Prevention of Infant Pertussis Through Maternal Vaccination Strategies Open Access

Kriss, Jennifer Lara (2015)

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Despite routine childhood vaccination against pertussis and high vaccine coverage, there has been a recent resurgence in pertussis in the U.S. In the last five years (2010-2014) there have been an average of 31,000 reported cases annually. Infants too young to be completely vaccinated are at especially high-risk for pertussis-related complications and death. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) is recommended for pregnant women as a strategy to protect young infants against pertussis before they are fully vaccinated. This dissertation explored maternal vaccination as a method of preventing pertussis in young infants. Aim 1 evaluated disparities in Tdap vaccination of pregnant women in the U.S. and in factors that inform vaccination decisions. We found that 40% of pregnant women were vaccinated with Tdap. Compared to white non-Hispanics, Hispanic women were more than twice as likely to be vaccinated. Higher income and residing in the western U.S. were independently associated with Tdap vaccination. The most common factor that influenced the vaccination decision was a recommendation from a medical provider. Aim 2 estimated the prevalence and determinants of obstetrician-gynecologist (ob-gyn) administration of Tdap to pregnant women. We found that 78% of ob-gyns administer Tdap to pregnant patients as part of routine practice, and 20% recommend Tdap but refer their patients elsewhere for vaccination. Residence in western or midwestern states, routine administration of influenza vaccine, and larger practices were associated with Tdap administration. Aim 3 evaluated whether two educational interventions improve perinatal Tdap vaccination among African American women. Thirty-two percent were vaccinated with Tdap during the perinatal period. The majority were vaccinated immediately postpartum instead of during pregnancy, according to outdated recommendations. An iPad app and an educational video both improved vaccination, although only the iPad app had a statistically significant effect. The observed effects were primarily based on improved Tdap vaccination in the postpartum period, rather than during pregnancy. Tdap vaccination during pregnancy remains sub-optimal. Maternal vaccination is strongly influenced by recommendations from medical providers and knowledge of the risks and benefits of vaccination, so identifying strategies to improve these factors is key to increasing maternal Tdap coverage.

Table of Contents

Chapter 1: Overview and Rationale 1

Chapter 2: Background and Literature Review 13

Chapter 3: Disparities in Uptake of Tdap Vaccine and Vaccine Information Needs among Pregnant Women in the United States 33

Chapter 4: Characteristics Associated with Obstetrician-Gynecologist Recommendation and Administration of Pertussis Vaccine for Pregnant Patients in the United States: Findings from a National Survey 54

Chapter 5: Evaluation of Two Vaccine Education Interventions to Improve Pertussis Vaccination among Pregnant African American Women: A Randomized Controlled Trial 78

Chapter 6: Conclusions and Future Directions 105

References 115

Appendices 133

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