Updated 11 February 2013
The Department of Health has recently announced the introduction of a temporary pertussis vaccination programme for pregnant women in response to the current outbreak. A DH factsheet [external link] providing useful background information including a set of FAQs is available on page 9. The following are additional FAQs compiled in response to queries received by the HPA. These will be updated and added to as required.
The purpose of this programme is to protect infants by boosting pertussis immunity in pregnant women. As most women will have been vaccinated or exposed to natural whooping cough in childhood, if they are given pertussis vaccine during late pregnancy this will temporarily boost the woman’s antibody levels. This enables the mother to transfer a high level of pertussis antibodies across the placenta to her unborn child, to passively protect her infant against pertussis until he/she is due the first dose of primary immunisations at 2 months of age.
JCVI has reviewed the currently available evidence - JCVI Minutes 30 August 2012 [external link]
JCVI considered that immunisation could be offered at one of the routine antenatal appointments following the routine week 20 anomaly scan and that immunisation within weeks 28 to 32 of pregnancy is likely to be optimal. Immunisation within weeks 28 to 38 of pregnancy may ensure greater overlap between the period of maximal antibody levels in the pregnant woman and the period of transplacental antibody transfer. Offering immunisation from 28 weeks would provide some protection to infants born prematurely who may be particularly vulnerable to complications from pertussis.
Repevax® (containing diphtheria (low dose), tetanus, acellular pertussis and inactivated polio antigens – dTaP/IPV) is the recommended vaccine for this programme. This vaccine is licensed as a booster from 3 years of age and contains low dose diphtheria suitable for adults.
The Department of Health have secured sufficient supplies of this vaccine for this programme, which can be ordered via ImmForm [external link] (ordering details given on page 11 (Annex B) of the CMO letter [external link]).
Yes, vaccine can be offered to pregnant women until they go into labour. However this is not the optimal time for immunisation.
Antibody levels in adults peak about two weeks after a pertussis booster and therefore vaccine administered between 28 – 38 weeks of pregnancy is likely to maximise the levels of pertussis antibodies transferred across the placenta, thereby providing passive immunity to the unborn child.
Immunisation after week 38 is unlikely to provide passive protection to the infant but would potentially protect the mother from pertussis infection and thereby reduce the risk of exposure to her infant
For those women who have not previously been vaccinated against pertussis in childhood, a single dose of Repevax® (dTaP/IPV) is recommended for new mothers. This can be offered to women until their child receives their first dose of pertussis containing vaccine at 2 months of age.
It is likely that most pregnant women would have been naturally exposed to pertussis in early childhood and therefore do not require additional doses of pertussis containing vaccine unless they become pregnant again. However for those women who are completely unimmunised, following administration of a single dose of Repevax® (dTaP/IPV) further vaccinations should be offered as recommended in the HPA guidelines “Vaccination of individuals with uncertain or incomplete immunisation status”:
Vaccination of individuals with uncertain or incomplete immunisation status (PDF, 672 KB)
Yes, pertussis vaccine should still be offered to provide optimal antibody levels for her to pass to her baby.
The woman should be offered a dose of Repevax® (dTaP/IPV) during pregnancy between 28-38 weeks. The rationale for repeating the dose is that the pertussis vaccine needs to be given after 28 weeks to maximise the levels of pertussis antibodies that are passed on to her infant (as explained above).
If the woman is likely to be contact with young infants she could be given Repevax® (dTaP/IPV) prior to travel. She should still receive a second dose of Repevax® (dTaP/IPV) once she is 28 weeks pregnant however to ensure high levels of antibodies pass across the placenta at the time of maximal antibody transfer.
The seasonal influenza vaccine is offered to women at any stage of pregnancy and administration should not be delayed. Repevax (dTaP/IPV) is offered to women from 28 weeks of pregnancy to maximise the transplacental transfer of maternal antibodies to the infant. Both vaccines are inactivated vaccines containing different antigens and therefore may be administered at the same time or at any interval from each other. No minimum interval needs to be left between these vaccines.
The dose of Repevax® (dTaP/IPV) should be repeated once the woman is 28 weeks pregnant (allowing a minimum of one month interval between doses). The rationale for repeating the dose is that the pertussis vaccine needs to be given after 28 weeks to maximise the levels of pertussis antibodies that are passed on to her infant (as explained above).
