Antenatal Pertussis Vaccination Research Articles

Vaccination uptake for pertussis and influenza vaccines in pregnancy among different practices at a single institution.

The authors investigated tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccination during pregnancy following Advisory Committee on Immunization Practices' (ACIP's) recommendation for antenatal pertussis vaccination. A retrospective chart review was performed in 2019 of women receiving prenatal care at our institution between January 1, 2014 and December 31, 2018. Receipt of ACIP-recommended vaccines were examined using Current Procedural Terminology codes to identify initiation of prenatal care, then administration of Tdap and influenza vaccines. Data were examined by individual practice (university faculty, community physicians, obstetrics and gynecology (OBGYN) residents, and family medicine residents, practice staff composition, vaccination protocol use, and insurance status. Statistical analyses were performed using χ2 testing and χ2 testing of linear trend. Within our cohort (n = 17 973), highest vaccination uptake occurred in the university-based OBGYN faculty practice (Tdap = 58.2%, influenza = 56.5%) with lowest uptake in the OBGYN resident practice (Tdap = 28.6%, influenza = 18.5%). Higher uptake occurred in practices with standing orders, more advanced practice providers, lower provider to nursing ratios, and lower rates of Medicaid insurance. These data demonstrated higher vaccination uptake with standing orders, more advanced practice providers, and lower provider to nurse ratios. Future work optimizing practice staff composition and vaccination protocols may increase vaccine uptake.

An observational, cohort, multi-centre, open label phase IV extension study comparing preschool DTAP-IPV booster vaccine responses in children whose mothers were randomised to one of two pertussis-containing vaccines or received no pertussis-containing vaccine in pregnancy in England

An antenatal pertussis vaccination programme was introduced in 2012 in the UK in the context of a national outbreak of pertussis. It has been shown that a lower antibody response to primary immunisation can be seen for certain pertussis antigens in infants born to women who received pertussis-containing antenatal vaccines, a phenomenon known as blunting. The longer-term impact of this has not been documented previously, and accordingly was evaluated in this study.Children were predominantly recruited from a previous study in which their mothers had received acellular pertussis-containing antenatal vaccines (dTaP3-IPV [diphtheria toxoid, tetanus toxoid, three antigen acellular pertussis and inactivated polio] or dTaP5-IPV [diphtheria toxoid, tetanus toxoid, five antigen acellular pertussis and inactivated polio]), or no pertussis-containing vaccine. Blood samples were obtained prior to and one month after the acellular pertussis-containing preschool booster (dTaP5-IPV) was given at around age 3 years 4 months. Pre- and post-booster immunoglobulin G (IgG) geometric mean concentrations (GMCs) against pertussis toxin, filamentous haemagglutinin, fimbriae 2 & 3, and pertactin, were compared.Prior to the receipt of the preschool booster, there was no difference in the IgG GMCs against pertussis-specific antigens between children born to women vaccinated with dTaP3-IPV and dTaP5-IPV; however, IgG GMCs against pertussis toxin were significantly lower in children born to women vaccinated with dTaP3-IPV compared with children born to unvaccinated women (geometric mean ratio 0.42 [95 % CI 0.22–0.78], p = 0.03). One month after the receipt of the preschool booster there was no differences between the groups.The blunting effect of antenatal pertussis vaccine on pertussis responses in children can persist until preschool age, although it is overcome by the administration of a booster dose.ClinicalTrials.gov registration number: NCT03578120

The knowledge, perceptions, and attitudes toward vaccination in pregnancy, pertussis, and pertussis vaccination during pregnancy among pregnant women in Hong Kong.

