Pertussis In Pregnancy Research Articles

Maternal predictors of timeliness & uptake of Measles, Mumps & Rubella vaccine: A birth cohort study

Abstract Background In the United Kingdom (UK) measles, mumps & rubella (MMR) vaccine uptake is below national recommendations. We aimed to identify maternal predictors for missed or late vaccination, including the association with pregnancy pertussis vaccination, added to the UK schedule in 2012. Methods We used electronic primary care records from the Clinical Practice Research Datalink to create a UK birth cohort following babies born between 01.01.2000 to 12.12.2020 and linked to their mother's record from birth. We estimated the proportion who received their 1st MMR vaccine by 2 years and 1st & 2nd MMR vaccines by 5 years and examined associated maternal predictors using survival analysis and Cox proportional hazard models. We examined a sub-cohort of babies born from 01.01.2013 to estimate the impact of pregnancy pertussis vaccination on children's subsequent MMR uptake. Results Overall, 92.6% (736,495/795,497) children had 1st MMR by 5 years with 89.4% (710,797) by 2 years. Among children still in the cohort when eligible for 2nd MMR, 85.9% had two MMRs by 5 years (478,480/557,050). Lower 1st & 2nd MMR uptake was associated with living in more deprived areas of England, being Black or Black British ethnicity or having mothers aged <20 years (1st MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively). Children of mothers vaccinated in pregnancy were more likely to have 1st & 2nd MMRs after adjusting for ethnicity, deprivation and maternal age (1st & 2nd MMRs by 5 years adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53). Conclusions There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics. Mothers vaccinated against pertussis in pregnancy are more likely to have a child vaccinated with MMR. Health professionals should promote pregnancy and childhood vaccinations during pregnancy and consider how families can be supported to access childhood vaccines. Key messages • There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics with MMR uptake lower among children living in more deprived areas. • Maternal vaccination and subsequent childhood vaccination uptake are related; pregnancy offers an opportunity to promote childhood vaccines and ensure families can access childhood vaccine services.

Vaccination in Pregnancy against Pertussis: A Consensus Statement on Behalf of the Global Pertussis Initiative.

Infants are at high risk for severe morbidity and mortality from pertussis disease during early infancy. Vaccination against pertussis in pregnancy has emerged as the ideal strategy to protect infants during these early, vulnerable, first months of life. On 30 November and 1 December 2021, the Global Pertussis Initiative held a meeting that aimed to discuss and review the most up-to-date scientific literature supporting vaccination against pertussis in pregnancy and outstanding scientific questions. Herein, we review the current and historically published literature and summarize the findings as consensus statements on vaccination against pertussis in pregnancy on behalf of the Global Pertussis Initiative.

The safety and immunogenicity of a combined pertussis containing vaccine Tdap for HIV infected pregnant women and their newborns (WoMANPOWER) – A study protocol for a randomized clinical trial

Background: Globally there are an estimated 24.1 million cases and 160,700 deaths from pertussis annually in children under five years. The disease burden is higher in low- and middle-income countries, especially the African region, which contributes the largest proportions of cases and deaths. Immunization against pertussis in pregnancy is a recommended strategy for the prevention of infant pertussis in many high-income countries. However, vaccine immunogenicity and effectiveness may be different in immunocompromised individuals such as women living with HIV. There is a need to generate data on the impact of HIV infection in pregnancy on maternal and infant immunity to vaccines against pertussis. Methods: This is a phase II, randomized controlled observer blind clinical trial of 100 women living with HIV and 100 uninfected women randomized to either standard vaccines (tetanus diphtheria vaccine, Td) or a tetanus diphtheria-pertussis vaccine (Tdap). Participants aged 18-40 years carrying a low-risk singleton pregnancy with a gestational age between 16 and 26 weeks confirmed on ultrasound scan, with no history of receipt of tetanus or pertussis vaccines in the current pregnancy will be recruited. Women will receive either two doses of Td or a first dose of Td and second dose of Tdap vaccine. Participants will complete 14-day diary cards to monitor reactogenicity. Mother-infant dyads will be followed up until the infant is one year old. The outcomes include: safety for the pregnant woman and infant; anti-pertussis toxin (PT) and anti-filamentous haemagglutinin (FHA) IgG concentrations in maternal, cord and infant blood and breastmilk, compared by maternal HIV status. Discussion: This study will investigate whether vaccines given to women living with HIV have similar immunogenicity and reactogenicity to vaccines given to pregnant women without HIV and monitor the effect of Tdap in pregnancy on infant immune responses. clinicalTrials.gov registration: NCT04589312 (19/10/2020)

