Okay -- thank you for this. I'm sure I haven't had this (or my husband) since the last vaccines we got were in college, and that was long before 2005.
I was reading up on pertussis, and the CDC says you be a carrier, even if you've been infected or vaccinated. They also say the only way to accurate test for it is a nasal swab test, and most doctors don't do that routinely. My mom has had a persistent cough for the last year, but her doctor has never tested her for this. She freaked out when I told her and called to demand a test.
I'm forwarding this information to all of our immediate family. I'm giving them a grandkid -- the least they can do is get a shot!
Ginger - do you know if this booster is something I can get while pregnant? I have this all on my list of things to ask my doc at our next appointment, but I'm just curious now.
Also, is there anything else I should get? I haven't heard of a measles outbreak or anything, but is there a "new mom" schedule of vaccines? Do I need an MMR booster, just to be safe?
Poor grandma, one does not cough for a year with pertussis, rather it is more like months. Of course, anyone with a persistent cough needs to have a medical evaluation. It could be anything from a chronic heart or lung condition to a few rare infections (still unlikely if the cough has really been going on that long). But you need not worry that your mom's cough is pertussis. It does not sound like it.
OK, back to the other stuff. It just so happens the CDC has addressed the Tdap and pregnancy question.
Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
You should look through the whole paper but it sounds like this is the key part for you:
As with most inactivated vaccines and toxoids, pregnancy is not a contraindication for use of Tdap. Although the safety and immunogenicity of Tdap is expected to be similar in pregnant and nonpregnant women, few data on the safety of Tdap for women, fetuses, and pregnancy outcomes are available, and no information is available on the immunogenicity of Tdap in pregnant women. Vaccinating pregnant women with a single dose of Tdap might provide a degree of protection against pertussis to the infant in early life through transplacental maternal antibody, but evidence supporting this hypothesis is lacking. A concern is the unknown effect of potential interference by maternal antibody on the ability of the infant to mount an adequate immune response when the infant receives pediatric DTaP or conjugate vaccines containing tetanus toxoid or diphtheria toxoid.
In special situations, administration of Tdap during pregnancy might be warranted for pregnant women who were not vaccinated previously with Tdap. Health-care providers who choose to administer Tdap to pregnant women should discuss with the women the potential risks and benefits of immunization including the lack of data on Tdap administered during pregnancy or its unknown effects on active immunization of their infant. The following recommendations are intended to provide guidance to clinicians until additional information is available.
1. Routine Tdap Vaccination
1-A. Recommendations for Use of Postpartum Tdap
For women who have not received Tdap previously (including women who are breastfeeding), Tdap is recommended as soon as feasible in the immediate postpartum period to protect the women from pertussis and reduce the risk for exposing their infants to pertussis. The postpartum Tdap should be administered before discharge from the hospital or birthing center. If Tdap cannot be administered at or before discharge, the dose should be administered as soon as feasible thereafter. Elevated levels of pertussis antibodies in the mother are likely within 1--2 weeks after vaccination.
My clinical opinion with this vaccine and pregnancy is, if you got a deep puncture wound, I would not hesitate to give you a Tdap booster. If you were in your first trimester (and no puncture wound), I tend to wait. It's not that the vaccine is an issue, it's that spontaneous miscarriage is common in the first trimester and one would not want a parent fearing they caused the miscarriage by some decision that they made. If you are in your third trimester, I would base the decision to vaccinate before or after delivery on the rate of pertussis in the immediate community and your age, history and likelihood of exposure.
So let your OBGYN help you decide if you are going to get the vaccine before or after delivery.
As for people carrying pertussis without symptoms, I think the issue is more that pertussis looks like a mild cold for the first week, so early cases are missed. And, the cough is not always typical, so those cases are missed. But get the vaccine, use reasonable precautions and don't worry about the things that are rare and not avoidable without extreme measures. Those extreme measures are not called for, the reasonable measures are called for.
There are many things that pose a risk to you and your infant. The way to deal with this situation is to manage risks, not think you can eliminate all risk. You will go nuts if you worry about everything. Managing risk means is you take all the easy risk reduction measures: vaccinations, check the smoke alarm batteries, seat belts and car seats, stuff like that. These are low cost high benefit measures.
Then you look at risks and the cost of avoiding the risk and make informed decisions. Decide where risk reduction is reasonable, feasible, affordable and you reduce risk as much as you can. This is where factual information comes in to play.
Take the pertussis vaccine and the following hypothetical scenario: you and your husband get your boosters. You are not exposed to anyone with pertussis that you know of and it is not occurring in your community in large numbers. You or your husband come down with a cold. Should you worry or take any extra precautions?
No, that would be unreasonable. The risk would be extremely low and completely isolating a family member with a cold from an infant is extremely costly in terms of time and resources. Good hand washing and make reasonable effort to prevent spread within the household is feasible, but it is not possible to prevent every infection your child is going to be exposed to. That's why I say to think of it as risk reduction, not risk elimination. You'd be surprised how far something as simple as hand washing goes to prevent the spread of infection.
Where most people go wrong is overestimating some risks and ignoring many common risk reduction measures. No matter how much we harp on the importance of smoke alarms, look how many people die in fires because they didn't have a working smoke alarm. It's so unnecessary. Accidental drownings should be extremely rare, but they aren't. Kids should not be able to play with guns and accidentally shoot friends, but they do.
These are the things that are easily prevented. If we could take care of those things, then maybe it would be reasonable to worry about the rare stuff that is costly to prevent.
As for the other vaccines, there is
an adult vaccine recommendation just like we have one for kids.
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