The Centre for Health Protection of Hong Kong has issued a recommendation on pertussis vaccination during pregnancy to protect infants against pertussis. This study aimed to explore the knowledge, perceptions, and attitudes toward pertussis vaccination during pregnancy among pregnant women in Hong Kong. This was a cross-sectional study conducted over a 6-week period from August 17 to September 30 2019 among pregnant women in an obstetrics department in a regional public hospital in Hong Kong. Information on participants' demographics, medical, and immunization history, their knowledge, perception and attitudes, toward pertussis vaccination during pregnancy were gathered. Point-biserial correlation coefficients were used to determine correlation between variables. Only 112 (24.6%) women knew that pertussis vaccination can be given during pregnancy and 53 (11.6%) recognized that antenatal pertussis vaccination should be given in each pregnancy. Despite poor knowledge on the vaccination, over 80% of women showed an intention to receive pertussis vaccination during pregnancy. Fifty-two (71.3%) women expressed that recommendations by healthcare professionals may alter their decision on vaccination uptake. The score in the knowledge section and the perception to the vaccination positively correlated with the intention to be vaccinated. Those who were given advice by healthcare professionals were more likely to indicate an intention to receive the vaccination. Pregnant women in Hong Kong are likely to accept antenatal pertussis vaccination despite the poor knowledge on vaccination in pregnancy and antenatal pertussis vaccination. Recommendations by healthcare professionals are a key factor affecting women's decision on vaccination uptake.

Routine vaccinations during pregnancy: an update.

Antenatal vaccination is usually delivered in primary care, yet a recent survey highlighted that many UK GPs are not confident discussing vaccination with pregnant women, and would value concise guidelines.1 Antenatal vaccination boosts maternal antibody levels and therefore the amount of antibody transferred to the fetus. ### Pertussis (whooping cough) #### Recommendation: between 16–32 weeks of gestation The UK antenatal pertussis vaccination programme was introduced following the 2012 pertussis outbreak, when >9000 individuals were infected and 14 infants died.2 Although numbers of cases have since reduced, rates of pertussis remain significantly higher than prior to 2012. A similar trend has been observed globally, and at least 14 countries have implemented similar recommendations.2 Pertussis disproportionately affects young infants, who have the highest rates of disease, and are at highest risk of severe disease and death. Most cases occur in early childhood before completion of primary immunisation, and therefore antenatal vaccination provides effective protection during this ‘window-period’ of …

Influenza and pertussis vaccination during pregnancy \u2013 attitudes, practices and barriers in gynaecological practices in Germany

BackgroundIn Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy.MethodsGynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists’ journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer’s Exact or t-tests. Variables associated with gynaecologists’ self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses.ResultsOf 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage.ConclusionsThe large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists’ confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.

Small interface changes have dramatic impacts: how mandatory fields in electronic medical records increased pertussis vaccination rates in Australian obstetric patients

IntroductionElectronic health records have been widely introduced into clinical practice. The aim of this study was to determine whether a small interface change could improve compliance with a key quality...

Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors

BackgroundInfluenza and pertussis vaccines have been recommended in Australia for women during each pregnancy since 2010 and 2015, respectively. Estimating vaccination coverage and identifying factors affecting uptake are important for improving antenatal immunisation services.MethodsA random sample of 800 Western Australian women ≥18 years of age who gave birth between 4th April and 4th October 2015 were selected. Of the 454 (57%) who were contactable by telephone, 424 (93%) completed a survey. Data were weighted by maternal age and area of residence to ensure representativeness. The proportion immunised against influenza and pertussis was the main outcome measure; multivariate logistic regression was used to identify factors significantly associated with antenatal vaccination. Results from the 2015 study were compared to similar surveys conducted in 2012–2014.ResultsIn 2015, 71% (95% CI 66–75) of women received pertussis-containing vaccine and 61% (95% CI 56–66) received influenza vaccine during pregnancy; antenatal influenza vaccine coverage was 18% higher than in 2014 (43%; 95% CI: 34–46). Pertussis and influenza vaccine were co-administered for 68% of the women who received both vaccines. The majority of influenza vaccinations in 2015 were administered during the third trimester of pregnancy, instead of the second trimester, as was observed in prior years. Women whose care provider recommended both antenatal vaccinations had significantly higher odds of being vaccinated against both influenza and pertussis (OR 33.3, 95% CI: 15.15–73.38). Of unvaccinated mothers, 53.6% (95% CI: 45.9–61.3) and 78.3% (95% CI: 70.4–85.3) reported that they would have been vaccinated against influenza and pertussis, respectively, if their antenatal care provider had recommended it.ConclusionsPertussis vaccination coverage was high in the first year of an antenatal immunisation program in Western Australia. Despite a substantial increase in influenza vaccination uptake between 2014 and 2015, coverage remained below that for pertussis. Our data suggest influenza and pertussis vaccination rates of 83% and 94%, respectively, are achievable if providers were to recommend them to all pregnant women.

