Tdap Vaccination in Post-Partum Women
Tdap vaccine is strongly recommended for administration during the immediate post-partum period for women who have not previously received it, as this protects both the mother from pertussis and reduces the risk of exposing her infant to this potentially fatal disease. 1
Administration Protocol
Timing and Eligibility
- Administer Tdap as soon as feasible in the immediate post-partum period
- Ideally before discharge from the hospital or birthing center
- If not possible before discharge, administer as soon as feasible thereafter
- Applies to all women who have not previously received Tdap, including those who are breastfeeding 1
Dosage and Administration
- Dose: 0.5 mL administered intramuscularly (IM)
- Preferred injection site: deltoid muscle
- Can be administered simultaneously with other indicated vaccines using separate syringes at different anatomic sites 1
Vaccine Selection
- For women aged 19-64 years: ADACEL®
- For adolescent mothers aged 11-18 years: either ADACEL® or BOOSTRIX® 1
Special Considerations
Interval Since Previous Tetanus Vaccination
- Although routine Td boosters are recommended every 10 years, for post-partum Tdap:
- An interval as short as 2 years since the most recent Td is acceptable
- Even intervals shorter than 2 years may be used when the benefit of protection against pertussis outweighs the risk of local and systemic reactions 1
Safety Monitoring
- Observe patients for 15 minutes after vaccination to monitor for syncope, which may be more common in young adults
- If syncope occurs, continue observation until symptoms resolve 1
Evidence of Effectiveness
The effectiveness of post-partum Tdap has been evaluated in several studies with mixed results:
A 2012 study found that immunizing only post-partum mothers with Tdap did not significantly reduce pertussis illness in infants ≤6 months of age, suggesting that a broader strategy including all household contacts might be needed 2
A 2017 study demonstrated that Tdap vaccination during pregnancy (at 27-36 weeks gestation) was 85% more effective at preventing infant pertussis than post-partum vaccination 3
However, for women who did not receive Tdap during pregnancy, post-partum vaccination remains important as it provides protection for the mother and may reduce transmission to the infant 1
Implementation Strategies
Hospital-based procedures significantly increase post-partum Tdap vaccination rates:
- Standing orders are most effective, increasing coverage up to 69% in one study
- Opt-in physician orders are less effective but still increased coverage to 18% from baseline 4
Potential Pitfalls and Caveats
Pediatric DTaP should never be administered to adults or adolescents as it can cause more severe local reactions
If pediatric DTaP is inadvertently administered to an adult, count it as the Tdap dose and do not give an additional dose
Similarly, if BOOSTRIX® is inadvertently given to a woman over 19 years, count it as the Tdap dose 1
While maternal antibodies can be transferred to infants through breast milk, this mechanism alone provides modest protection against pertussis disease 5
No Tdap-associated serious adverse events have been reported in post-partum women or their infants in clinical trials 6
Post-partum Tdap vaccination remains an important strategy for protecting mothers and reducing the risk of infant pertussis exposure, especially for women who did not receive Tdap during pregnancy.