American Board of Family Medicine (ABFM) Practice Exam

A 29-year-old woman at 30 weeks gestation received Tdap 3 years ago. What vaccine should she receive?

1. Influenza vaccine

2. Tdap vaccine

3. Meningococcal vaccine

4. Hepatitis B vaccine

The correct answer is: Tdap vaccine

During pregnancy, especially in the third trimester, immunization plays a crucial role in protecting both the mother and the newborn. The Tdap vaccine is specifically recommended for pregnant women to boost immunity against tetanus, diphtheria, and pertussis (whooping cough). The recommendation for the Tdap vaccine is particularly strong because maternal vaccination during the third trimester helps transfer protective antibodies to the fetus, providing the newborn with passive immunity against pertussis, a severe and potentially life-threatening illness in infants. While the influenza vaccine is also recommended during pregnancy, the context of the question specifically mentions the Tdap vaccine, which is indicated here since the patient received her last dose three years ago, and she is currently at 30 weeks of gestation. In pregnant women, it is generally advised to receive Tdap during each pregnancy, ideally between 27 and 36 weeks, regardless of their prior vaccination history. Other vaccines mentioned, such as the meningococcal and hepatitis B vaccines, are typically not routine requirements during every pregnancy unless there are specific health indications or risk factors present. Thus, the Tdap vaccine aligns with current guidelines aiming to provide optimal protection against respiratory infections in newborns, especially when the need for maternal immunization is indicated.