Disparities in Tdap Vaccination and Vaccine Information Needs Among Pregnant Women in the United States

Kriss, Jennifer L.; Albert, Alison P.; Carter, Victoria M; Jiles, Angela J.; Liang, Jennifer L.; Mullen, Jennifer; Rodríguez, Leslie; Howards, Penelope P.; Orenstein, Walter A.; Omer, Saad B.; Fisher, Allison

doi:10.1007/s10995-018-2633-8

Cited by 20 publications

(14 citation statements)

References 21 publications

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“…Others have found HCP recommendation and/or endorsement of safety helps MV uptake [12,18,19,27], and that not all HCPs providing antenatal care provide this [12,13,19,30]. Certainly, we found the HCP important, particularly the midwife, but the general practice, pharmacy, and hospital HCPs also aided the uptake or sometimes missed opportunities to engage with women about MVs.…”

Section: Comparison With Other Literature and Implicationsmentioning

confidence: 76%

“…The uptake of maternal vaccinations (MVs) is suboptimal in many countries [11][12][13][14], particularly among those experiencing greater socioeconomic deprivation [15,16] and among indigenous people and people born overseas [16,17]. Lack of awareness, misperceptions, safety concerns and access challenges hinder maternal vaccine uptake [14,[18][19][20][21][22][23][24][25]. Conversely, promotion and administration of MVs by antenatal care providers can increase the uptake [26].…”

Section: Introductionmentioning

confidence: 99%

“…While health care professional (HCP) recommendation and/or endorsement of safety encourages uptake [12,18,19,23,27], sometimes antenatal care providers do not inform people about MVs [12,13,19], with some providers lacking confidence and/or knowledge [21,22,[28][29][30]. Specific training about MVs to health professionals increases their confidence to give appropriate advice to pregnant women [31,32].…”

Section: Introductionmentioning

confidence: 99%

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Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study

Gauld

Martin²,

Sinclair

et al. 2022

Vaccines

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The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explores the factors influencing pregnant women’s and health care professionals’ (HCPs) behaviour regarding maternal vaccinations (MVs). Pregnant/recently pregnant women, midwives, pharmacists and general practice staff in Waikato, New Zealand, were interviewed. The analysis used the behaviour change wheel model. Interviews of 18 women and 35 HCPs revealed knowledge about MVs varied with knowledge deficiencies hindering the uptake, particularly for influenza vaccination. HCPs, especially midwives, were key in raising women’s awareness of MVs. Experience with vaccinating, hospital work (for midwives) and training increased HCPs’ knowledge and proactivity about MVs. A “woman’s choice” philosophy saw midwives typically encouraging women to seek information and make their own decision. Women’s decisions were generally based on knowledge, beliefs, HCPs’ emphasis and their perceived risk, with little apparent influence from friends, family, or online or promotional material. General practice’s concentration on children’s vaccination and minimal antenatal contact limited proactivity with MVs. Busyness and prioritisation appeared to affect HCPs’ proactivity. Multi-pronged interventions targeting HCPs and pregnant women and increasing MV access are needed. All HCPs seeing pregnant women should be well-informed about MVs, including how to identify and address women’s questions or concerns about MVs to optimise uptake.

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Section: Comparison With Other Literature and Implicationsmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study

Gauld

Martin²,

Sinclair

et al. 2022

Vaccines

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“…7,13,19,21,24 Tdap coverage varied from 20.8% in the South to 26.2% in the West. Similarly, Kriss et al 16 reported that Tdap coverage was lowest in the South and highest in the West. Conversely, Butler and colleagues 28 reported that Tdap coverage was highest in the South and lowest in the Northeast.…”

Section: Discussionmentioning

confidence: 86%

“…Conversely, Butler and colleagues 28 reported that Tdap coverage was highest in the South and lowest in the Northeast. However, it should be noted that the 2 previous studies were soon after 16 or spanned 28 the 2012 recommendation to provide Tdap during every pregnancy. 4 In both cohorts, immunizations were administered by a range of providers, highlighting the need for all providers to act upon the maternal immunization recommendations, as provider recommendations are strongly influential on maternal vaccine uptake.…”

