Maternal TDAP Vaccination in Malaysia: A Step Forward in Eradicating Pertussis

Prof Dr Jamiyah Hassan FETOMATERNAL MEDICINE, Hospital Al-Sultan Abdullah Pertussis

The Malaysian Health Ministry (MOH) will provide free TDAP vaccination for all pregnant women, including non-citizens, to combat pertussis (whooping cough).

On August 28, 2023, Health Minister Dr. Zaliha Mustafa announced that all pregnant women in their second to third trimester will be given a free dose of tetanus, diphtheria and acellular pertussis (TDAP) vaccine from 2024 onwards. This initiative is meant to reduce the risk of pertussis among babies under 5 months of age. 

What is Pertussis?

Pertussis, commonly known as whooping cough, is an upper respiratory tract infection caused by the infecting organism, Bordetella pertussis. Transmission occurs through direct contact with respiratory secretion or aerosolised droplets from infected individuals.  

Initially, patients may appear to have symptoms of common cold such as: 

  • Runny nose
  • Low grade fever
  • Mild cough 

As the infection worsens, they may develop rapid, violent and uncontrollable coughing fits. In many patients, the coughing fits are usually followed by a high-pitched ‘’whoop’’ when they are finally able to catch a breath.

The infection is usually milder in adolescents and adults, especially those who have been vaccinated against pertussis. A large number of babies with pertussis do not cough at all. Instead, they may exhibit 

  • slowed breathing
  • apnea (life-threatening pauses in breathing)
  • cyanosis (turn blue/purple)
  • convulsions

Those who do cough may end up vomiting at the end of their coughing fit. Pneumonia is also common. Complications of pertussis in babies can be fatal.   

Maternal TDAP Vaccination to Reduce Infant Mortality

TDAP is the adult formulation of tetanus toxoid, reduced diphtheria and acellular pertussis vaccine. It is not DTAP, the child formulation given to babies at 2, 3, 5 and 18 months of age. TDAP contains smaller amounts of diphtheria toxoid and pertussis antigens than DTAP.

343 cases of pertussis with 24 deaths in Malaysia were reported as of August 23, 2023. 172 (50.4%) of these cases were infants under 5 months old. 19 of the 24 deaths were also infants under 5 months old.

The University Malaya Medical Centre’s 2017 study discovered that infants under 3 months old faced a higher risk of severe pertussis than older age groups. As infants receive their pertussis vaccination around 2 months of age, they are vulnerable to catching it from caregivers during this window period.

Maternal TDAP vaccination transfers protection to the unborn child. A vaccinated mother develops antibodies against pertussis from vaccination and passes it to her unborn child via the umbilical cord. This provides the newborn with passive immunity for the first two months of life until they receive their first vaccination against pertussis.

The MOH recommends TDAP vaccination for pregnant women between the second and third trimester (13- 36 weeks). 

Safety of TDAP Vaccination in Pregnancy

Multiple studies have demonstrated the safety of the TDAP vaccine. Maternal vaccination with TDAP has up to 95% efficacy in preventing infant death. Studies have also proven that maternal TDAP immunisation reduces the chances of getting pertussis up to 3 months after birth compared to postpartum vaccination. 

The MOH has allocated RM25 million for TDAP vaccines annually, hoping to help vaccinate 500,000 pregnant women yearly.

Doctor’s Insight

Professor Dr. Jamiyah Hassan, a consultant in fetomaternal medicine at the Department of Obstetrics and Gynaecology in Hospital Al-Sultan Abdullah, strongly supports including the TDAP vaccine in the public vaccination programme involving pregnant mothers. 

She shared “Vaccine confidence among health care providers and the ability to address issues on misinformation and availability of vaccines on-site has a significant impact on improving vaccination rates among pregnant women in Malaysia. Thus, I urge my peers to actively engage in discussions with their patients and recommend maternal TDAP immunisation.”

Dr. Jamiyah is part of the first public hospital to provide maternal TDAP.

Call for Action

While pertussis spreads easily and can be deadly in infants, maternal TDAP vaccination can significantly reduce its effects. Therefore, this will enable smooth recovery for mothers after childbirth and proper development in newborns. Free TDAP vaccinations for pregnant women is a great step forward in combating the rise of pertussis not only locally but worldwide. 

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