Pertussis (whooping cough) vaccine in pregnancy

Key vaccine facts

In 2012 the UK experienced a nationwide outbreak (epidemic) of pertussis (whooping cough), a highly infectious disease that can cause serious complications including death, especially in young babies. In 2012 there were over 9,300 cases in England alone – more than ten times as many as in recent years. The causes of this are not clear. In 2013 and 2014 there was a fall in cases, but numbers were still high compared to previous years. In 2015 the numbers of cases increased again by 24% compared to the previous year. (See graph at the bottom of this section.) 14 babies under three months old died of pertussis in 2012, seven died in 2013, three died in 2014, and four died in 2015. Cases of pertussis continued to increase in the first nine months of 2016, and another three young babies with pertussis died in this period. Babies under three months of age are most vulnerable to severe disease.

Vaccination of mothers can protect babies from pertussis. In the UK, a temporary programme began in October 2012 to offer pertussis vaccination to pregnant women. In July 2014 it was recommended that this programme should continue for at least 5 more years, owing to continuing high levels of pertussis in the UK. A similar programme is now offered in the US, Australia, and some other European countries. Around 70% of pregnant women in England currently receive the whooping cough vaccine.

In this film, experts talk about why it is important for pregnant women to be vaccinated against pertussis. Since the film was made the UK government advice has changed. Pregnant women can now be vaccinated any time after 16 weeks of pregnancy (rather than just in the third trimester). The vaccine will usually be offered at the routine 20-week scan.

Even people who were vaccinated against pertussis as babies can catch the disease. It can then be passed on to those they come into contact with, including newborn babies. In years like 2012-2015 when there were thousands of cases of pertussis, newborn babies are at a much higher risk of catching this life-threatening disease. Read a BBC news article about an Australian mother who passed pertussis on to her newborn baby .

In the UK babies currently get protection against whooping cough as a result of their routine vaccinations at 2, 3 and 4 months (see information on the 5-in-1 vaccine). However, newborn babies are vulnerable until they have had at least 2 doses of the vaccine (i.e. until they are 3-4 months old). Babies under 3 months old are at greatest risk of complications and death from pertussis.

Vaccinating babies at birth does not offer them the best protection against pertussis, for two reasons. Firstly, newborn babies’ immune systems do not respond well at this age to the first dose of pertussis vaccine. Secondly, vaccination does not offer immediate protection. It takes several days to respond to the vaccine, and at least two doses of vaccine are needed to give high levels of protection.

Vaccination during during weeks 16 to 32 of pregnancy helps the mother make antibodies to fight pertussis. It takes about two weeks for antibody levels to peak. These antibodies are then transferred through the placenta to the baby, who thus has the mother’s own protection against the disease in their blood right from birth. Very small quantities of pertussis antibodies may also be transferred to the baby through breast milk. In addition, the mother is protected against catching pertussis and passing it to her newborn baby. Pregnant women can be vaccinated any time up until they go into labour, but vaccination before week 32 is advised because it takes about two weeks for antibodies to pass across to the unborn baby. Overall, vaccinating women during pregnancy is the best way to protect newborn babies who are too young to be vaccinated themselves.

The protection offered by the mother’s antibodies lasts only a few months. It is therefore important for babies to get their routine immunisations at 2, 3 and 4 months (the 5-in-1 vaccine) so that they continue to be protected.

It is recommended that women have the pertussis vaccine in each pregnancy, even if they have been vaccinated in a previous pregnancy.

The pertussis vaccine can safely be given to pregnant women at the same time as the Flu vaccine.


Source: Public Health England Archive and Public Health England Health Protection Report May 2016

Ingredients

Apart from the active ingredients, the vaccine used in the UK (Boostrix-IPV) contains very small amounts of:

  • Aluminium, which strengthens and lengthens the immune response to the vaccine. See more information on aluminium in vaccines.
  • Medium 199, a stabiliser containing amino acids, mineral salts, vitamins and other substances
  • sodium chloride (salt)
  • Polysorbate, used as an emulsifier (to hold other ingredients together)

The polio part of the vaccine is grown in the laboratory using animal cell-lines. See more information on animal cell-lines in vaccine production.

The vaccine used in the UK does not contain the preservative thiomersal (mercury).

Side effects

Very common side effects in adults (affecting more than 1 in 10 people):

  • redness, pain and swelling at the injection site
  • headache
  • tiredness
  • generally feeling unwell

Common side effects in adults (between 1 in 100 and 1 in 10 people):

  • fever (up to 39°)
  • bruising, itching, warmth, numbness or a lump at the injection site
  • stomach pain, feeling sick or being sick

Less common side effects (between 1 in 1000 and 1 in 100 people):

  • fever (over 39°)
  • swelling of the vaccinated limb
  • chills, pain, itching, dizziness or sleepiness
  • joint or muscle pain
  • lack of appetite
  • numb or tingling hands or feet
  • flu-like symptoms
  • cold sores
  • swollen glands
  • asthma

For rarer side effects (affecting fewer than 1 in 1000 people), see the Patient Information Leaflet for Boostrix-IPV . Reactions listed under ‘possible side effects’ or ‘adverse events’ on vaccine product information sheets may not all be directly linked to the vaccine. See Vaccine side effects and adverse reactions for more information on why this is the case.