Section: Discussionmentioning

confidence: 99%

Maternal Immunization in the U.S.: A Nationwide Retrospective Cohort Study

Ghaswalla

Poirrier

Packnett

et al. 2019

American Journal of Preventive Medicine

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Introduction: At present, pregnant women in the U.S. are recommended to receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccines. This study assessed maternal coverage of these 2 vaccinations. Methods: Data for this retrospective cohort study were extracted from 2 large administrative claims databases, the MarketScan Commercial and Multi-State Medicaid Databases, for 2009−2017 and analyzed in 2018. Women aged 15−44 years on the date of pregnancy end were included. Pregnancies with gestational age of less than 23 weeks were excluded from the Tdap vaccination endpoint owing to the optimal recommended gestational age for Tdap vaccination. Multivariable logistic regression models identified predictors of vaccination. Results: The Tdap vaccination subpopulation included 1,421,452 Commercial and 523,635 Medicaid pregnancies; the influenza vaccination subpopulation included 1,862,705 Commercial and 628,079 Medicaid pregnancies. There were marked increases in vaccination coverage from 2010 to 2017: from 1.0% to 56.3% (Commercial) and from 0.5% to 31.4% (Medicaid) for Tdap, and from 14.7% to 31.3% (Commercial) and from 9.7% to 17.5% (Medicaid) for influenza. The likelihood of Tdap/influenza vaccination increased significantly with receipt of the other vaccine and more pregnancy-related healthcare visits. Conclusions: Although maternal Tdap and influenza vaccination coverage increased substantially from 2010 to 2017 among large, geographically diverse U.S. cohorts, coverage remained suboptimal, potentially putting newborns at risk of pertussis and influenza. Strategies to increase maternal vaccination coverage could target women identified to have a reduced likelihood of vaccination: those who are younger, black, residing in rural areas, with multiple gestation, and a prepregnancy inpatient admission.

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Factors Influencing Maternal Antepartum Tdap Vaccination

Bernstein

Tong-Miller

Cleary

et al. 2022

Matern Child Health J

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Introduction Antepartum Tdap remains low despite national recommendations. This prospective observational study aims to identify factors associated with lower antepartum Tdap rates. Methods Maternal demographics, personal health beliefs, Tdap vaccination status, and recall of in-office obstetric provider actions were collected from a convenience sample of postpartum women in a New York metropolitan hospital. Bivariate and multivariable logistic regression were used to identify significant factors and adjusted odds ratios (OR) for recorded Tdap; OR > 1 reflects elements with increased odds of not receiving antepartum Tdap, while OR < 1 demonstrates increased odds of receipt. Results Surveys were collected (n = 1682) from a study population demographically similar to New York City and more diverse in race/ethnicity than the national population. Demographic analysis showed Hispanic women less likely than white, non-Hispanic women to vaccinate (OR 2.44, CI 1.54–3.88). Health beliefs associated with non-receipt of antepartum Tdap included “It is dangerous for pregnant women to get vaccines” (OR 1.68, CI 1.01–2.77), and “I worry about the safety of the Tdap vaccine” (OR 1.59, CI 1.12–2.24). Obstetric provider actions associated with vaccination included receiving an OB recommendation (OR 0.39, CI 0.23–0.65), getting written information about Tdap (OR 0.44, CI 0.30–0.64), and having Tdap offered in office (OR 0.24, CI 0.15–0.37). Health beliefs associated with antepartum Tdap included “I generally do what my OB/GYN provider recommends” (OR 0.49, CI 0.30–0.80), and “Pregnant women should get the Tdap (pertussis) vaccine” (OR 0.17, CI 0.09–0.33). Discussion Maternal race/ethnicity, personal health beliefs, and obstetric provider actions predict antepartum Tdap.

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Disparities in Tdap Vaccination and Vaccine Information Needs Among Pregnant Women in the United States

Cited by 20 publications

References 21 publications

Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study

Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study

Maternal Immunization in the U.S.: A Nationwide Retrospective Cohort Study

Factors Influencing Maternal Antepartum Tdap Vaccination

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