Women\u2019s views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: a multi-methods study in the UK

BackgroundCOVID-19 vaccines are advised for pregnant women in the United Kingdom (UK) however COVID-19 vaccine uptake among pregnant women is inadequate.MethodsAn online survey and semi-structured interviews were used to investigate pregnant women’s views on COVID-19 vaccine acceptability for themselves when pregnant, not pregnant and for their babies. One thousand one hundred eighty-one women, aged over 16 years, who had been pregnant since 23rd March 2020, were surveyed between 3rd August–11th October 2020. Ten women were interviewed.ResultsThe majority of women surveyed (81.2%) reported that they would ‘definitely’ or were ‘leaning towards’ accepting a COVID-19 vaccine when not pregnant. COVID-19 vaccine acceptance was significantly lower during pregnancy (62.1%, p < 0.005) and for their babies (69.9%, p < 0.005). Ethnic minority women were twice as likely to reject a COVID-19 vaccine for themselves when not pregnant, pregnant and for their babies compared to women from White ethnic groups (p < 0.005). Women from lower-income households, aged under 25-years, and from some geographic regions were more likely to reject a COVID-19 vaccine when not pregnant, pregnant and for their babies. Multivariate analysis revealed that income and ethnicity were the main drivers of the observed age and regional differences. Women unvaccinated against pertussis in pregnancy were over four times more likely to reject COVID-19 vaccines when not pregnant, pregnant and for their babies. Thematic analysis of the survey freetext responses and interviews found safety concerns about COVID-19 vaccines were common though wider mistrust in vaccines was also expressed. Trust in vaccines and the health system were also reasons women gave for accepting COVID-19 vaccines.ConclusionSafety information on COVID-19 vaccines must be clearly communicated to pregnant women to provide reassurance and facilitate informed pregnancy vaccine decisions. Targeted interventions to promote COVID-19 vaccine uptake among ethnic minority and lower-income women may be needed.

Digital devices to assess vaccine hesitancy and promote pertussis vaccination during pregnancy

Abstract Introduction Vaccination against pertussis in pregnancy is the main strategy to prevent the disease in the first trimester of life of new-borns. Effective communication is essential to successfully engage pregnant women. The use of digital devices within the outpatient setting may be helpful to engage patients before and during the consultation. The aim of this study was to develop and test an e-health tool to assess vaccine hesitancy and to deliver tailored information and education interventions to raise awareness and promote vaccine acceptance. Methods One-hundred-and-five participants were recruited in 4 ob-gyn clinics. Participants were invited to complete a self-administered psychometric questionnaire to assess vaccine hesitancy, disease beliefs and self-efficacy perception on health behaviours on a tablet. Participants were randomly allocated to three communication-format types providing equivalent content: 1)a single video simulating a patient-doctor conversation on the topic; 2)an interactive platform with five infographics videos; 3)a paper leaflet followed by a brief consultation with the physician. The intention to get vaccinated during pregnancy was assessed through a specific question before and after the intervention. Results In the pre-intervention phase there was no difference observed between groups in terms of the variable “intention” to get vaccinated. After the intervention, participants of groups 1 and 3 showed a higher intention to get vaccinated than group 2 at the Kruskal-Wallis test (H(2)=6.008, p &amp;lt; 0.05). Post-intervention intention to vaccinate correlated with Individual Self-Efficacy (rs(105)=0.30, p &amp;lt; 0.001) and was inversely associated with vaccine hesitancy (rs(105)=0.34, p &amp;lt; 0.001). Conclusions We implemented and assessed the impact of different communication strategies to promote vaccine uptake among pregnant women. Our results suggest comparable effect may be obtained using simulated versus live patient-physician communication. Key messages The use of digital devices allows an effective and manageable communication about vaccination to pregnant women. In the present study, the implementation of digital forms of communication allowed a comparison with standard procedures of information towards vaccination, demonstrating their equivalence.

