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Tetanus, diphtheria, pertussis vaccination coverage before, during, and after pregnancy - 16 States and New York
Insights
Tdap vaccination during pregnancy is recommended for maternal antibodies, but coverage varies widely by state and demographics. Postpartum vaccination was more common than during pregnancy in 2011.
Area of Science:
- Public Health
- Immunization Practices
- Maternal and Child Health
Background:
- The Advisory Committee on Immunizations Practices (ACIP) updated recommendations for tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy.
- Initial recommendations in 2011 advised Tdap for previously unvaccinated pregnant women, later expanded in 2012 to recommend Tdap during each pregnancy.
Purpose of the Study:
- To assess Tdap vaccination coverage among women around the time of delivery following the 2011 ACIP recommendation.
- To identify variations in Tdap vaccination coverage by state and demographic factors.
Main Methods:
- Utilized data from the Centers for Disease Control and Prevention's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) survey.
- Analyzed Tdap vaccination status (before, during, or after delivery) for 6,852 women who delivered live infants between September-December 2011 in 16 states and New York City.
Main Results:
- Overall median Tdap vaccination coverage was 55.7%, with significant state-level variation (38.2% in NYC to 76.6% in Nebraska).
- Median vaccination percentages were 13.9% before pregnancy, 9.8% during pregnancy, and 30.9% after delivery.
- Coverage varied by demographics, with higher postpartum rates among non-Hispanic white women, those receiving early prenatal care, and those with private insurance.
Conclusions:
- Tdap vaccination coverage around pregnancy in 2011 was suboptimal and highly variable across jurisdictions.
- Demographic factors influenced vaccination uptake, highlighting potential disparities.
- Findings underscore the need for targeted strategies to improve adherence to Tdap vaccination guidelines among pregnant women and their providers.
Abstract:
In June 2011, the Advisory Committee on Immunizations Practices (ACIP) recommended 1 dose of a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy for women who had not received Tdap previously. 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. The optimal time for vaccination is at 27-36 weeks' gestation as recommended by ACIP. In response to ACIP's Tdap recommendation for pregnant women in 2011, CDC added a supplemental question to the Pregnancy Risk Assessment Monitoring System (PRAMS) survey to determine women's Tdap vaccination status before, during, or after their most recent delivery. This report describes overall and state-specific Tdap vaccination coverage around the time of pregnancy using data from 6,852 sampled women who delivered a live-born infant during September-December 2011 in one of 16 states or New York City (NYC). Among the 17 jurisdictions, the median percentage of women with live births who reported any Tdap vaccination was 55.7%, ranging from 38.2% in NYC to 76.6% in Nebraska. The median percentage who received Tdap before pregnancy was 13.9% (range = 7.7%-20.1%), during pregnancy was 9.8% (range = 3.8%-14.2%), and after delivery was 30.9% (range = 13.6%-46.5%). The PRAMS data indicate a wide variation in Tdap vaccination coverage among demographic groups, with generally higher postpartum coverage for non-Hispanic white women, those who started prenatal care in the first trimester, and those who had private health insurance coverage. This information can be used for promoting evidence-based strategies to communicate the importance of ACIP guidelines related to Tdap vaccination coverage to women and their prenatal care providers.