Abstract
Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.
Highlights
Morbidity and Mortality Weekly ReportVariation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type — Florida, 2016–2018
In a random sample of 341 mothers who delivered at a large, quaternary care and referral academic health center in Florida during 2016–2018, a significantly smaller percentage of Medicaid-insured women received Tdap and influenza vaccines during pregnancy than did privately insured women
Few studies have included information on receipt of Tdap and influenza vaccines during the postpartum period. Results from this analysis show that compared with privately insured pregnant women, a significantly larger proportion of pregnant women with Medicaid received Tdap and influenza vaccines during the immediate postpartum period, a strategy that confers less protection for infants [6]
Summary
Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type — Florida, 2016–2018. To provide protection for both mothers and infants, maternal immunization with Tdap is recommended during pregnancy and with influenza vaccine before or during pregnancy, rather than during the postpartum period; vaccination during the postpartum period has been shown to be less effective in preventing infant pertussis [6] Data for this analysis were obtained through a retrospective review of charts of women who delivered a live birth at the University of Florida Health Shands Hospital during 2016 2018. Among 341 women eligible to receive Tdap, 215 (63.1%) received it, including 123 (36.1%) who were vaccinated during pregnancy and 92 (27.0%) who were vaccinated during the immediate postpartum period (Table 2) This varied significantly by insurance type: 96 of 140 (68.6%) women with private insurance and 27 of 201 (13.4%) with Medicaid received Tdap during the recommended time (27–36 weeks’ gestation)
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