Tetanus, Diphtheria, and Acellular Pertussis and Influenza Vaccinations among Women With a Live Birth, Internet Panel Survey, 2017-2018

Neil Chandra Murthy, Carla Black, Katherine E Kahn, Helen Ding, Sarah Ball, Rebecca V Fink, Rebecca Devlin, Denise D'Angelo, Amy Parker Fiebelkorn, Neil Chandra Murthy, Carla Black, Katherine E Kahn, Helen Ding, Sarah Ball, Rebecca V Fink, Rebecca Devlin, Denise D'Angelo, Amy Parker Fiebelkorn

Abstract

Objectives: Pregnant women are at increased risk of complications from influenza, and infants are at increased risk of pertussis. Maternal influenza and Tdap (tetanus, diphtheria, and acellular pertussis) vaccination can reduce risk of these infections and related complications. Our objective was to estimate vaccination coverage with influenza and Tdap vaccines during pregnancy among women with a recent live birth.

Methods: An opt-in Internet panel survey was conducted from March 28 to April 10, 2018 among pregnant and recently pregnant women. Respondents with a live birth from August 1, 2017 through the date in which the participant completed the survey were included in the analysis. Receipt of influenza vaccination since July 1, 2017 and Tdap vaccination during pregnancy were assessed by sociodemographic characteristics, receipt of a health care provider (HCP) recommendation and/or offer of vaccination, and vaccination-related knowledge, attitudes, and beliefs.

Results: Less than a third (30.3%) of women with a live birth were unvaccinated during their pregnancy with both Tdap and influenza vaccines. Almost a third (32.8%) of the women reported being vaccinated with both vaccines. The majority (73.0%) of women reported receiving an HCP recommendation for both vaccines, and 54.2% of women were offered both vaccines by an HCP. Reasons for nonvaccination included negative attitudes toward influenza vaccine and lack of awareness about Tdap vaccination during pregnancy.

Conclusions: Maternal Tdap and influenza vaccinations can prevent morbidity and mortality among infants and their mothers, yet many pregnant women are unvaccinated with either Tdap or influenza vaccines. Clinic-based education, along with interventions, such as standing orders and provider reminders, are strategies to increase maternal vaccination.

Keywords: OB/GYN; Tdap; Vaccination; health care providers; influenza; pregnancy.

Conflict of interest statement

Declaration of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
Enrollment and inclusion of survey participants, Internet Panel Survey, March to April 2018. *Screening criteria: respondents reported they were women, aged 18-49, and pregnant any time since August 1, 2017. †A total of 115 were excluded because they did not know whether they had ever received a Tdap vaccination or did not know when they received their most recent Tdap vaccination.