As with any vaccine, medicine or food, there is a very small chance of an immediate severe allergic reaction called anaphylaxis. Anaphylaxis is different from less severe allergic reactions because it causes life-threatening breathing and/or circulation problems. It is always serious but can be treated with adrenaline. In the UK between 1997 and 2003 there were a total of 130 reports of anaphylaxis following ALL immunisations, but all of these people survived. Around 117 million doses of vaccines were given in the UK during this period, making the overall rate around 1 in 900,000. Depending on the cause of the reaction, and following expert guidance, the person may be able to have vaccinations in the future.

See more information on the Monitoring of vaccine safety.

More information about the vaccine

Pertussis vaccination for adults travelling abroad to visit newborn babies

Some countries recommend that all the close contacts around a newborn baby are vaccinated against pertussis. This means that some UK residents travelling to other countries to visit newborn babies are being asked by family or friends to get vaccinated against pertussis before they go. This approach is often called ‘cocooning’.

There is some evidence that cocooning will help to prevent transmissions from family members to the newborn baby, but it is a difficult programme to implement nationally. Vaccination of mothers in pregnancy is the most effective way to protect newborn babies against pertussis. In addition to the UK, many countries now offer pertussis vaccination during pregnancy (including Australia and the US).

Travellers planning to visit friends and relatives who are pregnant or who have just had a baby can check that the mother has had a pertussis vaccine before they visit. It may be possible to obtain the vaccine privately, but the UK government does not officially recommend that adult UK travellers should get vaccinated against pertussis in these circumstances, so it is not generally available as a travel vaccine. (Babies and children who are travelling will already be protected by the 5-in-1 and Pre-school Booster vaccines.)

For more information, see the NaTHNaC website . NaTHNaC (the National Travel Health Network and Centre) is commissioned by Public Health England to provide up to date and reliable information on travel vaccines for UK travellers.

Does the vaccine work?

In July 2014 The Lancet published a study by Public Health England which showed that babies born to vaccinated mothers had high levels of protection against pertussis. These babies had a 91% reduction in the risk of pertussis disease in their first weeks of life when compared with babies whose mothers had not been vaccinated. Since the disease reached its peak in 2012, the greatest decrease in pertussis cases has been in babies under six months of age, which also shows that vaccination during pregnancy is having a significant effect.

In April 2016 the UK’s Department of Health updated its advice on the best time for pregnant women to get the pertussis vaccine. The vaccine is now recommended any time between week 16 and week 32 of pregnancy. Before April 2016 pregnant women were advised to get the vaccine in the third trimester (between week 28 and week 32), which was thought to be the best time for antibodies to be made and passed from the mother to the baby across the placenta. The change in advice is based on a new study by Swiss researchers which showed that more antibodies crossed from the mother to the baby when the pertussis vaccine was given earlier in pregnancy.

Is the vaccine safe?

There are no safety concerns about the use of the vaccine in pregnancy, and there is considerable experience of its use both in the UK and the United States. The vaccine offered to pregnant women (Boostrix-IPV) is also used as a pre-school booster vaccine, and protects against diphtheria, tetanus and polio as well as pertussis. Boostrix-IPV has been used extensively in Australia, New Zealand and other countries. These combination vaccines are being used because a single pertussis vaccine is not available. Many millions of doses have been given to children in recent years without any concerns about harm. Boostrix-IPV contains low-dose diphtheria and tetanus, which means that the rate of side effects is lower than with the 5-in-1 vaccine, for example.

A large safety study involving over 20,000 vaccinated pregnant women , undertaken by the UK's Medicines and Healthcare products Regulatory Agency (MHRA), has found no risks in pregnancy from Repevax, which was the vaccine used for this programme until summer 2014. Repevax is one of the two pre-school booster vaccines used in the UK, and is very similar to Boostrix-IPV but made by a different manufacturer. Similar vaccines have also routinely been given to pregnant women in the USA over the last few years without concerns (see information from the US Centers for Disease Control and Prevention ). Although there is so much experience of the use of the vaccine, it was not studied as part of a clinical trial in pregnancy. This is why the manufacturer’s information leaflets for both Repevax and Boostrix-IPV state that the vaccine is 'not recommended for use in pregnancy' or 'should be used during pregnancy only when clearly needed'.

Page last updated: 
Tuesday, January 3, 2017

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