Introduction
Young infants who cannot receive vaccination are often most vulnerable to severe forms of pertussis (whooping cough) disease. It affects respiratory problems and is highly contagious. To curb the problem, the United States introduced passive immunization for infants by vaccinating pregnant women (Kandeil et al., 2020). Particularly, women are often given a combination of acellular pertussis, tetanus toxoid, and diphtheria toxoid. In America, the Advisory Committee on Immunization Practices (ACIP) advises that women get the Tdap during each pregnancy from 27 to 36 weeks of gestation (Kahn et al., 2018). More than twenty countries have since adopted the policy for Tdap vaccination for pregnant women. However, the main challenge with the strategy is that the antibody concentration in the infants following maternal vaccination interferes with the immune responses of the child during post-natal years.
Research Objective and Question
The objective of this research paper is to establish if maternal Tdap vaccination during the gestational period can protect infants below two months from getting pertussis. Therefore, the clinical question is: In pregnant women, how does receiving the Tdap vaccine compared to not receiving the Tdap vaccine reduce the risk of developing pertussis in infants under the age of two months?
Methodology
The research looked at various library databases that offer scholarly articles on medical and nursing topics, including Medline, PubMed, ProQuest, and Cochrane. The keywords used to identify the articles were Tdap, pertussis, and maternal vaccines. Related key terms, including gestational vaccine, and infants/babies under two years, were also used to get a wide range of papers. The search strategy used was Boolean, which combines keywords with either “AND” or “OR.” In addition, the researcher refined the articles using filters where only the articles were peer-reviewed and published within the last five years. Reading through the abstract of the papers was the final step in determining the articles to include in the study.
Research Findings
Most studies indicate that the maternal Tdap vaccination during gestation increases the infants’ protection against pertussis. The vaccination protected 77.7% to 93% of infants below two years across several studies in a systematic review (Kandeil et al., 2020a). An experimental study that used 601 infants established that babies of mothers who had taken the Tdap vaccine had low rates of vaccine response (Perrett et al., 2020).
Particularly, the researchers used 296 Tdap group and 305 control group and found that one month after the priming, there was 100% protection against diphtheria and tetanus with more than 98.5% hepatitis B for both groups (Perrett et al., 2020). Therefore, pertussis antibodies transferred during pregnancy lower the risk of the infection within the first month after birth but interfere with the ability of the infant to produce antibodies against the disease in consecutive months.
It is vital to delay the pertussis vaccination for children whose mothers received the Tdap. Noteworthy, findings show that the concentration of pertussis antibodies is higher in infants whose parents took the Tdap vaccine compared to the vaccine (16·6, 95% CI 10·9-25·2) within the first two months of life. The challenge is that according to Barug et al. (2020), the post-primary level of vaccination only increased for diphtheria toxoid and not the tetanus toxoid at a respective ratio of 0.4, 95% CI and 0.9, 95% CI). The maternal antibodies that are transmitted through the placenta affect the immune responses to the pertussis antigens but can be adjusted with a booster vaccination (Kandeil et al., 2020b). Thus, the maternal Tdap vaccination affects the infant’s antibody development, and nurses should know to make adjustments in planning for the vaccination calendar of the baby.
Furthermore, findings indicate that the time when the mother takes the vaccination significantly affects the success rates. For instance, when the Tdap is given during the first or second semester, the protection to the infants is only 64.3% versus 77.7%, respectively (Perrett et al., 2020). Comparatively, if given during the last trimester, the effectiveness in protecting the infants against the disease is more than 90% (Perrett et al., 2020). Moreover, the effectiveness of the Tdap vaccine significantly decreases as the infant grows.
Conclusion
Findings indicate that Tdap boosts pertussis antibodies in young infants below two months old. For the most effective results, the mother has to take the vaccination within the last trimester. When taken earlier in the pregnancy, the success rate reduces significantly. Moreover, the Tdap is taken by the mother for every pregnancy and not just one in a lifetime. Despite the promising results, research establishes that children whose mothers took the Tdap delay producing their own antibodies.
Moreover, they do not respond well to the vaccines given in post-natal. The implication is for nurses to adjust the vaccination period for children whose mothers had the Tdap injection. More research to determine the viability of the positive effects of maternal vaccination will make it easy to weigh the strengths and the shortcomings. Therefore, in as much as results are positive that the use of maternal Tdap protects infants against whooping cough disease which is contagious and serious for newborn babies, it is vital to understand the interference with the baby’s antibody development.
References
Barug, D., Berbers, G. A. M., van Houten, M. A., Kuijer, M., Pronk, I., Knol, M. J., Sanders, E. A. M., & Rots, N. Y. (2020). Infant antibody levels following 10-valent pneumococcal-protein D conjugate and DTaP-Hib vaccinations in the first year of life after maternal Tdap vaccination: An open-label, parallel, randomised controlled trial. Vaccine, 38(29), 4632–4639. Web.
Kahn, K. E., Black, C. L., Ding, H., Williams, W. W., Lu, P., Fiebelkorn, A. P., Havers, F., D’Angelo, D. V., Ball, S., Fink, R. V., & Devlin, R. (2018). Influenza and Tdap vaccination coverage among pregnant women — United States, April 2018. MMWR. Morbidity and Mortality Weekly Report, 67(38), 1055-1059. Web.
Kandeil, W., Savic, M., Ceregido, M. A., Guignard, A., Kuznetsova, A., & Mukherjee, P. (2020a). Immune interference (blunting) in the context of maternal immunization with Tdap-containing vaccines: is it a class effect?Expert Review of Vaccines, 19(4), 341–352. Web.
Kandeil, W., van den Ende, C., Bunge, E. M., Jenkins, V. A., Ceregido, M. A., & Guignard, A. (2020b). A systematic review of the burden of pertussis disease in infants and the effectiveness of maternal immunization against pertussis. Expert Review of Vaccines, 19(7), 621–638. Web.
Perrett, K. P., Halperin, S. A., Nolan, T., Martínez, A. C., Martinón-Torres, F., García-Sicilia, J.,… & Mesaros, N. (2020). Impact of tetanus-diphtheria-acellular pertussis immunization during pregnancy on subsequent infant immunization seroresponses: Follow-up from a large randomized placebo-controlled trial. Vaccine, 38(8), 2105-2114. Web.