Incorporating Tdap Vaccination into Prenatal Care to Increase Coverage in Pregnant Women

Current guidelines recommend that pregnant women receive vaccination with tetanus, toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine between 27 to 36 gestation weeks during each pregnancy.

Despite the recommendations, Tdap vaccine coverage in pregnant women remains suboptimal.

In a new report published in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report, investigators observing trends in pertussis cases in California discovered that only about 52% of pregnant women received the Tdap vaccine during the recommended time period. Additionally, vaccination coverage was found to be lower in women with Medicaid compared with women with private insurance.

During 2016—a low-incidence pertussis year in California&mdash;114 cases of pertussis were reported, including 2 pertussis-related deaths among infants <4 months. As part of the investigation, local health departments in California designed a questionnaire to collect information about vaccinations from the mothers of children who fell ill with pertussis and their prenatal care providers.

The interviewed mothers were asked to identify their prenatal care provider, whether their provider recommended a Tdap vaccine during pregnancy, whether the vaccine was received, and if so, when and where the vaccine was administered.

In the provider section of the survey, the providers were asked to identify the mother’s insurance type during pregnancy, whether the Tdap vaccine was recommended during pregnancy, whether the Tdap vaccine was stocked at the clinic, and to verify the mother’s vaccination status and the date and place of administration.

The investigators offered survey participation to the mothers of the 114 infants who were infected with pertussis and 66 mothers and their prenatal care providers provided information for the survey.

Survey data indicates that 26 of the 66 reported receiving the Tdap vaccine during pregnancy; 24 of these women were vaccinated at their prenatal care provider’s office. Documentation for vaccination was cross-referenced with the medical record of the California Immunization Registry. Of the 26 women, documentation was verified for 25.

Among the vaccinated women, 20 were vaccinated between 27 to 36 weeks, the recommended timeline; five were vaccinated outside of the recommended timeline. Of the infants of the vaccinated women, 6 were hospitalized, 1 of whom was admitted to the intensive care unit (ICU) and died.

The remaining 40 women reported not receiving the Tdap vaccine; 20 of their infants were hospitalized for pertussis, 8 of whom were admitted to the ICU and 1 died.

Among the 40 unvaccinated mothers, 10 reported that they did not receive a recommendation or referral off-site for vaccination from their prenatal care provider, 9 were referred off-site for vaccination but did not receive the vaccine, and 8 refused the vaccine for personal reasons.

Twenty-seven providers did not stock T-dap vaccine onsite and cited cost (44%) and reimbursement issues (41%) for not doing so.

According to the authors, having vaccines on site in prenatal clinics are the best way to ensure that women who are pregnant are getting vaccinated and to reduce the incidence of pertussis among infants who would otherwise be vulnerable to infection.

A limitation of this study is that the population was a relatively small sample size that may not be able to be generalized to findings of all pregnant women and providers across the United States.

Working to promote on-site prenatal vaccination and strengthening off-site referral tactics should improve Tdap vaccination coverage during pregnancy, the authors conclude.