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

Abstract

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.

Sociodemographic and health‐related determinants of seasonal influenza vaccination in pregnancy: A systematic review and meta‐analysis of the evidence since 2000

“…[30][31][32][33][34][35][36] The articles were published from 2010 to 2020. Eleven articles were from the USA, 30,32,35,41,45,46,48,59,60,65,66 six from Australia, [49][50][51]53,61,63 four from France, 31,43,47,57 two from Canada, 56,62 two from the UK 40,55 and one each from Belgium, 54 Brazil, 33 Greece, 44 Hong Kong, 64 Ireland, 52 Japan, 42 Nicaragua, 58 Singapore 34 and Spain. 36 The main characteristics of the included studies are summarized in Tables 1 and S2.…”

Using a Harm Reduction Model to Reduce Barriers to Vaccine Administration

“…For example, the 2016 vaccine rates for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine administration to adults aged 18 years and older in the United States using the interactive AdultVaxView system 34 shows significant regional variations in vaccine uptake, with Vermont and Minnesota having the highest vaccination rates at 54.2% and 51.7%, respectively, and Mississippi having the lowest vaccination rate at 23.2%. A retrospective cohort study 35 examining Tdap and influenza vaccinations during pregnancy found that in 2017, rates of these vaccinations ranged from 31.4% to 56.3% and 17.5% to 31.3%, respectively. Hill et al 36 found that rates of recommended pediatric vaccinations by age 24 months from 2017 to 2019 were 35.7% for influenza vaccine in uninsured children and 69.6% for those with private insurance coverage and were 84.7% and 95.9%, respectively, for Tdap.…”

A Qualitative Study of Views and Experiences of Women and Health Care Professionals about Free Maternal Vaccinations Administered at Community Pharmacies

“…For example, health care professional electronic record automated alerts and the provision of maternal vaccinations by midwives at antenatal appointments significantly increase uptake of a pregnancy dose of acellular pertussis vaccine [26]. However, antenatal vaccine uptake is suboptimal in many countries [22][23][24][27][28][29].…”