Vaccine Utilization and Timing of Administration in Pregnant Women: A South African Perspective

Maternal immunization is a valuable public health measure protecting the mother, fetus and newborn infant against targeted infectious diseases, playing an integral role in pregnancy outcomes. Limited literature exists from the African continent pertaining to the timing and utilization of maternal influenza and tetanus toxoid immunization. Maintaining high vaccine coverage is imperative for successful disease control, highlighting the importance of continued maternal immunization. We aimed to describe the utilization and timing of influenza and tetanus vaccinations during pregnancy, within South African publicly financed antenatal care facilities.

A secondary analysis was conducted of clinical antenatal, vaccination and delivery data collected during a retrospective review of randomly selected maternity charts of women who delivered between July 2018 and June 2019 in Johannesburg and Cape Town, South Africa.

Influenza vaccination uptake within the sampled population was 16.6% (806/4851), with significantly higher odds of influenza vaccination in women 21-30 years of age and women with ≥6 antenatal care visits. Of 7031 (99.0% of the population) women who received at least 1 dose of tetanus toxoid-containing vaccine (TTCV), 39.2% (2759) received 1 dose; 51.0% (3590) received 2 and 9.7% (682) received 3 doses in their index pregnancy.

Antenatal facilities are ideally suited to administer vaccines to pregnant women; however, targeted educational campaigns and immunization promotion by antenatal staff will improve maternal influenza immunization coverage. There is high utilization of TTCV in South Africa, with over 99% of women receiving at least 1 dose of TTCV, which is encouraging, especially considering that South Africa is implementing a single dose of a combination tetanus-diphtheria-acellular pertussis vaccine to replace tetanus toxoid (TT) in pregnancy.