Clinical Edge

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Reactogenicity & Immunogenicity of Tdap in Pregnancy

Vaccine; ePub 2018 Sep 13; Fortner, et al

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine was well-tolerated in both pregnant and nonpregnant women, with pain at injection site more likely in pregnant women, a recent study found. Researchers compared local injection-site and systemic reactions and serologic response following Tdap in pregnant women (gestational age 20-34 weeks) and nonpregnant women and in pregnant women by self-reported prior Tdap receipt. Injection-site and systemic reactions were assessed for 1 week post-vaccination. They found:

  • 374 pregnant and 225 nonpregnant women were vaccinated.
  • Severe local or systemic reactions or “any” fever were uncommon in both groups.
  • Moderate/severe injection-site pain was significantly higher in pregnant vs nonpregnant women (18% vs 11%) but did not necessitate a healthcare visit.
  • Prior Tdap receipt did not increase occurrence of moderate/severe local or systemic reactions in pregnant women.
  • Serologic responses to all vaccine antigens were robust.

Citation:

Fortner KB, Swamy GK, Broder KR, et al. Reactogenicity and immunogenicity of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant and nonpregnant women. [Published online ahead of print September 13, 2018]. Vaccine. doi:10.1016/j.vaccine.2018.07.012.

Commentary:

This study highlights that the Tdap vaccine is very well tolerated. The side effect of local pain is a very well-expected phenomenon. The side effect was more common in pregnant women in this study, but this localized tenderness was mild and transient. The study showed that the vaccine had a good immune response which is important if we will give this vaccine every pregnancy to protect newborns from tetanus and pertussis. —John Russell, MD

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