Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination Uptake Among Pregnant Women--2010-11 Influenza Season, United States

Background: 

Pertussis is easily transmitted mother-to-infant with outcomes including pneumonia, apnea, and death.[1] In December 2006, the Advisory Committee on Immunization Practices (ACIP) recommended tetanus, diphtheria, pertussis vaccination (Tdap) for women before or after pregnancy.[2] In October 2011, ACIP recommended Tdap during pregnancy after 20 weeks gestation.[3] Despite recommendations, 2008 data show that <6% of adults (unknowns excluded) 18-64 years reported Tdap receipt. [4] Compared to other vaccine-preventable diseases, pertussis remains poorly controlled.

Objectives: 

To estimate Tdap coverage among U.S. pregnant women.

Methods:  An internet panel survey fielded April 4-25, 2011, estimated influenza vaccination coverage among women pregnant anytime August 2010 through mid-April 2011. Tdap uptake was also examined. Weighted percentages and 95% confidence intervals were calculated.  Sensitivity analyses assessed the range of potential effects due to unknown Td/Tdap status.

Results:  Of all eligible pregnant women starting the survey, 91.1% (1,937) completed it. Of them, 60.7% (1,176) reported a tetanus shot in past 10 years and 16.7% (323) didn’t know if they had been vaccinated. Of those reporting a tetanus shot in past 10 years, 70.2% (825) reported tetanus vaccination since 2005; 11.2% (132) didn’t know if they had been vaccinated. Excluding women who didn’t know vaccination status or type of vaccine (38.7%, 749) from the sample, self-reported Tdap coverage was 20.1% (246). Tdap vaccination sensitivity range was 12.7-51.4%.

Conclusions:  Recall of Tdap vaccination appears to be improving compared to previous years,[5] however, an estimated 38.7% of pregnant women in this panel were unsure of their vaccination history. Tdap vaccination among this sample of pregnant women was low, although higher than the 2008 Tdap vaccination levels among all adults 18-64 years. To improve coverage, public health agencies and providers should focus public health messages on reinforcing the safety and benefits of Tdap during pregnancy for the health of mother and baby.