Repevax® (dTaP/IPV) is the recommended vaccine for this programme and this vaccine can be ordered via Immform as described above.
Where vaccine stocks are limited, Repevax® (dTaP/IPV) should be reserved for pregnant women and Infanrix IPV® (DTaP/IPV) used for the pre-school booster vaccine.
However, in those exceptional circumstances where there is no Repevax® (dTaP/IPV) vaccine when a woman attends for vaccination and it is very unlikely that she will present again, it would be preferable to give either Infanrix IPV® (DTaP/IPV) or Pediacel® (DTaP/IPV/Hib) rather than give nothing at all. This would be an off-label use of a licensed vaccine. As these vaccines contain a higher dose of diphtheria than is normally used in adults, there may be a higher risk of a local reaction.
In adults, a month gap is normally advised between successive vaccines in a course to ensure an adequate response. There is good evidence to suggest that dTaP/IPV may be administered to adults as soon as one month after Td/IPV without significantly increasing the frequency or severity of side effects.
Please ensure that all relevant staff are familiar with the Repevax packaging:
Repevax packaging (PDF, 321 KB)
Women should be reassured that there is no known risk as this is an inactivated vaccine, which means that it doesn't contain any live organisms. Since inactivated vaccines cannot replicate, they cannot cause infection in either the mother or her baby. There is no known risk associated with giving inactivated vaccines at any stage of pregnancy and by 28 weeks the baby is physically fully developed. As Revaxis does not protect against pertussis, a dose of Repevax® (dTaP/IPV) should be given as soon as possible after the error is realised.
Women who have inadvertently received MMR vaccine instead of Repevax as part of the programme to immunise pregnant women against pertussis at 28-38 weeks gestation should be reassured that, based on comprehensive surveillance in a number of countries, there is no known risk if immunised with a rubella-containing vaccine whilst pregnant. By 28 weeks the baby is physically fully developed and there would be no concerns about congenital rubella syndrome even after natural exposure to rubella infection in any woman who has reached this stage of pregnancy. The woman should be offered Repevax as soon as possible after the error has been realised.
The inadvertent administration of MMR vaccine should be reported to:
MMR vaccine is included in the VIP surveillance because of the established risk of congenital rubella syndrome following natural rubella infection in the first 20 weeks of pregnancy, not because of any known risk with the vaccine.
Women who have inadvertently received Gardasil vaccine instead of Repevax as part of the programme to immunise pregnant women against pertussis at 28-38 weeks gestation should be reassured that HPV vaccine is an inactivated vaccine, which means that it doesn't contain any live organisms. Since inactivated vaccines cannot replicate they cannot cause infection in either the mother or her baby. There is no known risk associated with giving inactivated vaccines at any stage of pregnancy and by 28 weeks the baby is physically fully developed.
The woman should be offered Repevax as soon as possible after the error has been realised. The inadvertent administration of HPV vaccine should be reported to:
HPV vaccines are included in the VIP surveillance as HPV vaccine is not advised in pregnancy as a matter of caution and not because of any known risk with the vaccine.
Yes, the JCVI [external link] identified no safety or efficacy reasons why Repevax could not be administered at the same time as anti-D treatment. Repevax is an inactivated vaccine which will not be affected by, nor interfere with, anti-D treatment. The administration of Repevax should not be delayed due to the individual receiving anti-D treatment.
Yes - Repevax® (dTaP/IPV) can be given to women who plan to breast feed.
There is evidence that pertussis antibodies in breast milk are increased after immunisation in pregnancy and breastfeeding may therefore help reduce the likelihood of a baby becoming ill with pertussis. However, whilst there may be some pertussis antibodies transferred to the infant in breast milk of women vaccinated at 28-38 weeks gestation, this will not be enough to replace the need for the infant to complete the recommended primary immunisation schedule on time.
Infants may receive their first dose of primary immunisations from 6 weeks of age in exceptional circumstances e.g. pre-travel but it is not routinely recommended to offer infants vaccine before 2 months of age. It is however important that infants complete their primary schedule on time.
Last reviewed: 11 February 2013