Tdap in every pregnancy: circling the wagons around the newborn.

Abstract

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. In 2014, the >10 000 reported cases of pertussis in California surpassed a recent previous record set in 2010 and all other records in the postvaccine era. The national experience mimics that of California, with rising numbers of cases widespread over the last 4 years. Sadly, the rising disease rate is accompanied by an increase in deaths from pertussis, almost exclusively in young infants. Why is this happening? 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 1 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 and position statement by Forsyth et al1 in this issue of Pediatrics , we must circle the wagons around young infants. Very young infants suffer the greatest morbidity and almost exclusively the mortality related to pertussis, before they can be immunized. Couple this with an inability to … Address correspondence to Mark H. Sawyer, MD, 3020 Children’s Way, MC 5124, San Diego, CA 92123. E-mail: mhsawyer{at}ucsd.edu