References

    1. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices—United States, 2017-18 influenza season. MMWR Recomm Rep. 2017;66:1-20.
    1. Yudin MH. Risk management of seasonal influenza during pregnancy: current perspectives. Int J Womens Health. 2014;6:681-689.
    1. Nunes MC, Madhi SA. Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: a systematic review and meta-analysis. Hum Vaccin Immunother. 2018;14:758-766.
    1. Poehling KA, Edwards KM, Weinberg GA, et al. The underrecognized burden of influenza in young children. N Engl J Med. 2006;355:31-40.
    1. Nunes MC, Madhi SA. Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy. F1000Res. 2018;7:122.
    1. Poehling KA, Szilagyi PG, Staat MA, et al. Impact of maternal immunization on influenza hospitalizations in infants. Am J Obstet Gynecol. 2011;204:S141-S148.
    1. Masseria C, Martin CK, Krishnarajah G, Becker LK, Buikema A, Tan TQ. Incidence and burden of pertussis among infants less than 1 year of age. Pediatr Infect Dis J. 2017;36:e54-e61.
    1. Liang JLTT, Tiwari T, Moro P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018;67:1-44.
    1. Amirthalingam G, Andrews N, Campbell H, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet. 2014;384:1521-1528.
    1. Dabrera G, Amirthalingam G, Andrews N, et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-2013. Clin Infect Dis. 2015;60:333-337.
    1. Winter K, Nickell S, Powell M, Harriman K. Effectiveness of prenatal versus postpartum tetanus, diphtheria, and acellular pertussis vaccination in preventing infant pertussis. Clin Infect Dis. 2017;64:3-8.
    1. Ding H, Black CL, Ball S, et al. Influenza vaccination coverage among pregnant women—United States, 2014-15 influenza season. MMWR Morb Mortal Wkly Rep. 2015;64:1000-1005.
    1. Stark LM, Power ML, Turrentine M, et al. Influenza vaccination among pregnant women: patient beliefs and medical provider practices. Infect Dis Obstet Gynecol. 2016;2016:3281975.
    1. Jones KM, Carroll S, Hawks D, McElwain CA, Schulkin J. Efforts to improve immunization coverage during pregnancy among Ob-Gyns. Infect Dis Obstet Gynecol. 2016;2016:6120701.
    1. Kerr S, Van Bennekom CM, Liang JL, Mitchell AA. Tdap vaccination coverage during pregnancy—selected sites, United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66:1105-1108.
    1. Kahn KE, Black CL, Ding H, et al. Influenza and Tdap vaccination coverage among pregnant women—United States, April 2018. MMWR Morb Mortal Wkly Rep. 2018;67:1055-1059.
    1. Standards for practice: vaccine recommendation. . Updated May 2, 2016. Accessed December 27, 2019.
    1. Frew PM, Saint-Victor DS, Owens LE, Omer SB. Socioecological and message framing factors influencing maternal influenza immunization among minority women. Vaccine. 2014;32:1736-1744.
    1. Ahluwalia IB, Singleton JA, Jamieson DJ, Rasmussen SA, Harrison L. Seasonal influenza vaccine coverage among pregnant women: pregnancy risk assessment monitoring system. J Womens Health (Larchmt). 2011;20:649-651.
    1. Wiley KE, Massey PD, Cooper SC, Wood N, Quinn HE, Leask J. pregnant women’s intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey. Vaccine. 2013; 31:3972-3978.
    1. Wiley KE, Cooper SC, Wood N, Leask J. Understanding pregnant women’s attitudes and behavior toward influenza and pertussis vaccination. Qual Health Res. 2015;25:360-370.
    1. Henninger ML, Irving SA, Thompson M, et al. Factors associated with seasonal influenza vaccination in pregnant women. J Womens Health (Larchmt). 2015;24: 394-402.
    1. Wiley KE, Massey PD, Cooper SC, et al. Uptake of influenza vaccine by pregnant women: a cross-sectional survey. Med J Aust. 2013;198:373-375.
    1. Recommendations from the National Vaccine Advisory Committee: standards for adult immunization practice. Public Health Rep. 2014;129:115-123.
    1. Bridges CB, Hurley LP, Williams WW, Ramakrishnan A, Dean AK, Groom AV. Meeting the challenges of immunizing adults. Am J Prev Med. 2015;49:S455-464.
    1. Vila-Candel R, Navarro-Illana P, Navarro-Illana E, et al. Determinants of seasonal influenza vaccination in pregnant women in Valencia, Spain. BMC Public Health. 2016;16:1173.
    1. Kriss JL, Frew PM, Cortes M, et al. Evaluation of two vaccine education interventions to improve pertussis vaccination among pregnant African American women: a randomized controlled trial. Vaccine. 2017;35:1551-1558.
    1. Donaldson B, Jain P, Holder BS, Lindsey B, Regan L, Kampmann B. What determines uptake of pertussis vaccine in pregnancy? a cross sectional survey in an ethnically diverse population of pregnant women in London. Vaccine. 2015;33:5822-5828.
    1. Vaccination programs: provider reminders. . Updated March, 2015.
    1. O’Leary ST, Riley LE, Lindley MC, et al. Immunization practices of U.S. obstetrician/gynecologists for pregnant patients. Am J Prev Med. 2018;54: 205-213.
    1. AAPOR guidance on reporting precision for nonprobability samples. .
    1. Ding H, Black CL, Ball S, et al. Influenza vaccination coverage among pregnant women—United States, 2016-17 influenza season. MMWR Morb Mortal Wkly Rep. 2017;66:1016-1022.
    1. Increase the percentage of pregnant women who are vaccinated against seasonal influenza. Healthy People 2020. . Updated 2018. Accessed May 15, 2018.
    1. Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Maternal Tdap vaccination: coverage and acute safety outcomes in the vaccine safety datalink, 2007-2013. Vaccine. 2016;34:968-973.
    1. Butler AM, Layton JB, Li D, et al. Predictors of low uptake of prenatal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis immunization in privately insured women in the united states. Obstet Gynecol. 2017;129:629-637.
    1. Marshall H, McMillan M, Andrews RM, Macartney K, Edwards K. Vaccines in pregnancy: the dual benefit for pregnant women and infants. Hum Vaccin Immunother. 2016;12:848-856.

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