Is this normal/common? - asked to get DTaP vax after birth.

[filiadeluna]

When I was in the process of being discharged from the hospital after my daughter's birth, the nurses tried to convince me to get a tentenitus shot. I refused, of course, and told them I'm pretty sure I had one in high school - less than 10 years ago - which is true.

I really didn't understand the logic (ha!) behind this. What makes someone who just gave birth more at risk for it anyway? Even if I felt it was needed, why in the heck would I want to put myself through possible side effects when I am already recovering from a 2nd degree tear and birth in general?

Has anyone else been asked about this after a hospital birth?

[MissRubyandKen]

It's my understanding its being pushed now on exactly that group to 'protect the baby'. But I thought it was supposed to be the Tdap? Not sure, bet someone else will now more.

[Marnica]

I personally was not, but I have heard of many mamas on here who had this same experience. The rationale I thought for the DTaP was not about you being up to date on the tetnus vax, but the pertussis portion since WC in small babies can be dangerous. Hopefully moms who had had this happen to them will chime in.

[juliav]

I think Marnica is right. No one tried to give me a shot (I think they knew better by the time we were checking out) but I do believe it is mostly for pertussis. It can be dangerous in young babies and you can carry it even if you were vaccinated at some point and immunity diminishes over time. So, I guess they're trying the whole captive audience thing to keep infants from catching pertussis. Blech :

[filiadeluna]

Maybe it was the TDaP? They justified it to me as being for the tentenitus portion of it, though. They didn't mention a thing about the baby or about pertussis.

I think I literally LOLed when they mentioned the shot b/c the first thought that came to my head was, "I don't see myself stepping on a rusty nail anytime soon." I didn't say that, but I should have! I'm surprised they even asked me about it since I refused the HepB, VitK, and eye goop, but I guess they thought I wouldn't mind giving myself a shot.

[Ophelia]

If it is indeed being pushed for Pertussis, studies have shown that the vax does NOT prevent transmission, so even if the vax helped the new mom to have a milder form of the virus, that still does not mean her baby wouldn't get it.

[listipton]

I was asked if I wanted to have the Whooping cough booster (I assumed Dtap) after I had my son in October as well as the flu shot. I was asked at the hospital, 2 week check, and six week check. My midwife was always respectful and smiled every time I said 'no thank you', but the nurse eyeballed me every time. My FP was adamant that we give ds the DTap b/c ONE case had been reported in our area (this apparently constitutes an outbreak...) and made it very clear that while she was comfortable with selective/delayed vax (the ones she wouldn't budge on), she was not comfortable with no vaxes.

[texmati]

I was told that I would need a shot after I delivered-- Apparently my immunity has decreased since i last got the shot?

[gr8blessings]

Originally Posted by Ophelia

If it is indeed being pushed for Pertussis, studies have shown that the vax does NOT prevent transmission, so even if the vax helped the new mom to have a milder form of the virus, that still does not mean her baby wouldn't get it.

Could you provide sources for this please? I've been looking and all I can find is that it is thought to prevent transmission but the studies haven't been done to confirm either way.

gr8blessings

[mamakay]

Originally Posted by gr8blessings

Could you provide sources for this please? I've been looking and all I can find is that it is thought to prevent transmission but the studies haven't been done to confirm either way.

gr8blessings

http://pediatrics.aappublications.or...act/104/6/1381

The first is that a substantial number of B pertussis infections in unvaccinated children are mild and would not meet the case definition. The second is that all pertussis vaccines tend to modify duration and severity of disease rather than completely preventing illness

http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf

The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.

http://iai.highwire.org/cgi/content/full/68/12/7175

In summary, booster immunization of adults with acellular pertussis vaccines was not found to increase bactericidal activity over preimmunization levels. Identifying ways to promote bactericidal immune responses might improve the efficacy of acellular pertussis vaccines.

[mamakay]

http://www.mothering.com/discussions...9&postcount=33

[gr8blessings]

Thanks for the links. I didn't get the same message from them that you did so I'll have to go and think about it a bit more, but I'm further ahead then I was. Thanks again for your help.

gr8blessings

[cloak]

Originally Posted by gr8blessings

Thanks for the links. I didn't get the same message from them that you did

The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection

This means even if you are vaxed you won't get sick but you can still get infected. Then you can pass along your infection to anyone.

[luminesce]

Originally Posted by gr8blessings

Could you provide sources for this please? I've been looking and all I can find is that it is thought to prevent transmission but the studies haven't been done to confirm either way.

gr8blessings

Are you possibly thinking of Tdap? I think they were hoping it would be better at preventing transmission than DTaP (thus the target of teens/adults, the generally assumed reservoir) and maybe had some preliminary evidence but I don't think they have confirmed it.

[Deborah]

Gr8blessings,

What do you think the word "transmission" means in this context?

