Friday, August 27, 2010

California Pertussis Recommendation - Dr. Bob is Wrong

There is an outbreak of Pertussis in California.   Those dying are infants under 3 months because they are not old enough to be successfully immunized through vaccination.

To protect them, the usual recommendation is that teens and older  those who come into close contact with infants have a recent Pertussis vaccination (booster dose of Tdap).  Women planning to be pregnant should be vaccinated and women who haven't been recently vaccinated should be vaccinated when there child is born.  The tricky issue is the vaccination of pregnant women.  The normal recommendation is that pregnant women not get vaccinated with Tdap.

The California Department of Health, because of the community outbreak, is now recommending that pregnant women get vaccinated.  Here's the death toll as of August 24, 2010. 

This got Dr. Bob Sears (of the ridiculous alternate vaccination) upset. He vomited forth at Huffington-Post in an article titled:  Government Okays Untested Vaccine for Pregnant Women  If Dr. Bob had merely stated that there wasn't good testing of the effects of Tdap vaccines on pregnant women, I wouldn't have anything to complain about.

But Dr. Bob makes it appear as if the California Department of Public Health recommendations   are something new and that
The vaccine product insert, as well as the letter I got from the pharmaceutical company, states very clearly that the vaccine is not indicated  CONTRAINDICATED]  for pregnant women.

That's not true.  The current ACIP recommendations, the CDC and the vaccine product inserts recognize that there are special circumstances in which Tdap vaccination during pregnancy is appropriate. Pregnancy is NOT listed as a contraindication of Tdap vaccination.

The Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants Recommendations of the Advisory Committee on Immunization Practices (ACIP) May 30, 2008 states:

Special situations in which Tdap might be used [during pregnancy] might include instances when a pregnant woman has insufficient tetanus or diphtheria protection until delivery, or a pregnant woman is at increased risk for pertussis. Persons at increased risk for pertussis might include adolescents aged 11--18 years, health-care personnel, and women employed in institutions in which a pertussis outbreak is occurring or living in a community in which a pertussis outbreak is occurring . [emphasis added] 

The CDC in the transcript of a short video dated July 2, 2010 states: 

To help protect infants too young to be vaccinated, women should ideally receive Tdap before becoming pregnant. If a pregnant woman is at increased risk for contracting pertussis, such as during a community outbreak , you may want to consider Tdap during pregnancy since it's not contraindicated. New moms who have not received Tdap should routinely receive a dose immediately postpartum, before leaving the hospital or birthing center."  [emphasis added]
The  Boostrix and Adacel product inserts say.
"Adacel vaccine should be given to a pregnant woman only if clearly needed."
"Boostrix vaccine should be given to a pregnant woman only if clearly needed." Pregnancy is NOT listed as a contraindication in either product insert.

So Dr. Bob is wrong. 

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