Tdap Vaccination During Pregnancy Remains Low

Troy Brown, RN

May 22, 2015

Just more than half of women surveyed reported receiving tetanus, diphtheria, and acellular pertussis (Tdap) vaccination before, during, or after pregnancy, which falls far short of current goals. There was wide variation among the states surveyed, according to a report from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

Indu B. Ahluwalia, PhD, from the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues report their findings in the May 21 issue of the Morbidity and Mortality Weekly Report.

"In June 2011, the Advisory Committee on Immunizations Practices (ACIP) recommended 1 dose of a [Tdap] vaccine during pregnancy for women who had not received Tdap previously," the authors write. "Before 2011, Tdap was recommended for unvaccinated women either before pregnancy or postpartum. In October 2012, ACIP expanded the 2011 recommendation, advising pregnant women to be vaccinated with Tdap during each pregnancy to provide maternal antibodies for each infant."

Infants younger than 6 months have substantially higher rates of pertussis and suffer the largest burden of deaths related to the infection. Maternal vaccination with Tdap vaccine is considered the best way to protect infants from pertussis, although vaccination during the postpartum period helps when earlier vaccination is not desired or feasible, according to the Global Pertussis Initiative.

Dr Ahluwalia and colleagues analyzed supplemental data from 16 states and New York City participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) on 6852 women who delivered live newborns during September to December 2011.

Among the 5499 women with known vaccination coverage status, 55.7% reported Tdap vaccination, with statewide rates ranging from 38.2% in NYC to 76.6% in Nebraska. The median proportion of women with live births during that period who reported Tdap vaccination before pregnancy was 13.9% (range, 7.7% - 20.1%), during pregnancy was 9.8% (range, 3.8% - 14.2%), and postpartum was 30.9% (range, 13.6% - 46.5%).

"Knowledge of Tdap vaccination among women and health care providers might be lagging because the changes to the Tdap recommendation were relatively recent. Promoting communication strategies that increase awareness of Tdap recommendations to providers, pregnant women, adults, and anyone who might come into contact with infants aged <12 months is important," the authors explain.

Prevalence of postpartum Tdap vaccination was higher among non-Hispanic white women, privately insured women, and those who began prenatal care in the first trimester.

"With almost one fifth of women not knowing their Tdap vaccination status, there is a widespread need for providers to ensure they are communicating information about recommended vaccinations and to educate all women about the importance of keeping their vaccination status up-to-date and documented, especially reproductive-age women," the authors write. "Health care providers can assist pregnant women by providing specific information about where to obtain Tdap vaccination, or offering to provide the vaccination, and also to write a prescription in case it is needed; additional tools for providers are available."

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64;522-526. Full text

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