Is Tdap (Tetanus, diphtheria, and pertussis) vaccine required for individuals close to a pregnant patient or newborn?

Tdap Vaccination for Close Contacts of Pregnant Women and Newborns

Yes, Tdap vaccination is recommended for all adolescents and adults who have or anticipate having close contact with infants aged <12 months, including parents, siblings, grandparents, child care providers, and healthcare personnel, if they have not previously received Tdap. 1

Rationale for Vaccination of Close Contacts

The recommendation for vaccinating close contacts of pregnant women and newborns is based on the "cocooning" strategy, which aims to protect vulnerable infants from pertussis by immunizing those who will be in close contact with them.

• Pertussis is particularly dangerous for infants under 3 months of age, who experience the highest rates of morbidity and mortality 2
• Infants do not begin their own vaccine series against pertussis until approximately 2 months of age, leaving them vulnerable during early life 2
• Many infants contract pertussis from family members and caregivers, especially mothers, older siblings, or both 2

Specific Recommendations for Close Contacts

1. All household contacts and caregivers should receive a single dose of Tdap if they have not previously received it 1, 3

   • This includes parents, siblings, grandparents, babysitters, and other regular caregivers

2. Healthcare personnel with direct patient contact should receive Tdap if they have not previously received it 1

3. Timing of vaccination:

   • Ideally, close contacts should be vaccinated at least 2 weeks before beginning close contact with the infant 3
   • For postpartum mothers who did not receive Tdap during pregnancy, vaccination should occur immediately before hospital discharge 1

Implementation Considerations

• Prior vaccination history: Even if close contacts have received Td vaccine recently, they should still receive Tdap to protect against pertussis 1

  • An interval as short as 2 years from the most recent Td dose is acceptable 1

• Setting for vaccination: The vast majority of Tdap vaccinations (96%) are administered in traditional healthcare settings (obstetrician's office, primary care physician's office, or prenatal clinic) 4

• Effectiveness: Maternal Tdap vaccination reduces the risk of pertussis infections in infants' first 6 months by 36%, with even stronger protection during pertussis outbreaks 5

Special Considerations

• Preterm infants: Preterm infants are at higher risk for pertussis and benefit particularly from maternal vaccination 5

  • The risk of pertussis in unvaccinated preterm infants can be 2-3 times higher than in term infants 5

• Contraindications: Few contraindications exist for Tdap vaccination. It should not be given to individuals with:

  • History of severe allergic reaction to any vaccine component
  • History of encephalopathy within 7 days of previous pertussis-containing vaccine 1

• Precautions: Individuals with unstable neurologic conditions should consult with their healthcare provider before receiving Tdap 1

Importance of Multiple Protection Strategies

While cocooning through vaccination of close contacts is important, it should be part of a comprehensive approach:

1. Maternal vaccination during pregnancy (preferably between 27-36 weeks) is the primary strategy for protecting newborns 1, 3

2. Timely infant vaccination beginning at 2 months of age 2

3. Early recognition and treatment of pertussis cases and prophylaxis of contacts 1

By implementing all these strategies together, we can maximize protection for vulnerable infants against pertussis, which remains the only vaccine-preventable disease that has been increasing in the United States in recent years 1.