The neonatal period, i.e. the first four weeks of a newborn’s life, is the most vulnerable time for a child.
Neonatal pertussis, also known as whooping cough, is one of the major concerns during this period and maternal immunisation during pregnancy is highly recommended as a preventive strategy.
Considered the most critical time for babies, the first 28 days of life are when feeding patterns are established and infant-parent bonding starts.
During this time, the risk of infection is higher, making babies vulnerable and leaving them exposed to dangerous situations.
Indeed, babies are more likely to die during the first month of life compared to any other period during childhood.
The average global death rate in 2019 for infants aged one month and below was 17 deaths per 1,000 live births.
This is higher than the probability of death for babies aged between one and 12 months, which was 11 deaths per 1,000.
Neonatal infections are dangerous as a newborn’s immune system is underdeveloped and more susceptible to infection.
Such infections can be contracted in the womb via the placenta, in the birth canal during birth, or after birth from the mother or other infected persons.
HIV (human immunodeficiency virus), hepatitis B, pertussis and streptococcus are among the common infections that a child is susceptible to at this time.
There are two ways in which mothers provide passive protection against pathogens to their baby in the first few months of life.
The first is during pregnancy, when the mother’s antibodies are transferred via the placenta to her foetus.
The second is after birth, when babies are fed with breast milk, which contains antibodies.
Maternal immunisation, which enhances these forms of protection, provides two-fold protection to both mother and baby.
The mother is protected against infectious diseases that may lead to severe outcomes in pregnancy, and the baby is protected against certain critical illnesses during the neonatal period.
Generally, pregnant women can be vaccinated with inactivated viral or bacterial vaccines, or toxoids.
Maternal immunisations against pertussis, tetanus and influenza have been routinely recommended as part of the strategy to prevent neonatal infection.
Studies have found these vaccines to be safe with no evidence of adverse effects on the foetus.
In contrast, live, attenuated viral and bacterial vaccines, such as the MMR (mumps, measles, rubella) vaccine, may pose risks to the foetus, and are thus not recommended for pregnant women.
Malaysia’s National Immunisation Programme (NIP) schedules DTaP (diphtheria, tetanus, pertussis) vaccination for babies at two months of age.
However, babies are exposed to pertussis infection in the first 60 days of life.
Thus, pregnant women are strongly advised to take the Tdap vaccine to ensure protection for their newborns during this window period.
The Tdap vaccine is a booster shot covering tetanus, diphtheria and pertussis, which is given to adolescents and adults, while the DTaP vaccine is given to children in multiple doses.
The World Health Organization (WHO) recommends one dose of Tdap vaccine for every pregnancy, given during the 27th to 36th weeks of pregnancy, at least 15 days before the expected date of delivery.
Mothers are recommended to repeat Tdap vaccination for every pregnancy as the protection wanes over time.
If it is not taken during pregnancy, immediate postpartum (after birth) Tdap vaccination is recommended to reduce transmission.
Infected by close ones
A 19-day-old baby was admitted to the neonatal intensive care unit (NICU) after showing symptoms of cough, apnoea (temporary stops in breathing), cyanosis (bluish skin) and progressive respiratory failure.
She had first shown mild viral upper respiratory tract infection four days earlier, but the symptoms had worsened, requiring her to be hospitalised.
According to the mother, the baby had trouble clearing the thick mucus in her airway, depriving her of oxygen.
The continuous coughs also caused stress on her weak heart.
Upon arriving at the hospital, the baby had already turned bluish.
Later, she was diagnosed with pertussis.
The source of transmission was believed to be the mother who had a mild cough four weeks earlier and did not receive Tdap vaccination during her pregnancy.
Most neonatal pertussis cases occur when babies are infected by close family members, especially the mother, who do not realise they are infected.
This is due to mild or non-specific symptoms in adults, a lack of awareness about pertussis or the vaccine, and unavailable diagnostic facilities.
Pertussis or any other infection can cause serious and fatal complications in young infants.
In 2018, 22 deaths were recorded due to pertussis in Malaysia.
These deaths were mostly unvaccinated babies under six months of age.
Maternal vaccination during pregnancy is the best preventive measure against neonatal pertussis.
If you are pregnant, consult your doctor about getting the Tdap vaccination.
Dr Kaliammah M. Kuppannan is a consultant obstetrician and gynaecologist.This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email firstname.lastname@example.org. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.