Pregnancy and Whooping Cough Booster Questions

[want2becrunchy]

I got the Whooping Cough booster back in Feb 2012.  I am now 12 weeks pregnant and the OB office said I need another booster so baby will have some immunities.  I am not sure about this.  I plan to vaccinate on a delayed schedule with the baby so I'm very hesitate to introduce anything while in utero.  They also want me to get the flu shot.  Again, I'm very hesitate.

Thank you for any advice!

[hobojungle]

I was just reading the recommended WHO infant vaccines and was surprised to see this under the DTP section:

"Pertussis vaccine: Neo-natal immunization, and vaccination of pregnant women and household contacts (“cocooning”) against pertussis is not recommended by WHO"

It looks like ACIP now (as of oct 2012) recommends a dose of Tdap for each pregnancy regardless of prior Tdap shots. I wonder if this recommendation was driven by any scientific studies....

Anyone know the reason why the WHO and ACIP differ? The pertussis portion of the DTaP has the lowest efficacy yet they keep pushing more boosters for this.

My wife was asked to have this when pregnant but we declined.

http://www.who.int/immunization/policy/Immunization_routine_table1.pdf

Main page
http://www.who.int/immunization/policy/immunization_tables/en/
Edited by hobojungle - 1/8/13 at 12:45pm

[Rrrrrachel]

There was a discussion about this recently. The idea is that your antibodies that you produce are passed onto baby. There is a fair amount of evidence for the safety and efficacy of this approach, although the kind of ironclad scientific study that would be ideal is nearly impossible with pregnant women. I'll try to dig out some of the evidence I posted last time this came up.

Push comes to shove, make the decision you're most comfortable with and can live with.

[japonica]

Originally Posted by hobojungle 

It looks like ACIP now (as of oct 2012) recommends a dose of Tdap for each pregnancy regardless of prior Tdap shots. I wonder if this recommendation was driven by any scientific studies....
 

That's interesting. I thought the concern was with people getting the T portion too often and possible neurological consequences. If scientific evidence has shown that the previous caution was unnecessary, I'd like to see it too. I'm skeptical when something that was deemed "not recommended" is now given the green light without any new science to back it up. I remember when flu shots during pregnancy were contraindicated and not recommended by my OB but then the next pregnancy I was urged to get one. I asked him for the studies that supported this, but he couldn't provide me with any, unfortunately.

[Rrrrrachel]

That's interesting, I have never heard that about tetanus shots. I thought when you got a wound they would just give you one out of caution if you weren't sure (I've been in the position of no teeing sure if I've had one after a severe injury where I wasn't conscious, than needing one not long after).

[japonica]

I had read it somewhere (still looking for it, but the kids are clamouring for breakfast) that getting a T booster more often than once every ten years might increase the risk of adverse reactions down the road.

The Australian government site still says this:

In previously vaccinated people, administration of more than 1 dose of a tetanus-containing vaccine in a 5-year period may provoke adverse events.

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-tetanus

The Adacel site limits it to people who have experienced Arthus type sensitivity:

Persons who experienced Arthus-type hypersensitivity reactions following a prior dose of tetanus toxoid-containing vaccine should not receive Adacel vaccine less than 10 years since the last dose of tetanus toxoid-containing vaccine. 

http://www.adacelvaccine.com/about.html

[at_the_hip]

Where we are, pertussis is circulating.  I say this with certainty because my children got it and we are still recovering.

The recommendation in our area and in many areas with outbreaks is to vaccinate the pregnant mother at the end of the 2nd trimester or early 3rd because it allows for maternal antibodies to be passed to your baby.  Babies are most vulnerable before they've had their first couple sets of shots...and in general especially when they are under 6 months.

I can tell you that I got my shot a week ago, as did the children who are not still coughing.  My 13yo and I, who have not been vaccinated for over a decade, (my 13yo only had her first two sets of shots at 2 & 4 months), had a mild cold with a lingering cough.  Had i realised that pertussis could be spread so easily by those with fairly mild cough/cold symptoms, I would have gotten the shots for them long ago.  We narrowly missed risking our baby's life (due in April).  My kids have truly suffered and having watched the progression of this disease in our non-vaccinated, healthy, homeopathy and vitamin-supported children, I have no qualms about getting the shot now.  If those around us are spreading it with minor symptoms and there's nothing we can do to know a cold from a serious illness such as this, being unvaccinated for it is a serious disadvantage.  Being up with my 4, 9 and 11yo every 1/2 hr while they gasp for breath is enough for me to realise I chose the greater risk.  I was afraid of harm to come to them by vaccinating but I have since changed my mind.  A generation or two ago our loved ones SAW those they cared about suffer, be crippled or die from these diseases and the choice was easy for them.  My choice is easy now, but at nearly a great cost to my unborn baby...and with suffering to my little ones.

