Prenatal pertussis vaccination recommended to reduce infant pertussis deaths

The resurgence of pertussis in the United States and many other countries in the world has become a major problem, with no immediate solution in sight. Sadly, the rising disease rate is accompanied by an increase in deaths from pertussis, almost exclusively in young infants. We have learned that the immunity induced by acellular pertussis vaccines, the only type of vaccine used in the United States since the late 1990s, is not durable and wanes rapidly over just a few years. No sooner is one cohort of children protected from pertussis through immunization than another, older, cohort becomes susceptible again. We merely are treading water in our efforts to control pertussis with currently available vaccines.

As well-outlined in the Global Pertussis Initiative review, we must circle the wagons around young infants. It is clear that we must focus on bridging the protection of infants from birth until they themselves can be effectively immunized. We are falling woefully short. All of us can do better.

Obstetricians and family physicians must immediately increase their efforts to immunize during pregnancy because it is the standard of care and will continue to be for the foreseeable future. The anticipated birth of a child is a good opportunity to ensure that everyone who will have contact with the infant has received recommended pertussis vaccines.

We desperately need a new pertussis vaccine. Every indication is that large-scale pertussis outbreaks will continue until a new approach is developed. In the meantime, the best primary strategy to prevent infant deaths is to immunize every pregnant woman during every pregnancy and to present the immunization schedule as the standard of care rather than as an option.

Mark H. Sawyer, M.D., is a professor of clinical pediatrics and a pediatric infectious disease specialist at the University of California San Diego School of Medicine and Rady Children’s Hospital in San Diego, Calif. Sarah S. Long, M.D., is a professor of pediatrics and infectious diseases at Drexel University College of Medicine in Philadelphia, and chief of the Section of Infectious Diseases at St. Christopher’s Hospital for Children in Philadelphia. Dr. Sawyer is a member and Dr. Long is an ex-officio member of the American Academy of Pediatrics Committee on Infectious Diseases, and both are members of the Vaccines and Related Biological Products Advisory Committee to the U.S. Food and Drug Administration. Dr. Long is also an associate editor of Red Book: 2015 Report on the Committee on Infectious Diseases and a liaison to the Pertussis Workgroup of the Advisory Committee on Immunization Practices. They made their remarks in an accompanying editorial.