More research to support whooping cough vaccination during pregnancy

By , 19 May 2014

More research to support whooping cough vaccination during pregnancy

Whooping cough, also called the 100 day cough, is an illness cause by the bacterium Bordetella pertussis.  While often causing an irritating cough in adults, pertussis can be life-threatening in children, especially newborn infants.  In fact, over 90% of deaths from pertussis infection occur in babies under two months of age.  Pertussis vaccination forms part of the Australian Immunisation Schedule, and begins in children at two months of age.  Unfortunately, therefore, children cannot be vaccinated during the highest-risk period of their lives.  Immunisation does not provide lifelong immunity and, until recently, pertussis vaccine boosters were recommended for dads-to-be and new mums, in attempt to reduce the likelihood of their new baby being exposed to parents  with active pertussis infection.

The idea of vaccinating pregnant women has been around for a while, with the rationale that maternal antibodies will pass through the placenta, giving baby "passive immunity" against the infection at birth and in the newborn period.  Additionally, the safety of this vaccine is well-established (it is comprised of proteins only; it is not a "live" vaccine).  However, this concept has not been readily proven, as "protective levels" of antibody in baby's blood have not been accurately set.  Furthermore, there has also been concern that such maternal antibodies may dampen the baby's immune response to their own childhood vaccinations, lessening the protective effect of the vaccine schedule.

A research paper published this month in JAMA has provided further insights into the possible benefits of vaccinating expectant mothers during each pregnancy.  These researchers randomised women to pertussis vaccination during pregnancy, or vaccination after birth.  Most of the mothers vaccinated after birth had received vaccination at some point previously during their lives.  They measured levels of protective antibodies in mothers near delivery, and in children at birth, two months of age, and after completion of their routine childhood pertussis vaccination program.  Reassuringly, they found that vaccination during pregnancy did not dampen the children's response to routine childhood vaccination.  Additionally, they confirmed that levels of protective antibodies were significantly higher (4-5 fold) in children of mothers vaccinated during pregnancy.  Although this study was not powered to prove a reduction in newborn pertussis infection rates (this would need an enormous study), and the protective threshold of antibody levels is not known, this research adds strength to the argument for vaccination of all mothers during each pregnancy, to maximise the levels of protective antibodies present during their babies' most vulnerable time for infection.

 

More research to support whooping cough vaccination during pregnancy
 

About Dr David Moore

More research to support whooping cough vaccination during pregnancy

David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland.  He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery.  David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments.  He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.

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