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Pregnant women in UK are offered whooping cough vaccine to protect newborns

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6594 (Published 28 September 2012) Cite this as: BMJ 2012;345:e6594
  1. Matthew Billingsley
  1. 1BMJ

Pregnant women in the United Kingdom are being urged to be vaccinated against whooping cough to protect their babies against the virus.

The recommendation from the Department of Health for England follows new figures showing that 10 people, all infants under 12 months old, have died from whooping cough in the UK so far this year (nine in England and one in Northern Ireland). This is the highest mortality since 1982, when there were 14 deaths.

Whooping cough has increased in incidence in England and Wales since 2011, when there were 525 reported cases and five deaths. So far this year 4791 cases have been reported. Most of the severe cases are being seen in infants aged less than 2 months, before childhood vaccinations start.

England’s chief medical officer, Sally Davies, said, “We are going to give this vaccine to the mothers so they make an antibody against it [whooping cough] which will travel across the placenta into the baby. This will protect the baby from whooping cough up to the time of the first immunisation, which is at eight weeks.”

The health department said that the vaccine should be offered to the 650 000 pregnant women in the UK when they are 28-38 weeks into their pregnancy during routine antenatal appointments with a nurse, midwife, or GP. Women who have already been immunised should be vaccinated again to boost their immunity.

Although billed as a temporary measure, the vaccination of pregnant women will continue until numbers of cases begin to subside.

David Salisbury, director of immunisation at the health department, said that the UK Joint Committee on Vaccination and Immunisation carried out an options analysis to decide the best way to combat the “significant problem” of rising cases of whooping cough.

“The vaccine that we are offering to pregnant women has been recommended by experts, and a similar vaccine is already given to pregnant women in the United States,” he said at a press briefing.

Doctors will use Repevax in pregnant women, the vaccine that has been used for the past decade in UK children as a preschool booster. It contains inactivated or toxoid vaccines of tetanus, diphtheria, acellular pertussis, and polio and has also been used as a booster for adults in France and Germany, some of whom will have been pregnant.

Salisbury said that the joint committee had no concerns about the safety of use of this vaccine at any stage of pregnancy. “We’ve got close to a decade experience of using this vaccine in children. We know its safety profile is excellent. The adverse reactions are mostly local reactions with redness and sore arms, which is transitory,” he said.

However, the manufacturer’s summary of product characteristics for Repevax states that although “no teratogenic effect of vaccines containing diphtheria or tetanus toxoids or inactivated poliovirus has been observed following use in pregnant women,” there is “limited post-marketing information available on the safety of administering Repevax to pregnant women.”1

The effects of the immunisation campaign and the safety of the vaccine will be monitored by the Health Protection Agency and the Medicines and Healthcare Products Regulatory Agency.

The health department said that GPs had the vaccine in stock and that there was at least six months of supply of Repevax available for the routine childhood vaccination programme and for vaccinating pregnant women. Further supplies can be ordered through the online ordering service ImmForm.

Pregnant women can stay up to date by registering on the health department’s website to receive regular updates by email, text, or Facebook, that relate to each stage of their pregnancy (http://bit.ly/SU8vWo).

Notes

Cite this as: BMJ 2012;345:e6594

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