Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
An increasing number of expectant mothers are following through on the recommendation with physician advocacy serving as a key factor, a recent study says.
Pertussis can cause serious, even deadly infection in infants, but more mothers are adhering to a recommendation to receive the pertussis vaccine during pregnancy to protect their baby for the first few months of life.
Bordetella pertussis, the bacterium that causes whooping cough, is highly contagious and can cause serious and even fatal infection in newborns. Research has shown that mothers who are vaccinated during pregnancy pass immunity on to their newborns, and in late 2012, the Centers for Disease Control and Prevention (CDC)-along with the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Family Physicians and the American Academy of Pediatrics-began recommending that all pregnant mothers receive the vaccine between 27 weeks and 36 weeks gestation.
A recent study from Kaiser Permanente highlights the efficacy of the vaccine, noting that maternal Tdap vaccination was 91% effective at protecting infants against pertussis in the first two months of life and 69% effective in the first year of life in a survey of nearly 150,000 infants born at one of its medical centers in Northern California between 2010 to 2015.
Infants receive their own DTaP vaccination at two, four and six months of age, but maternal vaccination during pregnancy-sometimes called cocooning-can be effective in preventing pertussis prior to an infant’s first DTaP dose. Maternal antibodies start to decline around 6 weeks of age, but don’t go undetected until nearly 4 months of age, according to the report.
Previously, pregnant mothers were encouraged to get the vaccine in the immediate postpartum period, but that changed in late 2012. Since then, industry leaders have been working to spread the message about the new recommendation, and their work appears to be paying off. According to new surveillance from CDC, the number of pregnant women following the recommendation has jumped to 48.8% in 2016 from 27% in 2014.
Vaccination rate study
Carla Black, PhD, a researcher with CDC’s Immunization Services Division, co-authored the CDC report and said a maternal Tdap vaccination during pregnancy can protect an infant from birth to two months of age, when they can receive their own vaccination against pertussis.
The CDC report is the result of an online survey conducted between March and April 2016 among more than 2,000 pregnant women aged 18 to 49. The report found that mothers in the 25- to 34-year-old range were most likely to receive the vaccination compared to mothers aged 18 to 24 and those over 35 years of age. Non-Hispanic women of other races (53.1%) and non-Hispanic whites (51.3%) received the vaccine more often than Hispanic women (44.6%) and non-Hispanic black women (42.7%). Vaccination rates also rose with higher levels of education and among women living above the poverty level and with private insurance.
Of those women who did not receive the vaccine, 25.5% reported not knowing about the recommendation, 23.1% said they didn’t receive a recommendation from a healthcare provider, 12.7% reported that they feared the vaccine was not safe during pregnancy and 3.2% said they had trouble getting access to the vaccine.
The CDC report found that women were more likely to receive the Tdap vaccine when it was recommended to them by their physician or a nurse, and when the vaccine was immediately offered. In fact, 70% of women reported receiving the vaccine as a result of their clinician’s recommendation and offer to perform the immunization. In comparison, 31% of women were vaccinated when a clinician recommended the vaccine but did not offer to administer it. The study also found that 63.6% of women were offered the vaccine by a healthcare professional, 13.2% received a recommendation but no offer for vaccination and 23.3% did not have the vaccine recommended to them at all.
Critical role of physicians
As a result of the study, CDC is highlighting its recommendation that healthcare providers recommend and offer Tdap vaccination to women early in their pregnancies. Black told Medical Economics the CDC is now recommending OB/GYNs, family practitioners and midwives to incorporate Tdap vaccination into their routine prenatal care.
“Women who received a recommendation for and an offer of Tdap vaccination were nearly 50 times more likely to be vaccinated compared with women who did not receive a recommendation for vaccination,” Black said. “We also know that the most common reasons for not receiving a Tdap vaccination were lack of awareness about the need for Tdap vaccination during pregnancy and not receiving a provider recommendation.”
CDC has created a variety of resources for both providers and pregnant women to help encourage uptake of the vaccine. Having been recommended since 2013, Black said she hopes practitioners will continue to increase offerings of the vaccine.
“While we are encouraged to see Tdap vaccination is becoming a routine part of prenatal care, one out of two babies are born without protection from whooping cough,” Black said. “We hope that this report serves as a reminder of the critical role their recommendation plays in influencing their patients’ decision to get the Tdap vaccine.”