Tuesday, June 18, 2024

Crucial Update to Pertussis Vaccination for Pregnant Women

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The Government has announced a significant change in the pertussis vaccination (whooping cough) program for pregnant women, starting from July 1, 2024. ADACEL® (tetanus, diphtheria, pertussis vaccine [Tdap]), a non-inactivated polio (IPV)-containing vaccine, will replace Boostrix-IPV® (dTaP/IPV) for the maternal pertussis vaccination program. This change follows a recommendation by the Joint Committee on Vaccination and Immunisation (JCVI) to use a non-IPV-containing pertussis vaccine in the maternal program.

The recommendation was based on studies showing that infants born to mothers who received pertussis-containing vaccines (dTaP/IPV) during pregnancy had lower antibody responses to polio after completing their primary infant vaccination schedule, compared to infants born to unvaccinated mothers. Although all antibody levels remained above the protective threshold, the reduced response indicated a potential immunity gap.

The JCVI’s recommendation aims to address this gap by ensuring that the maternal pertussis vaccination does not interfere with the infant’s subsequent polio vaccinations. ADACEL® has been shown to be both safe and effective in maternal pertussis vaccine programs in several other countries, including the USA, Australia, and many European nations, where millions of doses have been administered.

This transition to ADACEL® is expected to maintain high levels of protection against pertussis for newborns while minimizing any impact on their immune response to polio.Healthcare providers will need to adjust their protocols and ensure they have adequate stocks of the new vaccine before the changeover date. This proactive measure reflects the government’s commitment to continuously improving public health strategies based on the latest scientific evidence and global best practices.

From July 1, 2024, the pertussis vaccine used in the maternal program will change to ADACEL® (Tdap). Vaccine ordering will open in June, with the exact date to be confirmed via an ImmForm news item. ADACEL® contains tetanus, diphtheria, and pertussis (acellular) antigens and was licensed for UK use in 2016. The JCVI advises that if ADACEL® is unavailable, dTaP/IPV vaccines should still be used to avoid delays in administration. Detailed resources to support the program are available in Annexe A.

Pertussis Vaccination

Continued Importance of Pertussis Vaccination

The maternal pertussis vaccination program, introduced in October 2012, has proven to be highly effective in protecting infants from birth against severe pertussis disease. The vaccine is usually administered around the time of the mid-pregnancy scan, typically at 20 weeks, but can be given from 16 weeks. For optimal protection, the vaccine should ideally be administered before 32 weeks of pregnancy. However, women who miss this window can still receive the vaccine later.

In the first quarter of 2024, five infants died from pertussis, underscoring the critical importance of maternal vaccination. Since the program began, the majority of deaths have occurred in infants of unvaccinated mothers. Vaccination coverage among pregnant women has declined from over 72.3% in December 2019 to around 59.5% in December 2023, raising concerns amid high levels of pertussis activity in England.

Healthcare providers must ensure that pertussis vaccination is offered to all eligible pregnant women, either opportunistically or upon request, and properly recorded in the patient’s medical record. Accurate data recording is vital for monitoring and evaluating the vaccination program. Key information to be recorded includes the date of delivery, the date of vaccination, and any relevant information regarding stillbirth or miscarriage.

ADACEL® (Tdap) will be available for order via the ImmForm website starting in June 2024. Providers should hold no more than two weeks’ worth of stock to manage local supplies effectively. After the introduction of ADACEL®, remaining stocks of Boostrix-IPV® can be used for the preschool program or continued use in pregnant women to prevent wastage. Detailed clinical guidance is available in the Green Book, chapter 24, and updated Patient Group Directions (PGDs) will be provided by UKHSA for NHS England areas.

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This update represents the UK’s ongoing commitment to improving maternal and infant health through vaccination. The shift to ADACEL® aims to address potential immunity gaps and ensure the highest levels of protection against pertussis. Healthcare providers are urged to familiarize themselves with the new regulations and ensure smooth

 

Resource: The UK Medicines and Healthcare products Regulatory Agency, May 29, 2024

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