Abstract
Although maternal pertussis vaccination is recommended, uptake is suboptimal in New Zealand (NZ), despite full funding in general practice and hospitals. We determined whether funding maternal pertussis vaccination in community pharmacy increases its uptake. Pertussis vaccination during pregnancy was compared between non-contiguous, demographically similar regions of NZ. The pertussis vaccine was funded at pharmacies from Nov 2016 in one NZ region (Waikato), but not in comparator regions (Northland, Hawkes Bay). Vaccinations during pregnancy were determined from the National Immunisation Register, general practice and pharmacy claims data, and a maternity database. Comparisons were made using adjusted odds ratios (OR) and 95% confidence intervals (CI) for Nov 2015 to Oct 2016 versus Nov 2016 to Oct 2019. The odds of pregnancy pertussis vaccination increased in the post-intervention versus pre-intervention period with this increase being larger (p = 0.0014) in the intervention (35% versus 21%, OR = 2.07, 95% CI 1.89–2.27) versus the control regions (38% versus 26%, OR = 1.67, 95% CI 1.52–1.84). Coverage was lower for Māori versus non-Māori, but increased more for Māori in the intervention versus control regions (117% versus 38% increase). It was found that funding maternal pertussis vaccination in pharmacy increases uptake, particularly for Māori women. Measures to increase coverage should include reducing barriers to vaccines being offered by non-traditional providers, including pharmacies.
Highlights
IntroductionPertussis (whooping cough) causes hospitalisations and deaths, of young infants [1,2], and disproportionately affects indigenous infants [1,3]
The final cohort for pertussis vaccination consisted of 27,576 eligible pregnant women in the maternity database in the three study regions for the three-year intervention data, limited by the strict inclusion criteria (Figure 1)
This is the first reported study to measure how funding in pharmacy affects the overall uptake of the maternal pertussis vaccination
Summary
Pertussis (whooping cough) causes hospitalisations and deaths, of young infants [1,2], and disproportionately affects indigenous infants [1,3]. Tetanus-diphtheriaacellular pertussis (Tdap) vaccination during pregnancy provides protection to this vulnerable young infant age group, preventing hospitalisations [4] and deaths [5]. Maternal pertussis vaccinations are recommended and funded in many developed countries [6,7], uptake is often suboptimal [8–10], in higher deprivation groups [10,11], including in New Zealand (NZ) [10]. Safety concerns hinder the uptake of maternal vaccinations [12–14]. While healthcare professional recommendations and/or the endorsement of the safety of maternal vaccinations encourages uptake [9,12,14], some antenatal carers do not provide this [9,14,15]
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