New Jersey Immunization Network (NJIN)

Transcription

1 New Jersey Immunization Network (NJIN)

2 IMMUNIZATION ISSUES FOR PREGNANT WOMEN Lawrence D. Frenkel, MD, FAAP Professor, Departments of Pediatrics and Microbiology University of Illinois College of Medicine at Rockford Member, Division of Immunology, Allergy, and Infectious Diseases Children s Hospital at St. Peters University Hospital, New Brunswick, NJ March 31, 2014

3 PERTUSSIS there are between ~800,000 and 3.3 million cases per year in the United States. A COMMON DISEASE!!! Reproduced with permission from Pediatrics, Vol. 115, Pages , Copyright 2005 by the AAP

4 You Can t Fool Mother Nature The whole cell Pertussis vaccine (P) was very effective in decreasing disease morbidity and mortality but it was associated with an appreciable incidence of mild to moderate adverse effects. The acellular Pertussis vaccine (more purified/fewer antigens) (ap) was associated with far fewer adverse reactions. DTaP replaced DTwP for the complete childhood series in 1997 (15 years ago), and Dtap was licensed in 2005 (8 years ago).

5 You Can t Fool Mother Nature (continued) However, within the past 5 years, increasing Pertussis susceptibility in children aged 7-10 years, who exclusively received DTaP and adolescents aged years, who received a TdaP booster suggests waning immunity to the newer (acellular) Pertussis component of the vaccines.

6 Pertussis (Whooping Cough) and Tdap Vaccine Over 48,000 cases of pertussis in the US in 2012 Data indicate a relatively short duration of protection from Pertussis after acellular Pertussis (ap) containing vaccination ooverall clinical effectiveness of 65% o75% effectiveness within the first year after vaccination o39% effectiveness 2-4 years later

7 Tdap Vaccines in Non-Pregnant Adults One dose of Tdap vaccine (adolescent and adult Tetanus, Diphtheria, and Pertussis vaccine) is recommended for all adults Regardless of the time since their last dose of Tetanus containing vaccine (other than Tdap) family members and other individuals in contact with newborns including health care workers should receive a dose of Tdap. After the one dose of Tdap, additional booster doses are not recommended at this time

8 Tdap Vaccine in Pregnancy Rational Pertussis disease is associated with increased mortality and morbidity in infants. Maternal immunization during gestation allows protective antibodies to be passed actively across the placenta (after 27 weeks gestation). Immunization of mother after gestation (ASAP) and of unimmunized close contacts allows for clinical cocooning (prevention of pertussis organisms being passed from close contacts to the immunologically susceptible infant.

9 Tdap Vaccine in Pregnancy ACIP Recommendations One dose of Tdap during each pregnancy Optimally at weeks gestation If not administered during pregnancy, Tdap should be given immediately postpartum

10 New Jersey Legislation # Assembly Bill 3978/Senate Bill 2832 includes the following mandates regarding pertussis vaccine: The Department of Health (DOH) must prepare and make available informational literature on pertussis vaccine for adults, including information on risks, infant morbidity/mortality rates, availability/efficacy of the Tdap vaccine, benefits of vaccinating pregnant women, a new mother, and other family members. The Department of Health would require hospitals and birthing centers to provide the informational literature to new mothers and family members at an infant s birth, including adoptive mothers and families, as part of discharge procedures.

11 Influenza Vaccine during Pregnancy Rational Influenza is five (5) times more likely to cause serious infection in pregnant women than in women who are not pregnant. This may result in hospitalization and death. There is an increased risk of preterm labor and delivery in pregnant women infected with influenza. Vaccination during pregnancy has been shown to protect the mother and infant (up to 6 months of age) from complications of influenza infection.

12 Influenza Vaccine in Pregnancy ACIP Recommendations Women who are or will be pregnant during influenza season should receive the inactivated influenza vaccine (IIV). It is safe and may be given in any trimester. The live attenuated vaccine (LAIV) is not recommended for use during pregnancy. Postpartum women can receive either the live or inactivated vaccine, including women who are breast-feeding. Postpartum women can receive either the live or inactivated vaccine, including women who are breastfeeding.

13 Antivaccine Forces Pray on the ignorance and fears of parents Reflect a historic antigovernment independence Are dependent on the misguided and profit driven motives of mass media Derive justification from pseudoscience: the lack of understanding that bad things (disease and death) happen coincidentally in large groups of people (i.e. those receiving vaccines) and that two events may be related temporally but not causally

14 Vaccine Safety Issues Are preeminent in the development of new vaccines, adjuvants and delivery systems in spite of increased cost and time requirements for development The current systems in the US for approving new vaccines and monitoring old vaccines have been remarkably effective but not perfect: FDA, ACIP, VAERS, Vaccine Safety Datalink, Manufacturers, CIC s, IOM, etc. To remedy rare adverse effects, the Vaccine Injury Compensation Program was set up in 1986, when pharmaceutical companies announced their intention to discontinue vaccine development because of litigation costs.

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16 References Center for Disease Control American Academy of Pediatrics Immunization Action Coalition State of New Jersey, Assembly, No.3978/ Senate, No.2832

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