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Public Health Wales updates pregnancy vaccination advice on pertussis and flu

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Public Health Wales has updated its recommendations for immunisation against pertussis and influenza during pregnancy.

Women should be offered the pertussis vaccine “as soon as possible” after 16 weeks gestation, according to the updated guidance that reflects expert advice on giving the immunisation early.

“It should be given as soon as possible after 16 weeks gestation”

PHW statement

It noted that previously available evidence indicated that vaccination would be most beneficial if administered early in the third trimester and should, therefore, be offered to women between 28 and 32 weeks of pregnancy.

However, since the original recommendation in 2012, it said new research had emerged showing that maternal immunisation earlier in pregnancy – during the second trimester – was “safe and increases antibody transfer to the infant”.

“The earlier timing will also help to ensure protection for babies who may be delivered prematurely,” said Public Health Wales. “This is particularly important as premature infants are over represented in cases of whooping cough occurring at this time,” it added.

The change followed a review of the new evidence last February by the Joint Committee on Vaccination and Immunisation, whose experts concluded that high levels of maternal antibody were transferred to the infant if women were vaccinated earlier in pregnancy.

As a result, from June 2016, it was recommended in a letter to health professionals that pregnant women should receive the vaccine ideally between gestational weeks 16 to 32 in every pregnancy.

This Gram-stained photomicrograph depicts numbers of Bordetella pertussis bacteria, which is the etiologic pathogen for pertussis, also known as whooping cough.

Whooping cought

Source: Public Health Image Library

Bordetella pertussis bacteria

The circular informing staff of the earlier timing for vaccination has now been formalised in an updated chapter in the “green book” on immunisation.

“Women should be offered the pertussis for every pregnancy and it should be given as soon as possible after 16 weeks gestation but can be given right up to birth if absolutely necessary, although unlikely to confer passive immunity to the newborn,” said Public Health Wales in a statement today.

It added that flu vaccination could be given at any stage of pregnancy and at the same time as the pertussis vaccine – albeit a different limb preferably – and was given usually by the practice nurse.

At the present time, midwives are not giving the vaccination as immunisation is not part of core midwifery care, noted Public Health Wales.

It said that once a woman was pregnant and saw her midwife a “sharing information in pregnancy” (SIP) form should be completed and copied to the patient’s GP and health visitor.

This would ensure that any information that needed to be shared between health professionals was “done at the earliest opportunity”.

“It is also a great tool to allow GP practices to keep a dataset on all their pregnant women and invite them to vaccination clinic for pertussis and flu,” said Public Health Wales.

Public Health England also published updated guidance on the public health management of pertussis in December.

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