Different recommendations for TDaP vaccinations?

[elam84]

I’m curious about the reason behind differences between recommendations around the TDaP vaccine between the US and Canada. (Other countries as well obviously, I’m just speaking about US/Canada as a direct comparison)

I’m in Canada and was given a booster at around 28 weeks as per guidelines. Today we asked if my husband should also get a booster, as he hasn’t had one since he was a child, and were told that it isn’t standard procedure, and if he wants a booster then it would have to be paid for out of pocket. They only have recommendations in place for the mother to get a booster so antibodies are passed to the baby.

It seems like guidelines are vastly different in the US where they recommend anyone spending time with baby should get a booster if they haven’t in the past few years.

The recommendations are vastly different, could you please enlighten me as to why this is?

 

[glojoy5434]

@elam84 Since the USA is weird. https://academic.oup.com/cid/article/63/suppl_4/S221/2526409 did not find a difference in the rate of full cocoons around an infant with pertussis and uninfected controls. So this is part of the recommendation that pregnant women get the vaccine to pass along the protection to their kid, since cocooning doesn't matter. Nevertheless, the CDC still advocates for cocooning for... reasons https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm
Policy wise, the Canadian government is strongly incentivized not to pay for treatment that doesn't work. In the USA, the incentives are different, as so long as the recommendation is on the record, private insurance is required to pay for it.

Alright, one more edit. The evidence can be a little mixed. There are also studies that put the effect size somewhere between a 10-75% reduction in risk if both the father and mother are vaccinated. https://publications.aap.org/pediat...tal-Tdap-Boosters-and-Infant-Pertussis-A-Case The trouble is that compliance with this advice is bordering on terrible. Here is a study that is pretty pro cocooning (34% of infant pertussis cases coming from casual community contacts! Vaccinate everyone!), but also highlights how low the actual rate of people getting a Tdap is/was in 2011, when the American guidelines were changed. https://academic.oup.com/cid/article/53/9/893/346506

 

[jwilder9]

@glojoy5434 We had a whooping cough outbreak in our area in 2012 when my middle child was born, our ob-gyn recommended everyone is the house or with close contact get the vaccine who would interact with baby.

It took one You Tube video of a newborn with whooping cough to me send everyone to the doctor.

The science might be sketchy but it was highly helpful for my pregnancy hormones which I think is it's own sort of medical benefit. Lol

 

[micahinitiative]

@jwilder9 The vaccine positively impacted hormones during your pregnancy? That’s interesting… wondering how that worked! Could have been a placebo?

 

[jwilder9]

@micahinitiative Watching a video of a baby suffering from whooping cough was emotionally tough and made extra so by pregnancy hormones. Making everyone get the vaccine to help protect my baby made me feel safer and like I was at last trying to protect against my baby coming to that harm.

That is what I meant, it provided emotional comfort which has a value within itself.

 

[micahinitiative]

@jwilder9 Make sense! Thank you!!!

 

[human123]

@elam84 In the UK you can’t even get the TDAP vaccine as an adult if you’re not pregnant. It’s just simply not a thing that’s even thought about. And as far as I know we don’t have more babies catching diseases than anywhere else

 

[dcg]

@human123 That’s really bizarre to me! In Australia it was recommended that anyone having contact with my sisters baby be fully vaccinated, including TDaP boosters if it had been more than 5-10 years

 

[alisamiam]

@dcg In the UK we pretty much don’t get vaccinations after our teenage years unless for travelling…and even then we mostly just risk it. My friend is a Paeds doctor and I asked him about the risk of an unvaccinated adult passing something to my baby when he was small and he told me the risk is so negligible (as long as other hygiene like hand washing were being used) that he wouldn’t worry.

 

[theylivewesleep]

@alisamiam You can get it but it's not easy!

I was travelling back to Australia from the UK to see my nephew when he was born and struggled to find the TDAP vaccine - ended up at a travel clinic.

 

[dearestnatasha]

@human123 Yeah I’m Canadian but living in the uk so I asked at the GP if my husband should get the vaccine as well and no joke she looked at me like I had 2 heads and said “why is he pregnant too?”

 

[lionessofchrist]

@human123 Oh, I understand pertussis, but can you not even get a tetanus shot if your last one was over 10 years ago?

 

[pawel]

@lionessofchrist Yes, you can get a vaccine for tetanus, polio and diphtheria, just not one that also protects against pertussis

 

[cosmos123]

@human123 Are we recommended to get it when pregnant? I haven't had it with either pregnancy and was told it wasn't needed.

 

[human123]

@cosmos123 Are you sure you didn’t? We don’t call it TDAP here but every pregnant woman should be offered the ‘whooping cough vaccine’, which also protects against polio, diphtheria and tetanus. The vaccine is called Boostrix IPV, info here: https://www.nhs.uk/pregnancy/keeping-well/whooping-cough-vaccination/

 

[cosmos123]

@human123 Oh then I’m mistaken, I did get a whooping cough vaccine! I think I’m conflating two memories - I asked if my husband should get it and was told no. But I got the whooping cough vaccine both times, so sorry for the confusion.

 

[asaricommando]

@elam84 I’m also in Canada. All adults should be getting the TDAP vaccine every 10 years for their own protection even if not in contact with infants. If it has been more than 10 years since your husband last had it, he should be eligible for it at no cost. I’m not sure which province you’re in, but I would contact your local public health centre or his family doctor and request it. My husband got it in Alberta while I was pregnant and my parents in Ontario both got it too before coming to meet the baby, because they were all overdue for it.

 

[brittnyest]

@asaricommando This is the recommendation for adults in Germany, too. Every 10 years regardless of contact with infants.

 

[caowen]

@brittnyest That seems to be wrong. The RKI recommends only one pertussis booster for adults. If it has been more than 10 years since the last pertussis vaccine, a booster is recommended for people in certain work environments (like healthcare) and for people in close contact with newborns, like parents, grandparents, friends, and babysitters. (It's also recommended to get a pertussis vaccine in every pregnancy regardless of the time since the last vaccine dose.) Source (in German)

 

[brittnyest]

@caowen Interesting, I got my information from the English website of the Ministry of Health: “Booster against diphtheria and tetanus (recommended every ten years, combine next vaccination with pertussis vaccination)”

https://www.bundesgesundheitsministerium.de/en/topics/vaccinations.html