Factors affecting antibody responses to immunizations in infants born to women immunized against pertussis in pregnancy and unimmunized women: Individual-Participant Data Meta-analysis

BackgroundExploring factors that affect immune responses to immunizations in infants born to women immunized with tetanus-diphtheria-acellular-pertussis (Tdap) in pregnancy compared with unimmunized women is important in designing immunization programs. MethodsIndividual-participant data meta-analysis of 8 studies reporting post-immunization immunoglobulin G (IgG) levels to vaccine antigens in infants born to either women immunized with Tdap in pregnancy or unimmunized women, using mixed-effects models. ResultsIn infants of Tdap-immunized women, two-fold higher levels of anti-pertussis toxin (PT) and anti-diphtheria-toxoid (DT) IgG pre-primary immunization were associated with 9% and 10% lower post-primary immunization levels, (geometric mean ratio [GMR], PT: 0.91; 95% CI, 0.88–0.95,n = 494, DT: 0.9; 0.87–0.93,n = 519). Timing of immunization in pregnancy did not affect post-primary immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-primary immunization anti-B. pertussis and anti-DT levels. In infants of Tdap-immunized women, two-fold higher levels of anti-PT and anti-filamentous haemagglutinin (FHA) IgG pre-primary immunization were associated with lower post-booster immunization levels, (GMR, PT: 0.91; 0.85–0.97,n = 224, FHA: 0.92; 0.85–0.99,n = 232). Timing of immunization in pregnancy did not affect post-booster immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-booster immunization anti-PT, anti-pertactin (PRN), anti-TT and anti-DT IgG levels.In infants of unimmunized women, two-fold higher IgG levels of some vaccine antigens pre-primary immunization were associated with 8–17% lower post-primary immunization levels (GMR, PT 0.92, 95% CI:0.88–0.97, n = 373; FHA:0.88, 95% CI:0.85–0.92,n = 378; PRN:0.84, 95% CI:0.81–0.88, n = 367; TT:0.88, 95% CI:0.83–0.93, n = 241; DT: 0.83, 95% CI:0.79–0.87,n = 278). Two-fold higher levels of anti-FHA IgG pre-primary immunization were associated with 8% lower post-booster immunization levels (GMR, 0.92; 95% CI: 0.86–0.99,n = 138). DiscussionIncreased IgG levels pre-primary immunization is associated with reduced post-primary and post-booster immunization levels for some antigens in infants of women immunized or unimmunized in pregnancy, but their clinical significance is uncertain.

Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy: Aqualitative study.

To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. We conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. We carried out 18semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. We identified an overarching theme, 'factors that influenced participants' decision to be vaccinated or not', which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants' decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse-midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.

Case series of pertussis in pregnancy: A deadly, re-emerging disease

Background: Pertussis is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It can cause serious complications and can be deadly in infants. Maternal pertussis vaccination is effective in preventing disease in infants who are too young to be vaccinated. Case Description: Case 1: A 32 y old, G3P2 at 18 w of pregnancy, with underlying bronchial asthma presented with cough for 2 w and worsening breathlessness. She had prior contact with her sick child. Her chest radiograph was normal. She was initially treated for acute asthmatic exacerbation with bronchodilator and steroid. Pertussis was considered in view of multiple episodes of post-tussive vomiting and she was administered with oral azithromycin for 5 d. Her symptoms resolved upon discharge. Nasopharyngeal aspirate for pertussis PCR was positive. As she was in early pregnancy, she was given a booster dose of pertussis vaccine. Case 2: A 27 y old, pregnant at 38 w, presented with cough for 3 w and post-tussive vomiting. She was afebrile, respiratory examination and chest radiograph were normal. Pertussis was suspected and she was given 5 d of azithromycin. She delivered a healthy baby via emergency LSCS due to acute fetal distress. Pertussis was confirmed by positive pertussis PCR from nasopharyngeal aspirate. Case 3: A 30 y old woman, 36 w pregnant, presented with sore throat and productive cough for 2 w, associated with post-tussive vomiting for 3 d and dehydration. Her chest radiograph was normal. She was rehydrated and treated with azithromycin as pertussis was suspected. She was discharged well. PCR for Bordetella pertussis was detected in nasopharyngeal sample. Discussion: Diagnosis of pertussis in pregnancy or adults is challenging due to milder symptoms and the usual absence of classical inspiratory whoop. It should be considered in patients coughing longer than 2 w with post-tussive vomiting. Natural infection with pertussis and childhood vaccination does not provide lifelong immunity, thus booster Tdap is highly recommended in all pregnant women to reduce the risk of pertussis in young infants. Conclusion: Pertussis is often under-diagnosed due to lack of awareness among clinicians. Despite all, vaccination is still the most important and cost-effective measure to reduce pertussis transmission, its morbidity and mortality.

Motivational Interviewing for Maternal Immunisation (MI4MI) study: a protocol for an implementation study of a clinician vaccine communication intervention for prenatal care settings

IntroductionVaccination against influenza and pertussis in pregnancy offers a ‘two-for-one’ opportunity to protect mother and child. Pregnant patients have increased risk of severe disease from influenza and newborns have increased...

