Obstet Gynecol. 2017 Sep;130(3):e153-e157. doi: 10.1097/AOG.0000000000002301.
The overwhelming majority of morbidity and mortality attributable to pertussis infection occurs in infants who are 3 months and younger. Infants do not begin their own vaccine series against pertussis until approximately 2 months of age. This leaves a window of significant vulnerability for newborns, many of whom contract serious pertussis infections from family members and caregivers, especially their mothers, or older siblings, or both. In 2013, the Advisory Committee on Immunization Practices published its updated recommendation that a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) should be administered during each pregnancy, irrespective of the prior history of receiving Tdap. The recommended timing for maternal Tdap vaccination is between 27 weeks and 36 weeks of gestation. To maximize the maternal antibody response and passive antibody transfer and levels in the newborn, vaccination as early as possible in the 27-36-weeks-ofgestation window is recommended. However, the Tdap vaccine may be safely given at any time during pregnancy if needed for wound management, pertussis outbreaks, or other extenuating circumstances. There is no evidence of adverse fetal effects from vaccinating pregnant women with an inactivated virus or bacterial vaccine or toxoid, and a growing body of robust data demonstrate safety of such use. Adolescent and adult family members and caregivers who previously have not received the Tdap vaccine and who have or anticipate having close contact with an infant younger than 12 months should receive a single dose of Tdap to protect against pertussis. Given the rapid evolution of data surrounding this topic, immunization guidelines are likely to change over time, and the American College of Obstetricians and Gynecologists will continue to issue updates accordingly.
绝大多数由百日咳感染引起的发病率和死亡率发生在 3 个月及以下的婴儿中。婴儿要到大约 2 个月大时才开始接种自己的百日咳疫苗系列。这就为新生儿留下了一个显著的脆弱期，许多新生儿会从家庭成员和照顾者那里感染严重的百日咳，尤其是他们的母亲、年龄较大的兄弟姐妹，或者两者都有。2013 年，免疫实践咨询委员会发布了其更新的建议，即无论之前是否接受过 Tdap，每次妊娠期间都应接种一剂破伤风类毒素、白喉类毒素和无细胞百日咳（Tdap）。建议的母体 Tdap 疫苗接种时间为妊娠 27 周到 36 周。为了最大限度地提高母体抗体反应和被动抗体转移以及新生儿的抗体水平，建议在妊娠 27-36 周窗口期尽早接种疫苗。然而，如果需要进行伤口管理、百日咳爆发或其他紧急情况，Tdap 疫苗可以在妊娠期间的任何时间安全接种。没有证据表明接种灭活病毒或细菌疫苗或类毒素会对孕妇和胎儿造成不良影响，越来越多的有力数据证明了这种用法的安全性。以前没有接种过 Tdap 疫苗的青少年和成年家庭成员和照顾者，如果与 12 个月以下的婴儿有或预计有密切接触，应接种一剂 Tdap 以预防百日咳。鉴于围绕这一主题的数据迅速演变，免疫指南可能会随着时间的推移而改变，美国妇产科医师学会将继续相应地发布更新。
