Vaccinations in Pregnancy

This week we finally did our very special maternity shoot, but another very important to-do in my pregnancy was to get a pertussis vaccination and I am glad that I can now tick both off my list. I had to ask my gyne about it and the pharmacy had no clue why I wanted this particular vaccination. I chatted to some of my friends that have small babies, and no one had the pertussis immunisation. It seems like this is not common practise in South Africa yet.

As a pediatrician I would like to explain why I am so passionately overstepping into my Gyne-colleagues’ field:

Pertussis (better known as Whooping Cough) is a highly infective bacterial infection that affects your respiratory system. Children usually start with flu-like symptoms such as a runny nose, low-grade fever and an occasional cough. The cough then gets worse, changing into bursts of rapid coughing followed by a long whoop as the child tries to pull air into his lungs. This coughing-bout is often followed by vomiting. Infants may have no signs of coughing but can develop episodes of apnoea (where they stop breathing and turn blue). These symptoms can continue up to 6-10weeks! Recovery takes time and coughing bouts can return without warning. Antibiotic treatment is available, but it mostly prevents further spread of the bacteria and does not improve the symptoms dramatically as the damage to the lungs are caused by toxins produced by the bacteria.

Babies under 6 months are at the highest risk for severe complications and if they get sick they often end up in ICU on ventilators to assist their breathing. These babies can be perfectly healthy and growing well the one moment and stop breathing the next. I have battled many hours next to the bed of a baby with whooping cough. There are many heart-breaking stories to read on the internet and I pray none of you need to go through something similar.

Luckily there is a vaccine that help to prevent this disease, and it is part of the combination-vaccine given to babies at 6, 10 and 14 weeks. All three doses are important to ensure a proper antibody response to prevent the disease.  This means your baby will only be fully protected from about 3.5months.

The biggest problem with the pertussis vaccination is that the antibodies produced after the vaccination decreases after 5-6years. (The same is seen even if you had the actual infection). It is thus not so easy to totally eradicate this disease. Adolescents and adults are at a risk of getting and spreading pertussis. Fortunately they will not get as ill, some people might even have no symptoms, but unfortunately they can still spread the bacteria to babies who are not fully covered by their immunisations yet.

For this reason it is recommended that everyone who works with babies and small children receive a booster shot to increase their antibodies and thus protect themselves and the babies in their care. An added benefit if you get it early in the third trimester of your pregnancy is that your antibodies will pass through the placenta and protect your baby for the first 3-6months of his life until his own immunisations and antibodies can take over. Is it not amazing that you can provide both direct and indirect protection to your baby against this nasty bug?

Research done on vaccinations in pregnancy has proven that there is no risk for the mother or her unborn baby as long as it is an “inactivated vaccine” such as the pertussis vaccine. (Some vaccines such as those against German Measles and Chickenpox are “live vaccines” and are dangerous to give in pregnancy).

The current recommendation in South Africa, America, Canada and Australia is that all pregnant mothers receive a booster-shot for EACH pregnancy (to ensure maximum transfer of antibodies to each baby) between 28-36weeks (can be from as early as 13weeks and will still protect baby indirectly even if the mother gets it directly after birth).

The recommended booster vaccination is the Adacel Quadra® or Boostrix Tetra® (they contain a combination of diphteria, tetanus and acellular pertussis (dTaP) at the correct doses for children >10yr and adults). If you cannot find these specific vaccinations it is still ok to give the same one as given to babies on the vaccination schedule (Infanrix DTaP / Hexazim).

While we are on the topic of vaccinations, it is also very important to get the Flu-vaccine when you are pregnant. It is also an “inactivated vaccination” and thus safe. Your immunity functions differently in pregnancy, and you are at a higher risk to get very ill from Influenza (flu). You will thus protect yourself and also pass on the antibodies to your baby to protect him/her in the high risk first few months of life. The flu vaccination is made according to the most prevalent strains of the season and is usually available from end of March/beginning of April.

“So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand.”

Isaiah 41:10

As a pediatrician I want to urge you to talk to your healthcare practitioner about these immunisations during pregnancy to protect your soon-to-be-newborn. As a mom I am personally getting both vaccinations to ensure I did what I can to keep my baby safe and healthy. For the rest I can only trust in God. Please let me know if you have any questions!

1. Pertussis: NICD Recommendations for Diagnosis, Management and Public Health Response; REVISED DECEMBER 2018
2. Madhi SA, Nunes MC; “Experience and challenges on influenza and pertussis vaccinations in pregnant women.” Hum Vaccin Immunother. 2018;14(9):2183-2188
3. https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/immunisation-for-pregnancy
4. https://www.aafp.org/patient-care/public-health/immunizations/disease-population/tdap.html
5. https://www.canada.ca/en/public-health/services/publications/healthy-living/update-immunization-pregnancy-tdap-vaccine.html
6. https://www.who.int/vaccine_safety/publications/safety_pregnancy_nov2014.pdf