Impact of the US Maternal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Program on Preventing Pertussis in Infants <2 Months of Age: A Case-Control Evaluation

Clin Infect Dis. 2017 Nov 29;65(12):1977-1983. doi: 10.1093/cid/cix724.


Background: Infants aged <1 year are at highest risk for pertussis-related morbidity and mortality. In 2012, Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine was recommended for women during each pregnancy to protect infants in the first months of life; data on effectiveness of this strategy are currently limited.

Methods: We conducted a case-control evaluation among pertussis cases <2 months old with cough onset between 1 January 2011 and 31 December 2014 from 6 US Emerging Infection Program Network states. Controls were hospital-matched and selected by birth certificate. Mothers were interviewed to collect information on demographics, household characteristics, and healthcare providers. Provider-verified immunization history was obtained on mothers and infants. Mothers were considered vaccinated during pregnancy if Tdap was received ≥14 days before delivery; trimester was calculated using Tdap date, infant's date of birth, and gestational age. Odds ratios were calculated using multivariable conditional logistic regression; vaccine effectiveness (VE) was estimated as (1 - odds ratio) × 100%.

Results: A total of 240 cases and 535 controls were included; 17 (7.1%) case mothers and 90 (16.8%) control mothers received Tdap during the third trimester of pregnancy. The multivariable VE estimate for Tdap administered during the third trimester of pregnancy was 77.7% (95% confidence interval [CI], 48.3%-90.4%); VE increased to 90.5% (95% CI, 65.2%-97.4%) against hospitalized cases.

Conclusions: Vaccination during pregnancy is an effective way to protect infants during the early months of life. With a continuing resurgence in pertussis, efforts should focus on maximizing Tdap uptake among pregnant women.

Keywords: Tdap; infant; maternal immunization; pertussis.

Publication types

  • Evaluation Study

MeSH terms

  • Case-Control Studies
  • Diphtheria / epidemiology
  • Diphtheria / prevention & control
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / administration & dosage*
  • Female
  • Humans
  • Immunization Programs*
  • Immunization Schedule
  • Infant
  • Mothers*
  • Parturition
  • Pregnancy
  • Pregnancy Trimester, Third
  • Pregnant Women
  • Tetanus / epidemiology
  • Tetanus / prevention & control
  • United States / epidemiology
  • Vaccination / methods*
  • Vaccination / statistics & numerical data
  • Whooping Cough / epidemiology
  • Whooping Cough / microbiology
  • Whooping Cough / prevention & control*


  • Diphtheria-Tetanus-acellular Pertussis Vaccines