Tdap vaccine

Wow, it's almost been a year since my last post!  I've survived the oral boards, and am now board certified in OB/GYN, and a Fellow of the American College of OB/GYN!  I hope to resume more regular posts now that that's behind me...

One topic that I discuss almost daily is immunization for Tetanus, diptheria, and acellular pertussis (Tdap).  What the heck is it, and why do you need it?

Every adult should be immunized against tetanus at least once every 10 years.  Tetanus is an infection caused by the bacteria Clostridium difficile.  You get tetanus by transmission of inactive spores (often found in dirt) into an open wound.  The bacteria then enter the nervous system, causing severe painful muscle spasms.  This is why tetanus used to be called "lockjaw".  The muscle spasms can be severe enough to cause muscles to tear, bones to fracture, and respiratory problems.  Without treatment, one in four people die, but the disease is less than 10% fatal when treated.  Because of the increased risk of infection with open wounds, tetanus immunizations are routinely given in the emergency room when a patient presents with a laceration or other wound.

Diphtheria is a respiratory infection, caused by the bacteria Corynebacterium diphtheriae.  You should be immunized against this at least every 10 years also.  This disease is spread by droplets from the sneeze or cough of an infected person, or by ingestion of contaminated food.  It causes thick secretions which can block the airways, and bacterial toxins can also affect other organs, causing heart problems, and paralysis if it attacks the nervous system.  Thankfully, due to the effectiveness of the vaccine, diphtheria is very rare in the U.S.

The most important reason to receive this immunization, though, is to protect yourself and those around you from pertussis, or whooping cough.  Pertussis is an infection caused by the bacteria Bordetella pertussis.  It is transmitted by infected droplets from a cough or sneeze.  At first, the symptoms of the disease are no different than that of the common cold, but worsen into a terrible cough that sometimes causes the person to make a "whoop" noise when they try to breathe between coughs.  The severe cough can sometimes lead to vomiting or loss of consciousness, especially in infants.  Infected infants have the highest rate of death from this infection, generally due to respiratory failure.  Infants less than 6 months old are infected most often, because they have not been fully vaccinated.  During 2012 and the first few months of 2013, pertussis cases have been increasing throughout the U.S., thought to be due to waning immunity to pertussis.  The immunizations most adults received when they were infants are no longer effective.

For that reason, the Tdap vaccine is recommended for everyone aged 11 or older, one time, to prevent pertussis infection.  The Td (tetanus/diphtheria) vaccine should then be given every 10 years after Tdap.  This is especially important for anyone who will be around very small infants, who will not be fully immunized, and therefore very susceptible to infection.  The Tdap vaccine was recently approved for use in pregnant women, after 20 weeks gestation.  The advantage of giving it during pregnancy is that maternal antibodies to pertussis can then cross the placenta, and protect her infant from the time of birth.

In October 2012, the Advisory Committee on Immunization Practices (ACIP) recommended that every pregnant woman, irrespective of previous Tdap vaccination status, should receive Tdap between 27-36 weeks gestation, to optimize transplacental passage of maternal antibodies against pertussis to every infant.

Getting the Tdap vaccine is not harmful.  It generally causes you to have a sore arm for a day or two after, but side effects are otherwise rare.  Some people have reported chills, nausea, body aches, headaches, or rash related to getting the vaccine.  The only people who should NOT have the vaccine are those who have had a severe allergic reaction to the vaccine or any of its components, or those who have had a seizure or gone into a coma within 7 days of previously receiving the vaccine.

Tdap vaccine is available at most physician offices, county health departments, and many pharmacies.

I hope that you consider getting the Tdap vaccine, not only to protect yourself, but others around you.

Here are some helpful links for more information:

Tdap vaccine and pregnancy

Vaccine Information Statement

CDC pertussis website