Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine

Section 1.1

Midwives may independently prescribe, order and administer this drug.

The Tdap vaccine is an inactivated vaccine that protects against tetanus, diphtheria and pertussis. Tetanus is a nervous system disorder caused by Clostridium tetani that can cause life-threatening muscle spasms. Diphtheria is a serious infection of the nose and throat that can result in severe breathing problems, heart failure and paralysis. Pertussis (whooping cough) is a respiratory illness caused by the bacterium Bordetella pertussis.

Rates of pertussis and associated morbidity are high in infants less than six months of age. Pertussis contracted during early infancy is associated with mortality rates as high as 1% in infants less than 6 months of age. About 75% of infants with pertussis contract it from a family member or caregiver. For these reasons a dose of pertussis-containing vaccine may be recommended during pregnancy. The vaccine provides passive protection to the infant by transfer of IgG transplacentally in the third trimester and by transfer of secretory IgA in breast milk. It also helps prevent infection in the mother, and thus potential transmission of pertussis from the mother to the infant after birth. In addition, to minimize the risk of transmission to the infant even further, all family members caring for the infant should also consider vaccination against pertussis.

Indications and Clinical Use:

Tdap vaccination is indicated for all pregnant individuals ideally between 27 and 32 weeks gestational age, irrespective of their immunization history. Tdap may also be administered as early as 13 weeks and up until delivery if Tdap administration during the ideal window of 27 to 32 weeks is missed. Tdap is not yet universally covered by the BC Medical Services Plan; despite being indicated, clients may be asked to pay for the vaccine.

Contraindications:

History of anaphylactic reaction to a previous dose of any tetanus, diphtheria, or pertussis-containing-vaccine or to any component of the formulation. History of Guillain-Barré Syndrome (GBS) within 8 weeks of receipt of a tetanus containing-vaccine with no other potential cause identified.

Warnings and Precautions:

  • Use with caution in patients with a history of bleeding disorders, thrombocytopenia and/or patients on anticoagulant therapy.
  • Epinephrine (1:1,000) and Diphenhydramine hydrochloride should be available for immediate use in the event of an anaphylactic reaction.

Pregnancy:

Compatible

Lactation:

Category L1 – No Data – Compatible

Adverse Events:

Pain, redness and/or swelling at the injection site, fatigue, headache, fever, chills, nausea, diarrhea, muscle or joint aches.

Dosage and Administration:

IM: 0.5 mL