Medical Research

Study on Safety of Tdap and Flu Vaccines in Pregnancy Includes Only Live Birth Outcomes and Excludes Infants Born Before 34 Weeks

Captured 2023-04-04
Document Highlights

There are limited studies of the long-term safety in infants for vaccines administered during pregnancy.

We evaluate whether maternal receipt of influenza and Tdap vaccines increases the risk of infant hospitalization or death in the first 6 months of life.

We included singleton, live birth pregnancies in the Vaccine Safety Datalink between 2004 and 2014.

We found no association between infant hospitalization and maternal influenza or Tdap vaccinations. We found no association between infant mortality and maternal influenza or Tdap vaccinations.

We found no association between vaccination during pregnancy and risk of infant hospitalization or death in the first 6 months of life.

These findings support the safety of current recommendations for influenza and Tdap vaccination during pregnancy.

The Advisory Committee on Immunization Practices currently recommends 2 vaccines to be given during each pregnancy; influenza vaccine has been recommended at any time during pregnancy since 2004 to prevent maternal influenza disease and complications1 and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been recommended during each pregnancy since 2012, with a preference for administration between 27 and 36 weeks’ gestation…

In 2014, the US pertussis case rate in infants <6 months of age was 169 per 100 000 infants.

Furthermore, there were 8 deaths in infants <3 months of age and 1 death in infants 3 to 11 months of age out of 13 total deaths from pertussis in all age groups in 2014.*

For the 2013–2014 influenza season, there were 96 laboratory-confirmed, influenza-associated** pediatric deaths…

[We] excluded infants of multiple gestation pregnancies, infants born before 34 weeks’ gestation, and infants with major birth defects because these infants are at a higher risk of hospitalization and death. Furthermore, we excluded all infants who died during their delivery hospitalization because cause of death in these infants is often a perinatal complication (such as placental abruption) that would likely be unrelated to maternal vaccination.

Additionally, infants who die during the birth hospitalization may be less likely to be enrolled in the VSD and captured in our data.***

Comments

This study excluded all negative pregnancy outcomes / only included cases where infants survived maternal vaccination and survived past 34 weeks of pregnancy. (Tdap vaccination is recommended between 27 and 36 weeks.)

*US population was 318.4 million in 2014.

**The term influenza-associated deaths indicate that these children died while also testing positive for influenza. Influenza was not necessarily the cause of death - we do not know what percentage of the total influenza-associated deaths were actually caused by influenza.

***This is an assumption that placental abruption is unlikely to be related to maternal vaccination, and an admission that the Vaccine Safety Datalink is not capturing data on infants who die during the birth hospitalization.

There are reports of placental abruption post-vaccination in the VAERS database. For example: VAERS ID: 459541 / VAERS ID: 558952

We do not know the combined effect of maternal influenza and Tdap vaccination, in addition to hepatitis B vaccination on day 1 of birth. Infant mortality during hospital delivery with respect to exposure to these vaccines is an important endpoint to investigate.