Whooping cough (pertussis) and influenza vaccination for pregnant women
Video message to health professionals
Voice over: Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis bacteria.
In Australia, outbreaks of pertussis typically occur every three to four years. The last major outbreak was prolonged - from late 2008 through to 2012. Pertussis is an ongoing issue and our data shows there were 1,860 cases of pertussis reported in 2015.
Concern about the risk of whooping cough and the threat it presents to pregnant women and unborn babies is a priority for Queensland Health.
Whooping cough can be a very serious and life threatening disease, especially for young children who can't be fully vaccinated against it until six months old.
Most hospitalisations and deaths occur in infants under this age.
In Queensland, there have been more than 23,000 notifications of pertussis in children and adults over the past five years and, tragically, six Queensland babies have died from pertussis between 2000-2015.
The Queensland Department of Health provides the whooping cough vaccine free for women in the third trimester of each pregnancy, to protect them and their newborn baby against whooping cough. The vaccine is a combined diphtheria, tetanus and pertussis vaccine and can be ordered from the Queensland Health Immunisation Program through the usual processes.
Some people may have concerns about the safety of administering dTpa vaccine to pregnant women.
Use in pregnancy is not contraindicated and dTpa vaccine is safe and well tolerated in pregnant women.
The Australian Immunisation Handbook strongly recommends vaccination in the third trimester, between 28–32 weeks, to provide maximum protection to infants.
It's recommended for every pregnancy, including those which are closely spaced.
Discussions at the Pharmaceutical Benefits Advisory Committee recommended the inclusion of dTpa on the National Immunisation Program, which is under consideration by the Commonwealth Department of Health.
Research carried out for the Queensland Department of Health found pregnant women place great importance on advice from their GP, obstetrician or other health professional in relation to vaccinations during pregnancy - particularly vaccination against whooping cough.
The research also showed that not enough women know they can access the funded vaccine and the importance of being immunised.
I urge all health professionals to advise pregnant women:
- on the aetiology of whooping cough and the significance of the disease in infants
- on the benefits of the vaccination in pregnancy
- that the vaccine is safe to have during pregnancy
- to take advantage of the free vaccine by scheduling a vaccination appointment to get the vaccine at 28 weeks of pregnancy.
Vaccination for household members and carers of infants is also encouraged, however is not funded by the Queensland Department of Health.
Vaccination of pregnant women is the most effective method of protecting infants against whooping cough.
The flu vaccination is also important for pregnant women.
As flu vaccinations can be given at any time during pregnancy, women need not wait until 28 weeks to have it. They should be advised to have it early in their pregnancy, as possible, depending on the timing of the flu season.
Where flu vaccination has not occurred early in pregnancy, vaccinations for whooping cough and flu can be given at the same time.
Let's work together to improve the coverage of pertussis and influenza vaccination in pregnant women.
Authorised by the Queensland Government Brisbane.
This summary of research provides an overview of some key findings from research and statements from international public health authorities. Key points of note include:
- the whooping cough (pertussis) vaccine is safe for pregnant women and there is no evidence of an increased risk of adverse events related to pregnancy and no evidence of an increased risk of stillbirth (Donegan et al., Zheteyeva YA et al., WHO Strategic Advisory Group of Experts: pertussis working group 2014,Sukumaran L. et al, Munoz FM et al., Morgan J., Centres for Disease Control, Morbidity and Mortality Weekly Report, 2011, Vol. 60, No. 41., Public Health Agency of Canada www.publichealth.gc.ca , New Zealand Ministry of Health http://www.health.govt.nz, Australian Immunisation Handbook, Chapter 3, 10th Edition 2013, Updated version., Loving S., Pollard, A. Vaccine Knowledge Project, UK)
- the vaccine is effective in offering protection for babies against whooping cough (Amirthalingam G, et al., Dabrera G et al., Munoz FM et al., Centres for Disease Control, MMWR 2013;62(07):131-135., Centres for Disease Control, Morbidity and Mortality Weekly Report, 2011, Vol. 60, No. 41. New Zealand Ministry of Health http://www.health.govt.nz, Australian Immunisation Handbook, Chapter 3, 10th Edition 2013, Updated version., Loving S., Pollard, A. Vaccine Knowledge Project, UK)
The pertussis vaccine is available to pregnant women in a number of countries including Australia, the United Kingdom, United States, Canada and New Zealand. The following table summarises relevant key international literature on the safety, efficacy and acceptability of a pertussis vaccination program for pregnant women.
Note: In Australia the diphtheria, tetanus, pertussis vaccine is referred to as dTpa. Other countries may use a different acronym for the vaccine, for example in the US ‘Tdap’ is used. They are the same vaccine.
|Authors and Citation||Title and summary of findings|
|Donegan K, King B, Bryan P. British Medical Journal 2014; 349: p4219|
Safety of pertussis vaccination in pregnant women in UK: observational study
Amirthalingam G, Andrews N, Campbell H, Riberio S, Kara E, Donegan K, Fry NK, Miller E, Ramsay M. Lancet, published online 16 July 2014
Effectiveness of maternal pertussis vaccination in England: an observational study
|Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, Weintraub ES, Bednarczyk RA, King JP, DeStefano F, Orenstein WA, Omer SB Journal American Medical Association. 2015;314 (15):1581-1587.|
Association of Tdap Vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations
A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-2013.
Munoz FM, Bond NH, Maccato M, et al.. JAMA 2014;311:1760-9.
Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial
Top G and Paeps A Flemish Agency for Care and Health, Poster presentation
Pertussis vaccination and epidemiology in Flanders: the need for future alternative vaccination strategies
Zheteyeva YA, Moro PL et. al.
Adverse event reports after tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines in pregnant women
American College of Obstetricians and GynaecologistsObstetrics and Gynaecology 2013; 121: 1411-4.
Update on immunisation and pregnancy: tetanus, diphtheria and pertussis vaccination. Committee Opinion No. 566.
World Health Organisation (WHO)
WHO Strategic Advisory Group of Experts (SAGE) pertussis working group: background paper, SAGE April 2014
|Morgan J. Baggari S, McIntire D, Sheffield J. Obstetrics & Gynaecology 2015:125(6)1433-1438|
Pregnancy outcomes after antepartum Tetanus, Diphtheria and acellular pertussis vaccinations.
Centres for Disease Control
Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months-Advisory Committee on Immunisation Practices (ACIP), 2011
Centres for Disease Control. MMWR. 2013;62(07):131–135.
New Zealand Ministry of Health: Immunisation Handbook 2014
|Public Health Agency of Canada|
Immunization in Pregnancy and Breastfeeding
|Australian Immunisation Handbook, Chapter 3, 10th Edition 2016 Updated|
Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants
|Sarah Loving, Professor Andrew Pollard, Vaccines in Pregnancy: Pertussis (whooping cough), 2016|
Vaccine Kowledge Project