Tdap during pregnancy. A CDC evaluation found maternal vaccination is 90% effective at preventing infant hospitalization from pertussis. Another U.S. study showed that infants whose mothers got Tdap during pregnancy had a significantly lower risk of hospitalization and shorter hospital stays. That same study showed that no infants born to vaccinated mothers required intubation or died of pertussis.

Links to published research on Tdap vaccination during pregnancy are available here: www.cdc.gov/pertussis/hcp/vaccine-recommendations/pregnancy-research.html.

Last reviewed: March 31, 2022

Yes. If there is no written documentation that she received a dose of Tdap prior to or during pregnancy, a dose of Tdap should be administered to her immediately postpartum.

Last reviewed: March 31, 2022

The recommended schedule for the primary series given to an unvaccinated person is dose 1 now, dose 2 in 4 weeks, and dose 3 in 6 to 12 months. Tdap should replace at least 1 dose of Td, preferably between 27 and 36 weeks’ gestation to maximize the maternal antibody response and passive antibody transfer to the infant.

Last reviewed: March 31, 2022

Yes. ACIP looked into this issue and included related information in its recommendations published in MMWR on February 22, 2013 (www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm). ACIP reviewed available data on birth statistics and found that among those in the U.S. who have more than one pregnancy, a very small percentage (2.5%) have an interval of 12 months or less between births. The majority of people who have two pregnancies have an interval of 13 months or more between births. Approximately 5% of mothers have four or more pregnancies. ACIP concluded that (1) the interval between subsequent pregnancies is likely to be longer than is the persistence of maternal anti-pertussis antibodies, (2) most mothers would receive only 2 doses of Tdap, and (3) a small proportion of mothers would receive 4 or more doses.

A theoretical risk exists for severe local reactions (e.g., Arthus reactions, whole limb swelling) for pregnant people who have multiple, closely spaced pregnancies. However, the frequency of side effects depends on the vaccine’s antigen content and product formulation, as well as on preexisting maternal antibody levels related to the interval since the last dose and the number of doses received. The risk for severe adverse events has likely been reduced with current vaccine formulations (including Tdap), which contain lower doses of tetanus toxoid than did older vaccine formulations. ACIP believes the potential benefit of preventing pertussis morbidity and mortality in infants outweighs the theoretical concerns of possible severe adverse events in mothers.

Last reviewed: March 31, 2022

No, it is not recommended to give another dose of Tdap in such cases. Optimal timing for Tdap administration is between 27 and 36 weeks’ gestation because that stage of pregnancy is best for transplacental antibody movement to the fetus.

More information is available at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

ACIP does not recommend repeated doses of Tdap for fathers or other family members or caregivers of infants during every pregnancy. The recommendation for Tdap vaccination with each pregnancy to optimize immunity for the infant applies only to the pregnant mother.

The practice of “cocooning” infants by making a particular effort to vaccinate caregivers who have not received Tdap vaccination has been recommended by ACIP since 2005; however, the practice has been difficult to implement fully and may not be effective alone as a strategy for protecting newborns from pertussis exposure. The combined strategy of Tdap vaccination during each pregnancy, cocooning, and administering the childhood DTaP series on schedule provides the best protection to the infant.

Last reviewed: March 31, 2022

To maximize maternal antibody response and passive antibody transfer to the infant, the optimal time to administer Tdap is between 27 and 36 weeks’ gestation, preferably during the early part of that window. However, Tdap can be administered at any time during pregnancy.

Last reviewed: March 31, 2022

While the mother should have been given Tdap rather than Td, the Tdap dose may be given at any interval since the Td dose was given and preferably between 27 and 36 weeks’ gestation.

Last reviewed: March 31, 2022

Yes. ACIP recommends a dose of 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, optimal timing for Tdap administration is between 27 and 36 weeks’ gestation (preferably early in that window). For more information, see www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

No. Tdap is an inactivated vaccine and may be administered at the same time as Rhogam (in a separate site with a separate syringe).

Last reviewed: March 31, 2022

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