Predictors of Tetanus, Diphtheria, Acellular Pertussis and Influenza Vaccination during Pregnancy among Full Term Deliveries in a Medically Underserved Population Open Access

Abstract

OBJECTIVE: To evaluate predictors of vaccination for women that received tetanus, diphtheria, and acellular pertussis vaccination (Tdap), influenza vaccination, and Tdap and influenza vaccinations.  

Study Design: In a retrospective cohort study of all full-term (≥37 weeks gestation) deliveries between July 1, 2016 and June 30, 2018 at a single, safety net institution, we used multinomial logistic regression models to compare predictors of vaccination among women who received Tdap only, influenza only, and both Tdap and influenza vaccines. 

RESULTS: Among 3,133 full-term deliveries, women were primarily non-Hispanic black (67.5%), between the ages of 21-34 (65.3%), and multiparous (76.0 %). The rates of only influenza and Tdap vaccination were 9.2% and 23.6% respectively; 41.3% of women received both vaccines, and 26.0% of women did not receive either vaccine. In the adjusted model, Hispanic ethnicity and non-Spanish language interpreter use were positively associated with receipt of all types of vaccination. Inadequate and unknown prenatal care adequacy were negative predictors of all types of vaccination. HIV-positive status was negatively associated with influenza vaccination and Tdap and influenza vaccination. 

CONCLUSION: Compared to the national rate of both Tdap and influenza vaccination (32.8%), a higher proportion of women received both vaccines in our study population. Vaccine uptake may be affected by race/ethnicity, use of interpreter services, HIV status, and prenatal care adequacy. The lower rate of influenza vaccination, compared to Tdap vaccination, suggests that other factors, such as vaccine hesitancy and mistrust, may differentially impact influenza vaccination uptake in our predominantly minority population. Future provider and public health approaches to vaccine promotion should incorporate appropriate strategies that address vaccine-related beliefs and misconceptions. 

Table of Contents

Table of Contents

Chapter I: Introduction           1

Context of Project       1

Problem Statement    1

Purpose of Project      2

Chapter II: Literature Review3

Pertussis         3

Pertussis Infection      3

Pertussis Vaccination  4

Influenza         4

Influenza infection      4

Influenza Vaccination5

Predictors of Antenatal Vaccination  6

General Predictors of Vaccination      6

Vaccine Hesitancy and Medical Mistrust       7

Chapter III: Manuscript           9

I. Introduction14

II. Materials and Methods      16

III. Results       18

IV. Comment   19

V. References  23

VI. Tables and Figures26

Table 127

Table 228

Chapter IV: Conclusion and Recommendations         30

Chapter V. References            34

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Obstetrics and Gynecology Health Sciences, Immunology
Keyword	Tdap Influenza Vaccination
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Committee Members	Haddad, Lisa B., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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