Pertussis vaccine in pregnancy—first dose for every infant?

In what settings is pertussis vaccination in pregnancy most relevant? In low-income and middle-income countries, substantial price advantages of whole-cell vaccines, concerns about infant immune responses to whole-cell vaccines in the presence of high maternal concentrations of antibody, and scarcity of up-to-date data about disease burden will probably ensure that the focus will remain on maximisation of coverage for infant whole-cell vaccines. In high-income countries with longstanding pertussis immunisation and high coverage, severe morbidity (especially death) from pertussis is concentrated in the narrow window before infants receive their first dose. In such countries, the UK experience provides good evidence of protection in this window period,5 supporting the strong preference for pertussis vaccination in pregnancy over post-partum vaccination from modelling studies12 and making an important contribution to national decision making.