Current antenatal pertussis vaccination guidelines miss preterm infants: An epidemiological study from the Northern Territory.

Assessing gaps in antenatal pertussis vaccination to increase coverage. Antenatal pertussis vaccination has been proven effective in reducing pertussis disease in infants. Current guidelines recommend maternal pertussis vaccination from 28weeks gestation. The aim of this study is to determine antenatal pertussis vaccination coverage in the Northern Territory and potential socio-demographic factors affecting uptake, using validated birth and immunisation data. Cross-sectional population study including all viable births (from 24weeks gestation) in Northern Territory public hospitals in 2016. There were 3392 viable delivery episodes in 2016 with 48.9% coverage against maternal pertussis based on current guidelines. Mothers <35years old were more likely to receive antenatal vaccination (adjusted odds ratio (aOR)=1.26, CI 1.035-1.52, P=0.021). Pertussis vaccination coverage for preterm births was low at 0% for extreme, 18.86% for very preterm and 39.8% for moderate preterm births, with an overall coverage of 33.5% for all preterm births. Term births were two times more likely than preterm births to have had mothers receive an antenatal diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine (aOR=1.957, CI 1.53-2.50, P<0.001). A significant proportion (66.5%) of preterm babies are not benefiting from protection against pertussis with the current pertussis vaccination policy from 28weeks gestation. As timing of birth cannot be predetermined, a review of safety and acceptability of pertussis vaccine administration in the second trimester is needed. Implementation of pertussis vaccination from 20weeks gestation will provide a wider vaccination period and maximise the protection of all infants including pre-term infants from pertussis.

The effectiveness of an online module for midwives conducting antenatal pertussis vaccinations

Background An online education programme was developed to support midwives and maternity staff to implement the New South Wales antenatal pertussis vaccination programme from March 2015. Aims To determine if an educational programme met the needs of midwives and maternity staff to conduct an immunisation appointment confidently with a pregnant woman. Methods Pre- and post-surveys were conducted with learners completing the programme. Findings Before completing the programme, 57% of respondents reported feeling ‘confident’ or ‘very confident’ in conducting a vaccination encounter with a pregnant woman. This increased to 94.1% after completion of the programme. Conclusion The education programme met the needs of midwives and maternity staff in New South Wales. An informed and confident maternity workforce will increase vaccine uptake in pregnant women and ensure that pertussis vaccination is incorporated consistently into routine antenatal care, to protect vulnerable infants from life-threatening diseases such as pertussis and influenza.

Antenatal pertussis vaccination potentially cost effective in Japan

Antenatal pertussis vaccination potentially cost effective in Japan

The importance of involving midwives before and during the implementation of an antenatal pertussis vaccination program in New South Wales, Australia

