Tdap or dTaP/IPV administered before 16 weeks of pregnancy If the dose was given before 16 weeks of pregnancy, it should be repeated once the woman reaches 16 weeks of pregnancy or around the time of her fetal anomaly scan. A minimum interval of 4 weeks between doses should be observed to reduce the risk of a local reaction. Repeating the dose will ensure that the unborn baby benefits from optimal transfer of maternal antibodies. Infanrix hexa or Vaxelis vaccine (DTaP/IPV/Hib/Hep B) administered in error Women who have inadvertently received the 6 in 1 (DTaP/IPV/Hib/HepB) Infanrix hexa or Vaxelis vaccines instead of the recommended Tdap or dTaP/IPV vaccine should be reassured that both Infanrix hexa and Vaxelis will offer protection against pertussis and that no further action is required. Such women should also be advised that Infanrix hexa and Vaxelis contain a high dose of diphtheria that is not normally given to adults because it is more likely to cause a localised reaction. Women who have inadvertently received Infanrix hexa or Vaxelis should be informed of the higher risk of localised reactions. Healthcare practitioners should report the administration error via their local governance systems so that the appropriate action can be taken, lessons can be learned and the risk of future errors minimised.
Td/IPV (REVAXIS) vaccine administered in error As Td/IPV vaccine (REVAXIS) does not protect against pertussis, a dose of Tdap or dTaP/IPV should be given as soon as possible after the error is realised, ideally on the same day to reduce the risk of local reactions and so that the dose of pertussis-containing vaccine is not missed. If not given on the same day or shortly after, the woman should be advised of the increased risk of local reactions. Healthcare practitioners should report the administration error via their local governance systems so that the appropriate action can be taken, lessons can be learned and the risk of future errors minimised.
dTaP/IPV (REPEVAX or Boostrix-IPV) vaccine administered in error Although the JCVI expressed a preference for Tdap vaccine to be offered to pregnant women once this vaccine became available, if a dTaP/IPV vaccine is administered in error, this should still be counted as a valid dose. The overall aim of the programme is to ensure that the woman is given a pertussis-containing vaccine in order to protect her infant from pertussis in the first few weeks of life. Whilst studies have shown that there may be some blunting of infant’s antibody responses to polio when a polio-containing vaccine is given in pregnancy, the clinical relevance of this is unclear and the level of antibodies made is still above the protective threshold. Additionally, in future changes to the immunisation schedule, infants will routinely be boosted against polio at 18 months when an additional dose of DTaP/IPV/Hib/HepB is introduced into the routine childhood schedule.
Tdap vaccine administered as a pre-school booster vaccine in error If Tdap vaccine (ADACEL) is administered as a pre-school booster in error instead of the dTaP/IPV vaccine that should have been administered, the child should be offered a dTaP/IPV vaccine as soon as the error is realised. This is because the Tdap vaccine will not provide protection against polio. Healthcare practitioners should familiarise themselves with the difference between the vaccines and the vaccine packaging to minimise the risk of the error occurring again. Where possible, ADACEL should be kept in a separate part of the vaccine fridge away from the pre-school booster dTaP/IPV vaccine.