Whooping Cough Vaccine for Pregnant Women Among New Recommendations

MONDAY Jan. 28, 2013 -- The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have released new vaccine guidelines for 2013.

One change is a recommendation for women to receive a dose of the whooping cough (pertussis) vaccine with each pregnancy. Another is the suggestion that mild egg allergy need no longer prevent people from getting the flu vaccine under certain circumstances.

The guidelines also clarify the use of the pneumococcal vaccine -- which protects against sometimes life-threatening meningitis, pneumonia and blood infections -- in certain vulnerable populations.

Current levels of vaccination in adults are low, according to the CDC's Advisory Committee on Immunization Practices. Because of this, the committee recommended that providers review patients' vaccination records and recommend needed vaccines.

"It's so important to adhere to these immunization schedules. People need to understand: These schedules are put together with great care and discussion and review of scientific data," said Dr. H. Cody Meissner, a member of the American Academy of Pediatrics committee that makes vaccine recommendations.

Meissner said sometimes parents will ask to alter the way vaccines are given, requesting things like a half-dose now and the rest of the dose at a later time. "We just don't know if vaccines work at half-doses. It's critically important to adhere to the schedule," he said.

The latest vaccine recommendations can be found in the Feb. 5 issue of the journal Annals of Internal Medicine and the February issue of the journal Pediatrics.

The most notable change is the new recommendation that pregnant women -- whether adolescent or adult -- receive a booster dose of the tetanus, diphtheria and acellular pertussis (TDaP) vaccine during each pregnancy. Ideally, this booster will be given between 27 and 36 weeks of gestation.

"We're seeing more pertussis now than we have in earlier years. When the final numbers are in for 2012, the number of reported cases will probably be around 35,000," Meissner said. "But the actual number could be far more than that, because they don't all get documented. There were about 20 deaths last year, primarily children in the first two to three months of life."

Meissner, who also is chief of pediatric infectious disease at the Floating Hospital for Children at Tufts Medical Center in Boston, said that children in this age group don't yet have protection from vaccines. Since the vaccine crosses through the placenta, an immunization given later in the pregnancy should offer a high level of immunity to the baby.

He added that it's also a good idea for anyone who will be around the baby, including the father, siblings and grandparents, to be sure they're up to date on their vaccines.

Another expert said the resurgence of whooping cough is most likely due to a change in vaccine design that got rid of many side effects, but did so at the cost of long-term effectiveness.

Dr. Lorry Rubin, director of pediatric infectious diseases at the Cohen Children's Medical Center of New York, in New Hyde Park, said the current vaccines don't last as long as would be ideal.

Rubin, who also is a member of the Advisory Committee on Immunization Practices that develops vaccination guidelines, discussed the new idea in the guidelines that people who have mild egg allergies can still get a flu shot.

"If you have a localized reaction to eggs, meaning hives, and not a systemic reaction, like tongue swelling or wheezing, the flu vaccine should be very well tolerated," said Rubin, who added that it's important to have the immunization done at a doctor's office, where immediate care can be provided if a serious reaction does occur.

Rubin also said it's not too late to get a flu shot this year. Although there already has been one peak in flu activity, he said that in most flu seasons there are two peaks. If you get vaccinated now, you can protect yourself against a second spike in flu activity. He also noted that there will be a change in next year's flu vaccine that should make it more effective.

The other big change in the vaccine schedule is for adults aged 19 or older who are at high risk for pneumococcal infections, including people with compromised immune systems, people without a functioning spleen, those with cerebrospinal fluid leaks and people with ear implants. They should be given vaccines known as "PCV-13" followed by the "PPSV23" at least eight weeks later, the guidelines recommended. Rubin said the first vaccine helps prime the immune system for the second vaccine.

More information

Review the vaccine schedules for adults and children at the U.S. Centers for Disease Control and Prevention.

Posted: January 2013


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