ProblemTypically there is limited opportunity for stakeholder engagement to determine service delivery gaps when implementing an outbreak or supplementary vaccination program. BackgroundIn response to increasing pertussis notifications in NSW, Australia, an antenatal pertussis vaccination program was introduced offering pertussis containing vaccine to all pregnant women in the third trimester. AimTo explore the effectiveness of consulting with midwives prior to and during a new state-wide vaccination program. MethodsA pre-program needs analysis was conducted through an online audit of the NSW Clinical Midwifery Consultants followed by a post-implementation audit at 18 months. FindingsInformation received from the midwives was utilised during program planning which facilitated program implementation without any major issues in all Local Health Districts. The post-implementation audit provided feedback to program planners that that implementation was continuing consistently and Midwives were found to be very supportive and engaged. DiscussionEducation and support of clinicians is vital for high vaccine uptake in new vaccination programs which can be enabled through appropriate educational packages and program resources. ConclusionConsulting with the midwives in advance of a new vaccination program was a new initiative and highly recommended as it was time well spent gaining essential information on program resourcing and operational needs. Conducting a post-implementation audit is also strongly recommended as a check-point for issues and recommendations, to empower frontline staff and support consistent program implementation. Frontline staff engagement before and during implementation of a new vaccination program is a powerful mechanism for effective, efficient and consistent program delivery.

Antenatal influenza and pertussis vaccine uptake among Aboriginal mothers in Western Australia.

Antenatal influenza and pertussis vaccination prevent serious disease in mothers and infants. Aboriginal individuals are at increased risk of infection yet little is known about vaccine coverage among Aboriginal mothers. To estimate the uptake of influenza and pertussis vaccination among pregnant Aboriginal women in Western Australia and identify barriers and enablers to vaccination. Four hundred Aboriginal women, aged ≥18years, who gave birth to a live infant between April and October 2015, were randomly selected and invited to participate in telephone interviews. Of the 387 women who did not decline, 178 had a functioning phone number and 100 completed the survey. Analyses were weighted by maternal residence. During pregnancy the majority of Aboriginal mothers were recommended influenza (66%; unweighted, 65/96=68%) and pertussis (65%; unweighted, 62/94=66%) vaccines, with 62% (unweighted, 56/94=56%) and 63% (unweighted, 60/93=65%) receiving the vaccinations, respectively. Almost all vaccinated women (98%) reported wanting to protect their baby as the reason for immunisation. Rural mothers were more likely than metropolitan mothers to have been vaccinated against influenza (odds ratio (OR) 4.1, 95% CI 1.7-10.2) and pertussis (OR 3.1, 95% CI 1.2-7.6). Recommendation by a healthcare provider was strongly associated with vaccine uptake (influenza: OR 15.6, 95% CI 4.9-49.5; pertussis: OR 13.3, 95% CI 4.6-38.0). Vaccination uptake among Western Australian Aboriginal mothers is comparable with rates reported for non-Aboriginal populations worldwide. Provider recommendation is the single most important factor associated with vaccination uptake, underlining the importance of integrating vaccination into routine antenatal care.

Intention to accept pertussis vaccine among pregnant women in Karachi, Pakistan.

Maternal immunization against pertussis is a potential strategy to protect young infants from severe disease. We assessed factors associated with intention to accept pertussis vaccination among pregnant women in Karachi, Pakistan. We conducted a cross-sectional survey between May and August 2013 in pregnant women who visited healthcare centers in urban slums of Karachi city. Women completed a survey examining socio-demographic factors, vaccination history, knowledge on pertussis disease, perception of vaccine recommendation sources, and potential influences on vaccine decision-making. Of the 283 participants, 259 (92%) provided their intention to either accept or decline pertussis vaccination. Eighty-three percent women were willing to accept the pertussis vaccine if offered during pregnancy. About half (53%) of the participants had ever heard of pertussis disease. Perceptions of pertussis vaccine efficacy, safety, and disease susceptibility were strongly associated with intention to accept pertussis vaccine (p<0.01). Healthcare providers, Ministry of Health, and mass media were considered as highly reliable sources of vaccine recommendation and associated with intention to accept antenatal pertussis vaccination (p<0.001). Healthcare provider recommendation was a common reason cited by respondents for pregnant women to accept antenatal pertussis vaccination (p=0.0005). However, opinion of primary decision-makers in the family (husbands and in-laws) was a crucial reason cited by respondents for pregnant women to reject pertussis vaccination in pregnancy (p=0.003). Antenatal pertussis vaccination initiatives in South Asia should strongly consider inclusion of family members, healthcare providers, national health ministries, and mass media to help implement new vaccination programs.