FWIW, my husband and I, and 3 of our 5 children got our shots a week ago with no issues whatsoever.  My fears were much greater than the actual event, by far.  The constant reminder (coughing and gasping) of my recovering children is enough for me to remember why it is worth the small risk involved IMO.  We are a homeschool family who is very well educated on hygiene measures so have no idea how we caught this...but I can say that every non-vaccinated child of mine caught it.  The youngest (2) managed to get his antibiotics early enough that so far he has been mild in comparison (1-2 paroxysms a day).  But every time my kids cough my heart breaks for I feel I failed them despite my good intentions to protect them!

[Turquesa]

TDaP is a Class C drug, meaning that there is inadequate data to ensure its safety during pregnancy. I would proceed with your decision with that in mind.

[prosciencemum]

If I were pregnant I'd get the booster without a second thought. Whooping cough in newborns is really horrible. Due to recommendations thousands of pregnant women have had the booster - mostly with no problems.

[Dakotacakes]

If I were planning to get pregnant I would get a booster, I would also have my whole family get boosters.

[BeckyBird]

Originally Posted by Dakotacakes 

If I were planning to get pregnant I would get a booster, I would also have my whole family get boosters.

Would you get it if you were currently pregnant?

[BeckyBird]

double post, oops!

[japonica]

Okay, I found the info I recalled from earlier. 

This is from the product insert for Adacel:

https://www.vaccineshoppe.com/image.cfm?doc_id=10437&image_type=product_pdf

There are no data to support repeat administration of Adacel vaccine.

Five years should have elapsed since the recipient’s last dose of tetanus toxoid, diphtheria toxoid

and/or pertussis containing vaccine and the administration of Adacel vaccine.

This is from the FDA site re: use of the tetanus toxoid stand alone booster:

http://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm166873.pdf

A routine booster should not be given more frequently than every ten years. (This guideline should not preclude wound management considerations.) 

Now, I have no comment if health professionals feel the current situation with pertussis warrants going against the warnings in the product information. Perhaps manufacturers are being overly cautious with their advice, nevertheless, that is what is in the product inserts. 

[Rrrrrachel]

Because its not like medication is ever used off label . . . Oh wait . . .

[japonica]

Originally Posted by Rrrrrachel 

Because its not like medication is ever used off label . . . Oh wait . . .

Of course it is. I'm pointing out that the manufacturers have advised against it, citing increased risk of reactions. And that there is no data to support the practice of repeat boosters. But if HCPs and patients are content with "off label" use, then everyone's happy and go for it. 

[Rrrrrachel]

And every single homeopathic medicine says not to use it if you're pregnant or breastfeeding.

[japonica]

Originally Posted by Rrrrrachel 

And every single homeopathic medicine says not to use it if you're pregnant or breastfeeding.

Well, those are just placebos, right?   I rarely use homeopathic stuff anyway. Last one was teething meds for the kids as babies. So, it wouldn't have applied in my case.

[Rrrrrachel]

Yet the manufacturers still say you shouldn't use them if you're pregnant or breastfeeding. Or in children under two. You know why? To cover their butt. Not because the caution is actually warranted.

[japonica]

That's what I mentioned about manufacturers and the CYA wording. The CDC mentions the whole avoid frequent boosters thing, so I figure they must have a rationale for it, but I haven't found the specifics yet.

http://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html

If a dose is given sooner as part of wound management, the next booster is not needed for 10 years thereafter. More frequent boosters are not indicated and have been reported to result in an increased incidence and severity of local adverse reactions.

I'm not arguing against off label use. Many medications are used this way. I just think, as part of the whole informed medical consumer aspect, that if the OP's doctor is recommending a second Tdap booster in two years, and while pregnant, then the risk of possibly contracting pertussis must be higher than any risk from possible adverse reactions due to repeat tetanus boosters. I'm just curious to find out what these severe local adverse reactions are or if the CDC is also just doing a CYA, which is not unlikely either.

Edited by japonica - 1/11/13 at 7:34pm

[BeckyBird]

Originally Posted by Rrrrrachel 
 Not because the caution is actually warranted.

Your opinion, right? Maybe there is a reason for the manufacturer's warning, and maybe it is not only to "cover their butts".

This is not about homeopathy either, so maybe we can discuss Adacel's off-label use instead. That interests me, and is relevant to this thread. Unless you would rather talk about homeopathy to divert our attention from Adacel?

............................................................................................................................................................................

Quote:

"Because its not like medication is ever used off label . . . Oh wait . . ."

Just because it is common does not make it right.

You love evidence-based medicine, right?  I can't think of anything LESS evidence-based than using medicine off-label.

"Off-label drug use occurs when a physician prescribes medication to treat a condition before that use has been approved by the FDA." Repeat, BEFORE that use has been APPROVED....

So, were they wrong when they advised pregnant women against vaccines, or are they wrong now? Or are they right all the time no matter what they recommend?