Pertussis vaccination in pregnancy in Canada: a cost-utility analysis.

The Canadian National Advisory Committee on Immunization recommends universal vaccination against pertussis in pregnancy. We assessed the cost-effectiveness of vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy in Canada. We conducted a cost-utility analysis comparing a vaccination program to no program corresponding with the 2017 Canadian guideline for economic evaluation from the Canadian Agency for Drugs and Technologies in Health. We developed 2 models - part decision tree, part Markov model - to estimate the long-term cost and quality-adjusted life-years (QALYs) for pregnant women and their infants. We obtained epidemiologic data from 2006 to 2015, and derived costs and utility values from relevant sources. Results were reported in 2019 Canadian dollars. We obtained expected values through probabilistic analysis, with methodologic and structural uncertainty assessed through scenario analyses. The analysis adopted an acquisition price of Tdap vaccine of $12.50, with scenario analysis conducted to identify the threshold price for vaccination to be cost-effective. In the base-case scenario, for every 1000 pregnant women vaccinated, the program would lead to a gain of 0.3 QALYs, occurring solely in infants, at an increased total cost of $12 987, or $44 301 per QALY gained. Based on a threshold of $50 000 per QALY gained, vaccination would have been cost-effective in 6 of the 10 years included in the model (range of incremental costs $20 463-$100 348 per QALY gained). The threshold cost for Tdap vaccine to be cost-effective over the 10-year horizon was $14.03. Based on a threshold of $50 000 per QALY gained, vaccination against pertussis in pregnancy would be cost-effective if the acquisition cost per vaccine were $14.03 or less. Province- and territory-specific analyses should be done to inform local decision-making.

Clinical and Epidemiologic Characteristics of Pertussis in Hospitalized Children: A Prospective and Standardized Long-term Surveillance Study.

Surveillance of incidence and severity of pertussis is key to control success and shortcomings of vaccination programs followed by adaptations of recommendations if necessary. In Switzerland, nationwide reporting of hospitalizations due to pertussis in children has a long tradition and resumed in 2013 to evaluate the effects of pertussis immunization in pregnancy introduced in 2013. Since 2013, all patients <16 years of age hospitalized with suspected or proven pertussis have been reported to the Swiss Pediatric Surveillance Unit. Patient data comprising clinical and epidemiologic characteristics and laboratory confirmation were assessed in a standardized fashion, and case definitions were applied to all cases reported until the end of 2019. Two hundred thirteen of 294 cases were valid cases of pertussis. Of these, 168 (79%) occurred in <6-month-old infants. Mean duration of hospitalization was 8 days (median 5, range 2-47) overall and highest in neonates (14.2 days); 85% of all patients had ≥1 complication, most commonly cyanosis and dyspnea, especially in infants. Overall, case fatality rate was 1.4% (8.7% in neonates). Only 4 (2%) of 168 mothers of infants <6 months had been vaccinated during pregnancy; 14 (12%) of 112 patients with precise records of immunization had completed their primary series and were up-to-date for age. Despite a decline of cases associated with the introduction of immunization against pertussis in pregnancy, control of the disease remains challenging, mainly due to failure to vaccinate rather than vaccine failure.

The prevalence and clinical characteristics of pertussis-associated pneumonia among infants in Botswana

BackgroundThere are scant data on the prevalence and clinical course of pertussis disease among infants with pneumonia in low- and middle-income countries. While pertussis vaccination coverage is high (≥90%) among infants in Botswana, human immunodeficiency virus (HIV) infection affects nearly one-third of pregnancies.We aimed to evaluate the prevalence and clinical course of pertussis disease in a cohort of HIV-unexposed uninfected (HUU), HIV-exposed uninfected (HEU), and HIV-infected infants with pneumonia in Botswana.MethodsWe recruited children 1–23 months of age with clinical pneumonia at a tertiary care hospital in Gaborone, Botswana between April 2012 and June 2016. We obtained nasopharyngeal swab specimens at enrollment and tested these samples using a previously validated in-house real-time PCR assay that detects a unique sequence of the porin gene of Bordetella pertussis.ResultsB. pertussis was identified in 1/248 (0.4%) HUU, 3/110 (2.7%) HEU, and 0/33 (0.0%) HIV-infected children. All pertussis-associated pneumonia cases occurred in infants 1–5 months of age (prevalence, 1.0% [1/103] in HUU and 4.8% [3/62] in HEU infants). No HEU infants with pertussis-associated pneumonia were taking cotrimoxazole prophylaxis at the time of hospital presentation. One HUU infant with pertussis-associated pneumonia required intensive care unit admission for mechanical ventilation, but there were no deaths.ConclusionsThe prevalence of pertussis was low among infants and young children with pneumonia in Botswana. Although vaccination against pertussis in pregnancy is designed to prevent classical pertussis disease, reduction of pertussis-associated pneumonia might be an important additional benefit.