The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.

[luminesce]

Originally Posted by cloak

This means even if you are vaxed you won't get sick but you can still get infected. Then you can pass along your infection to anyone.

And if pertussis looks more like a cold, then could it conceivably be more easily transmitted to babies (who aren't quite as protected as we might like to think with vaccination), since a less ill person might not be as prone to isolate themselves?

I've worried a little about Tdap behaving the same way. What if it lessens disease severity even more in adults and teens (who probably already think they only have 'bronchitis' or a bad 'cold' when they actually have pertussis?)

Vaccine. 2008 Oct 16;26(44):5547-53. Epub 2008 Aug 22.

A retrospective respiratory questionnaire and anti-pertussis toxin immunoglobulin G measurement was undertaken in a convenience sample of adolescents and was repeated one year later. The US Centers for Disease Control clinical case definition of pertussis was used. At least a third of coughing illnesses met the CDC clinical case definition. Symptoms correlated with serology. Pertussis was endemic with a high annual incidence of new infections.

Emerg Themes Epidemiol. 2007 Oct 19;4:15.

We conclude that casual contact appears to be responsible for a substantial proportion of pertussis transmission to young infants.

[gr8blessings]

Yes, the Tdap, since the OP said she was offered the vaccine, not the baby. This recommendation came about in 2008 and the recommendation says:

Vaccinating adults and adolescents using Tdap reduces the burden of pertussis among vaccine recipients and might prevent transmission of B. pertussis to infants.

http://www.cdc.gov/mmwr/preview/mmwr...=rr57e0514a1_e (emphasis mine)

I'm sure the ACIP would be all over it if they could use a stronger language then "might" so I've been looking for more recent papers that confirm their hypothesis. The acellular pertussis vaccine has also undergone several modifications since it was first licensed so the reference to papers referring to these older vaccines (especially the whole cell vaccine in the Israeli study) does not make obvious sense to me when I glanced over them quickly. Thus I have to do some more cross-checking and that takes a bit of time. In the meantime, I wanted to be sure to thank Mamakay for taking the time to post the links.

I have no desire to debate the merits of the papers quoted with anyone.

gr8blessings

[gr8blessings]

Originally Posted by Deborah

Gr8blessings,

What do you think the word "transmission" means in this context?

The word "potential" preceding the word "transmitters" has a huge impact on diminishing the claim that the vaccine does not prevent transmission. Potential means it might or it might not, nobody really knows for sure. Also, the phrase "the effects of whole-cell pertussis vaccine wane after 5 to 10 years" also diminishes the claim that the vaccine does not prevent transmission in a recently vaccinated person.

gr8blessings

[mamakay]

Originally Posted by gr8blessings

Yes, the Tdap, since the OP said she was offered the vaccine, not the baby. This recommendation came about in 2008 and the recommendation says:

http://www.cdc.gov/mmwr/preview/mmwr...=rr57e0514a1_e (emphasis mine)

I'm sure the ACIP would be all over it if they could use a stronger language then "might" so I've been looking for more recent papers that confirm their hypothesis. The acellular pertussis vaccine has also undergone several modifications since it was first licensed so the reference to papers referring to these older vaccines (especially the whole cell vaccine in the Israeli study) does not make obvious sense to me when I glanced over them quickly. Thus I have to do some more cross-checking and that takes a bit of time. In the meantime, I wanted to be sure to thank Mamakay for taking the time to post the links.

I have no desire to debate the merits of the papers quoted with anyone.

gr8blessings

All I can say is that I've scoured all the original research, and there's no solid evidence that any pertussis vaccine prevents the most infectious "cold like" stage. The best I've found is evidence that it might reduce contagiousness by about 10%. But even that research is open to confounding factors.

There's also this:

http://whqlibdoc.who.int/hq/1999/WHO_V&B_99.03.pdf

In discussion, Dr Cherry pointed out that in Japan also the reported pertussis incidence in children under three months of age has not declined substantially with return to a high vaccination coverage.

Babies too young to be vaccinated are really the "canaries in the coalmine" with pertussis. If herd immunity starts kicking in, you'll see a lot fewer deaths in the newborns. If newborn deaths don't change, you're looking at a diagnostic phenomenon and the vax reducing the symptoms.

[mamakay]

Originally Posted by gr8blessings

The word "potential" preceding the word "transmitters" has a huge impact on diminishing the claim that the vaccine does not prevent transmission. Potential means it might or it might not, nobody really knows for sure. Also, the phrase "the effects of whole-cell pertussis vaccine wane after 5 to 10 years" also diminishes the claim that the vaccine does not prevent transmission in a recently vaccinated person.

gr8blessings

But they say it never prevents infection. It's effect (that wanes after 5 to 10 years) is in lessening the severity and duration of the cough. That is the only thing we know pertussis vaccines do.