User:M.song, Future UCSF Pharm.D/sandbox

Guidelines on prenatal care in the United States state that if an urgent need for tetanus protection occurs during pregnancy, Td vaccine should be administered. If no urgent need arises and the woman has previously received tetanus vaccine, Td vaccination should be delayed until the postpartum period. All postpartum women who have not received Td or Tdap vaccine in the last two years are recommended to receive Tdap prior to discharge after delivery. For pregnant women who have not previously received a tetanus vaccine (i.e., have never received DTP, DTaP, or DT as child or Td or TT as an adult) are recommended to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus. In such cases, administration of Tdap is recommended after 20 weeks' gestation, and in earlier pregnancy a single dose of Tdap can be substituted for one dose of Td, and then the series completed with Td.

According to the CDC's Advisory Committee on Immunization Practices (ACIP) guidelines, 1 dose of Tdap is recommended during each pregnancy to ensure protection against pertussis in newborn infants. Optimal timing to administer a dose of Tdap during each pregnancy is between 27 through 36 weeks gestation irrespective of the patient's prior history of receiving Tdap. If Tdap is administered early in pregnancy, it is not recommended to administer again during 27 through 36 weeks gestation period as only one dose is recommended during pregnancy.


 * Health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks of gestation although Tdap may be given at any time during pregnancy. 13
 * Currently available data suggest that vaccinating earlier in the 27 through 36–week period will maximize passive antibody transfer to the infant. 27
 * For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum. 13
 * Available data from… studies do not suggest any elevated frequency or unusual patterns of adverse events in pregnant women who received Tdap and that the few serious adverse events reported were unlikely to have been caused by the vaccine. 14
 * Wound Management: If a Td booster is indicated for a pregnant woman, health-care providers should administer Tdap. 13
 * Unknown or Incomplete Tetanus Vaccination: To ensure protection against maternal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids. The recommended schedule is 0, 4 weeks and 6 through 12 months. Tdap should replace 1 dose of Td, preferably between 27 and 36 weeks gestation… 13
 * Providers are encouraged to report administration of Tdap to a pregnant woman, regardless of trimester, to the appropriate manufacturer’s pregnancy registry: for Adacel® to sanofi pasteur, telephone 1-800-822-2463 and for Boostrix® to GlaxoSmithKline Biologicals, telephone 1-888-452-9622. 15

Pregnant women. No change has been made to the recommendations for routine Tdap immunization during pregnancy. Pregnant women should receive 1 dose of Tdap during each pregnancy, irrespective of their history of receiving the vaccine. Tdap should be administered at 27–36 weeks’ gestation, preferably during the earlier part of this period, although it may be administered at any time during pregnancy (3,5).

Immunization of pregnant women with tetanus-diphtheria-acellular pertussis vaccine (Tdap) provides protection against pertussis to the newborn infant.

A tetanus toxoid–containing vaccine is indicated for wound management when >5 years have passed since the last tetanus toxoid–containing vaccine dose. If a tetanus toxoid–containing vaccine is indicated for persons aged ≥11 years, Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown. If a tetanus toxoid–containing vaccine is indicated for a pregnant woman, Tdap should be used. For nonpregnant persons with documentation of previous Tdap vaccination, either Td or Tdap may be used if a tetanus toxoid–containing vaccine is indicated. Complete information on tetanus prophylaxis and the use of tetanus immunoglobulin when indicated for wound management is available at https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.

ACIP also recommends that adolescents and adults (e.g., parents, siblings, grandparents, childcare providers, and healthcare personnel) who have or anticipate having close contact with an infant younger than 12 months of age should receive a single dose of Tdap to protect against pertussis if they have not previously received Tdap. Ideally, these persons should receive Tdap at least 2 weeks before beginning close contact with the infant.

To protect infants younger than 12 months of age not vaccinated with Tdap against pertussis, ACIP also recommends, adults (e.g., parents, siblings, grandparents, childcare providers, and healthcare personnel) and children to receive Tdap at least 2 weeks before being in contact with the infant.

Infants younger than 12 months of age, specifically less than 3 months of age are at highest risk of acquiring pertussis. In U.S, there is no current tetanus-diptheria-pertussis vaccination (whooping cough) recommended or licensed for new born infants. As a result, in their first few months of life, unprotected infants are at highest risk of life-threatening complications and infections from pertussis. Infants should not receive pertussis vaccination younger than 6 weeks of age. Ideally, Infants should receive DTaP (name of whooping cough vaccine for children from age 2 months through 6 years) at 2, 4, 6 months of age and they are not protected until the full series is completed.

life-threatening complications and infections

unprotected

first few months of life

Package insert CI Info :


 * Severe allergic reaction (eg, anaphylaxis) after a previous dose of Pentacel, any ingredient of Pentacel, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine or H. influenzae type b vaccine. (4.1)
 * Encephalopathy within 7 days of a previous pertussis-containing vaccine with no other identifiable cause. (4.2)
 * Progressive neurologic disorder until a treatment regimen has been established and the condition has stabilized. (4.3)

Melody's correction:


 * Severe allergic reaction (anaphylaxis) after a previous dose of Pentacel, any type of ingredient of Pentacel, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine or H. influenzae type b vaccine.
 * Encephalopathy within 7 days of pertussis-containing vaccine.
 * Progressive neurologic disorder of spasms, epilepsy until the condition has stabilized.