Dear VaccineSmarts,

I received a dose of Tdap at my last visit to the obstetrician even though I was current on all of my vaccinations.

I received my first Tdap shortly after giving birth less than two years ago. I was hesitant to receive another dose even though my OB recommended it.

He didn’t seem too sure about why the recommendation changed. Did I do the right thing?


Texas City

Dear Cheri,

You absolutely did the right thing for your baby by getting the tetanus, diphtheria, pertussis vaccine during this pregnancy.

Pertussis, also known as whooping cough, is a serious illness. In 2012, 2,269 babies younger than 3 months of age were diagnosed with pertussis in the United States. Fifteen of them died.

More than half of children younger than 1 who have pertussis are hospitalized. Outbreaks of pertussis continue to occur throughout the country.

Studies indicate that babies frequently catch pertussis from those in close contact with them. During the time of your last pregnancy, cocooning was felt to be an adequate way to protect babies.

Cocooning refers to the practice of vaccinating mothers, family members and other caregivers to provide a layer of protection around the baby, since the baby cannot be vaccinated before 2 months of age.

Parents can’t always make sure everyone around their baby is free of pertussis. What has happened since your last pregnancy is that experts now believe that cocooning can be improved by vaccinating mothers during pregnancy.

The mothers’ immune system produces high levels of antibodies about two weeks after vaccination.

Vaccination is most effective between 27 to 36 weeks to maximize the number of antibodies transferred before birth.

It is believed that these antibodies will provide additional protection for the baby during the time that it takes for the baby to get fully immunized.

Babies are not fully protected until about 7 months of age, which is about a month after their third set of vaccinations.

You seem worried about the short interval between the two doses of the Tdap. This has been shown to be safe and well-tolerated in adults.

Mothers should be vaccinated every pregnancy to maximize the amount of antibodies that are transferred to their unborn baby.

Vaccination is safe for your baby as well. The tetanus and diphtheria portions of the vaccine have been used during pregnancy since the 1960s.

A significant number of women have been vaccinated with the Tdap during pregnancy. Surveillance studies conducted by the Food and Drug Administration and the U.S. Centers for Disease Control and Prevention looking at mothers vaccinated for pertussis during pregnancy have not found any safety issues for the baby or mother.

Although Tdap given every pregnancy is safe and well tolerated, it will take time to prove that it will better protect babies. Researchers are also looking at whether pertussis antibodies passed by breast-feeding also help protect babies.

To build upon your wise decision, make sure that everyone in close contact with your baby is current with their Tdap and flu vaccinations.

We wish you a healthy, happy baby.

Dr. Richard Rupp is a pediatrician and member of UTMB’s Sealy Center for Vaccine Development. Bridget Hawkins, Ph.D., is the assistant director of the Sealy Center for Vaccine Development. This column is supported by a UTMB President’s Cabinet Award to provide information about vaccines. Visit for more information.

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