Vital Signs: Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants — United States

Abstract

IntroductionVaccinating pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can reduce influenza and pertussis risk for themselves and their infants.MethodsSurveillance data were analyzed to ascertain influenza-associated hospitalization among pregnant women and infant hospitalization and death associated with influenza and pertussis. An Internet panel survey was conducted during March 27–April 8, 2019, among women aged 18–49 years who reported being pregnant any time since August 1, 2018. Influenza vaccination before or during pregnancy was assessed among respondents with known influenza vaccination status who were pregnant any time during October 2018–January 2019 (2,097). Tdap receipt during pregnancy was assessed among respondents with known Tdap status who reported a live birth by their survey date (817).ResultsFrom 2010–11 to 2017–18, pregnant women accounted for 24%–34% of influenza-associated hospitalizations per season among females aged 15–44 years. From 2010 to 2017, a total of 3,928 pertussis-related hospitalizations were reported among infants aged <2 months (annual range = 262–743). Maternal influenza and Tdap vaccination coverage rates reported as of April 2019 were 53.7% and 54.9%, respectively. Among women whose health care providers offered vaccination or provided referrals, 65.7% received influenza vaccine and 70.5% received Tdap. The most commonly reported reasons for nonvaccination were believing the vaccine is not effective (influenza; 17.6%) and not knowing that vaccination is needed during each pregnancy (Tdap; 37.9%), followed by safety concerns for the infant (influenza =15.9%; Tdap = 17.1%).Conclusions and Implications for Public Health PracticeMany pregnant women do not receive the vaccines recommended to protect themselves and their infants, even when vaccination is offered. CDC and provider organizations’ resources are available to help providers convey strong, specific recommendations for influenza and Tdap vaccination that are responsive to pregnant women’s concerns.

Vaccine Safety: Myths and Misinformation

“…Tetanus vaccine remains a recommendation in settings where there is an ongoing risk of neonatal tetanus. Recent data from the CDC indicate that from 2010-2018 pregnant women accounted for 24-34% of influenza-associated hospitalizations per season among women aged 15-44 years and a total of 3,928 pertussis-related hospitalizations among infants aged <2 months (Lindley et al, 2019). Despite this clear burden of disease vaccination rates during pregnancy remain poor.…”

“…Despite this clear burden of disease vaccination rates during pregnancy remain poor. Influenza and Tdap vaccination coverage rates during pregnancy in the United States reported in April 2019 were 53.7 and 54.9%, respectively (Lindley et al, 2019). Safety concerns and provider recommendation are among the most important factors influencing vaccine uptake in pregnancy (Wilson et al, 2015).…”

Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type — Florida, 2016–2018

“…First, the analyses are limited by the accuracy of the vaccination records available in the patient electronic health records; a vaccine administered at an outside site might not be documented. Second, there is likely to be variation in the number of times a patient was offered these vaccines depending on provider preference and the number of prenatal visits completed (5). Third, although the analysis estimated the number of women who would be responsive to vaccination if financial barriers were removed, other factors might have contributed to this decision.…”

“…ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type.…”

Helping Mom Help Baby: Nutrition-Based Support for the Mother-Infant Dyad During Lactation

“…Immunization of the mother is also a safe and effective means of protecting the neonate early in life. Administration rates for influenza and pertussistwo vaccines currently recommended during pregnancyremain low (36). Given this observation in conjunction with the development of several novel vaccines, evidence strongly suggests that vaccination offers a promising intervention for reducing infant mortality (37).…”