Reflections on life-course vaccination: the England experience

Abstract Since the introduction of the expanded programme on immunization in the 1970s, vaccination has evolved from being an intervention of early infancy to being a programme targeting individuals at all stages of life including birth, infancy, childhood, teenage years, pregnancy and adulthood. The UK has been at the forefront of this lifelong approach to vaccination and has introduced vaccines at all stages of life in its national schedule, including vaccination against hepatitis B at birth, Meningococcal disease group B in infancy, influenza in primary school years, Meningococcal disease groups A, C, W and Y in teenage years, pertussis in pregnancy and shingles in older adults. Based on a range of studies conducted by Public Health England, This session will reflect on some of the challenges brought on by the life course approach in the UK including issues of access in different age groups, choosing the right age and settings for vaccinations, age-specific attitudes to vaccination and subsequent communication strategies, and challenges with monitoring a life-course programme.

Round table: Using evidence for action – the story on life-course vaccination

Abstract Vaccination represents a cost-effective public health intervention that saves millions of lives globally each year as well as increasing health and wellbeing of the population. Approximately 20 vaccines are currently in use in routine schedules, with several new or improved in the research pipeline. While immunisation programmes have traditionally targeted children, in recent strategic thinking around vaccination has shifted from an infancy focus to a life course approach that considers the benefits of vaccination at all ages. There are many benefits to targeting different age groups for vaccination, such as targeting individuals at an age that maximises protection (HPV among teenagers, shingles among older adults); boosting waning immunity (Td/IPV among teenagers); protecting at-risk individuals when they are most vulnerable (influenza in pregnancy, pneumococcal vaccine in older adults at clinical risk); protecting newborns in utero before they have the chance to be vaccinated (pertussis in pregnancy); or targeting an older age group to indirectly protect younger infants (MenACWY vaccination of teenagers). Even though the public health benefits of the life-course approach are evident, delivering vaccination programmes spanning such disparate groups represent constant challenges. These challenges can be grouped into: a) limited access to services b) communication challenges influencing attitudes and knowledge of vaccination and c) logistical challenges associated with the use of a wide range of settings for vaccination. This session will explore, at country and regional levels, experiences and reflections on delivering vaccination across the life course, and evidence-based policy and operational actions taken to deliver an optimal programme at all ages. Key messages Life course vaccination presents opportunities to better protect the population but also brings unique challenges, both from the patient side and from the health systems side. Evidence-based tools and strategies to improve vaccine programmes across the life-course are increasingly available. Country and European level action is needed to achieve optimal results.

To vaccinate or not to vaccinate? Women's perception of vaccination in pregnancy: a qualitative study.

BackgroundVaccination against influenza and pertussis in pregnancy can reduce the significant morbidity and mortality associated with these infections. Despite this, there is poor uptake of both vaccines in pregnancy.AimTo explore women’s perception of vaccination in pregnancy and thereby determine the reasons behind such low vaccination rates.Design & settingThis is a qualitative study undertaken at a large maternity hospital.MethodSeventeen post-partum women completed a semi-structured interview discussing vaccination. They were recruited from a quantitative study looking at vaccination rates in pregnancy. The interview transcripts were discussed among three researchers and underwent thematic analysis.ResultsThree themes emerged. The first theme explored the influencing factors that shaped the women’s decision to vaccinate in pregnancy. The recommendation of a healthcare provider was the most important influencing factor for this study's cohort of women. The second theme highlighted the deficiency in knowledge women had regarding vaccine safety. The last theme related to the pertussis vaccine, and the reluctance of healthcare providers to discuss and offer this vaccine in pregnancy.ConclusionThe qualitative approach gives voice to the thoughts and concerns of women as they make the complex decision to vaccinate in pregnancy. Clinicians must be cognizant of the important role they play in advising women to vaccinate in pregnancy. They must advise women that the vaccine is safe and address any of their concerns. Lastly, a message on vaccine safety should be included in future public health campaigns to promote vaccination in pregnancy.

Pertussis in pregnancy.

During the period July 1979 to April 1980 four pregnant women in one general practice were found to be suffering from pertussis. The diagnosis was based on clinical and serological evidence. The paper gives a clinical and bacteriological account for their progress and that of their babies. The possibility of pertussis occurring in expectant mothers at the present time is stressed.