Influence of Population Demography and Immunization History on the Impact of an Antenatal Pertussis Program.

Background. Antenatal pertussis vaccination is being considered as a means to reduce the burden of infant pertussis in low- and middle-income countries (LMICs), but its likely impact in such settings is yet to be quantified.Methods. An individual-based model was used to simulate the demographic structure and dynamics of a population with characteristics similar to those of LMICs. Transmission of pertussis within this population was simulated to capture the incidence of infection in (1) the absence of vaccination; (2) with a primary course only (three doses of diphtheria, tetanus, and pertussis vaccines [DTP3] commencing in 1985, 1995, or 2005 at 20%, 50%, or 80% coverage); and (3) with the addition of an antenatal pertussis program.Results. Modeled annual incidence averaged over the period 2015–2024 reduced with increasing DTP3 coverage, regardless of the year childhood vaccination commenced. Over the same period, the proportion of infants born with passive protection did not change substantially compared with the prevaccination situation, regardless of DTP3 coverage and start year. We found minimal impact of antenatal vaccination on infection in all infants when mothers were eligible for a single antenatal dose. When mothers were eligible for multiple antenatal doses, incidence in infants aged 0–2 months was reduced by around 30%. This result did not hold for the full 0- to 1-year age group, for whom antenatal vaccination did not reduce infection levels.Conclusions. While antenatal vaccination could potentially reduce infant mortality in LMICs, broader gains at the population level are likely to be achieved by focusing efforts on increasing DTP3 coverage.

Antenatal pertussis vaccination: Are we implementing best evidence into practice?

Maternal immunisation is the most effective strategy to reduce infant morbidity and mortality from pertussis infection, and is now standard of care in many countries, including Australia. However, uptake cannot be guaranteed unless the barriers to implementing programs locally are understood. Education and resources for antenatal care providers, embedding vaccination within antenatal care, and provision of culturally appropriate information for pregnant women are integral to a successful antenatal vaccination program.

Antibody responses in infants after antenatal maternal pertussis vaccination.

Antibody responses in infants after antenatal maternal pertussis vaccination.

A prospective cohort study assessing the reactogenicity of pertussis and influenza vaccines administered during pregnancy

BackgroundPertussis vaccination during pregnancy can prevent 91% of infant infections. In 2015, antenatal pertussis vaccination programs were introduced across Australia. MethodsTo monitor the safety of this program, pregnant women who received trivalent influenza vaccine (TIV) and/or diphtheria-tetanus-acellular pertussis vaccine (dTpa) were surveyed by text message seven days post-vaccination about possible adverse events following immunization (AEFI). Univariate logistic regression models were used to calculate the odds of reporting an AEFI following dTpa compared to TIV. Similar analyses were used to compare AEFI reported by women who received a previous dose of dTpa in 2011/2012 as part of a state-wide cocooning program. ResultsOf 5155 women, 4347 (84.3%) replied; 10.8% indicated they experienced an AEFI. There was no difference in the proportion of women who reported any reaction by vaccine; however, women who received dTpa were more likely to report a local reaction than women who received TIV (7.1% and 3.2%, respectively; OR: 2.29; 95% CI: 1.61–3.26). There was evidence suggesting local reactions were more common among women with a previous dose of dTpa (11.4%) compared to women with no previous dose (6.0%; OR: 2.00; 95% CI: 0.95–4.25); 11 (0.3%) women reported attending a hospital emergency department. Subsequent follow-up indicated symptoms resolved and mother and infant were healthy. There was no difference in the proportion of women attending hospital by vaccine (p>0.05). DiscussionData on systemic and local reactions following receipt of TIV and dTpa during pregnancy support the safety of antenatal vaccination.

A study to enhance medical students’ professional decision-making, using teaching interventions on common medications

AimTo create sustained improvements in medical students’ critical thinking skills through short teaching interventions in pharmacology.MethodThe ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed.ResultsStudents enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies.ConclusionShort teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training.