妊婦への破傷風・弱毒化ジフテリア・無菌体百日咳3種混合ワクチン（Tdap）接種勧告の最新情報－Advisory Committee on Immunization Practices(ACIP)、2012年

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ホーム IMICライブラリ MMWR抄訳 2013年（Vol.62)妊婦への破傷風・弱毒化ジフテリア・無菌体百日咳3種･･･

MMWR抄訳

2013/02/22Vol. 62 / No. 07

MMWR62(7):131-135
Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women － Advisory Committee on Immunization Practices (ACIP), 2012

妊婦への破傷風・弱毒化ジフテリア・無菌体百日咳3種混合ワクチン（Tdap）接種勧告の最新情報－Advisory Committee on Immunization Practices(ACIP)、2012年

2011年10月、小児の百日咳感染を減少させるためAdvisory Committee on Immunization Practices (ACIP) はワクチン未接種妊婦への破傷風・弱毒化ジフテリア・無菌体百日咳3種混合ワクチン（Tdap）の1回接種を勧告した。妊娠中のTdap接種は母体の抗百日咳抗体産生を亢進させ、胎盤を通過する移行抗体によって新生児に百日咳に対する防御を付与するとともに、周産期の妊婦自身の感染と新生児への伝播を予防することが期待される。2011年の勧告ではワクチン接種歴のある妊婦は対象とされなかったが、2012年10月24日、ACIPは百日咳による小児の罹患率および死亡率の低減を目的に、全ての妊婦を対象にTdap接種を勧告することを決定した。Tdap接種2年以内の女性の出産時における抗百日咳抗体価と臍帯血抗体価を測定した結果、出生児の抗体価は百日咳感染防御に十分ではないと考えられた。これらの結果から、妊娠前のTdap接種では新生児に十分な抗体を付与することができず、ACIPは1妊娠期におけるTdapの1回接種では次回の妊娠時における免疫防御は不十分であると結論づけた。今回の勧告で、ACIPは妊娠期間中または分娩直後のTdap接種による防御効果について解析した2011年勧告時のモデルを再評価した。2000-2011年の12ヶ月未満児における百日咳症例数は年平均2,746例で、入院1,217例、死亡18例であった。モデルでは妊娠期のTdap接種により906例の発症、462例の入院、9例の死亡を予防すると推計された。一方、分娩後のTdap接種では549例の発症、219例の入院、3例の死亡を予防するに留まった。Tdapは妊娠期間中いつでも接種可能であるが、ACIPは出生児に高い抗体価を付与することが期待される第3妊娠期に接種を行うべきと結論づけた。

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