Abstract
Objective(s)
While antenatal vaccination is the most effective strategy to reduce newborn pertussis
infection and its associated morbidity and mortality, uptake has consistently been
reported to be suboptimal. “Cocooning” or vaccination of the close contacts of newborns
therefore remains an important strategy for protecting newborns when maternal vaccination
has not occurred or with insufficient time for antibody transfer. This study assesses
the uptake of pertussis vaccination by parents and close contacts of newborns providing
insight into the vulnerability of newborns to pertussis upon discharge from hospital
to their primary carers.
Study design
The study was conducted at three public and two private hospitals in Melbourne, Australia.
A survey was administered to 689 women and/or their partners admitted on maternity
wards of participating hospitals after delivery of a healthy newborn between August
and December 2016. The main outcomes measured were reported vaccination rates and
factors associated with uptake of pertussis vaccination. Kappa statistic and logistic
regression were used to determine factors associated with vaccination.
Results
70% of women and 66% of partners reported pertussis vaccination according to national
recommendations. Significantly 22% of newborns were discharged to a household where
neither parent reported vaccination. Compared to when maternal vaccination did occur,
in families where it didn’t there were low rates of vaccination of partners (83% vs
26%) and other carers, particularly carers usually resident overseas (76% vs 18.5%).
Conclusion(s)
While the majority of mothers and partners reported pertussis vaccination in accordance
with recommended guidelines, concerningly nearly a quarter of newborns were discharged
to a home where neither parent was vaccinated. When maternal vaccination did not occur,
rates of vaccination of the other close contacts was poor. Educating women to encourage
vaccination of partners and carers particularly those coming from overseas, prior
to their arrival is an important consideration when maternal immunization does not
occur. Cocooning remains an important approach to protect newborns of mothers vaccinated
late or not vaccinated in pregnancy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
WHO-recommended surveillance standard ofpertussis 2017 [Available from: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/pertussis_standards/en/ [Accesed 21 July 2017].
- The Australian immunisation handbook 10th ed (2015 update).in: Council NHaMR Australian Government Department of Health and Ageing, Canberra2015
- Maternal pertussis immunisation: clinical gains and epidemiological legacy.Euro Surveill. 2017; 22
- Knowledge and attitudes of postpartum women toward immunization during pregnancy and the peripartum period.Hum Vaccin Immunother. 2013; 9: 1926-1931
- National study of infants hospitalized with pertussis in the acellular vaccine era.Pediatr Infect Dis J. 2004; 23: 246-252
- Transmission of Bordetella pertussis to young infants.Pediatr Infect Dis J. 2007; 26: 293-299
- Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey.Vaccine. 2013; 31: 3972-3978
- Who gives pertussis to infants? source of infection for laboratory confirmed cases less than 12 months of age during an epidemic, sydney, 2009.Commun Dis Intell. 2010; 34: 116-121
- Survey of household contacts of infants with laboratory confirmed pertussis infection during a national pertussis outbreak In england and wales.Pediatr Infect Dis J. 2016;
- Protecting newborns from pertussis −the challenge of complete cocooning.BMC Infect Dis. 2014; : 397
- A cross sectional survey of attitudes, awareness and uptake of the parental pertussis booster vaccine as part of a cocooning strategy, Victoria, Australia.BMC Public Health. 2013; 13: 676
- Effectiveness of maternal pertussis vaccination in England: an observational study.Lancet. 2014; 384: 1521-1528
- A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012–2013.Clin Infect Dis. 2015; 60: 333-337
- Sustained effectiveness of the maternal pertussis immunization program in england 3 years following introduction.Clin Infect Dis. 2016; 63: S236-S243
- Effectiveness of vaccination during pregnancy to prevent infant pertussis.Pediatrics. 2017; (139(5).)
- Immunisation against infectious disease.2015 (United Kingdom)
Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012. 2013.
- Wirsing von Konig CH: Strategies to decrease pertussis transmission to infants.Pediatrics. 2015; 135: e1475-82
- Vaccine attitudes and practices among obstetric providers in New York State following the recommendation for pertussis vaccination during pregnancy.Hum Vaccin Immunother. 2015; 11: 713-718
- Maternal immunization: opportunities for scientific advancement.Clin Infect Dis. 2014; 59: S408-14
- Maternal Immunisation in Australia- how are we going? SA Vaccinology Update Conference.National Wine Centre, Adelaide, Australia2015
- Uptake of pertussis and influenza vaccines among pregnant women in Western Australia.in: Regan A.K. Mak D. Gibbs R. Effler P. Public Health Association Australia 15th National Immunisation Conference, Brisbane, Australia2016
- Australia's mothers and babies 2014- in brief.in: AIHW 2016 (Canberra)
- The optimal gestation for pertussis vaccination during pregnancy − A prospective cohort study.Am J Obstet Gynecol. 2016;
- Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants.Clin Infect Dis. 2013; 56: 539-544
- Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial.JAMA. 2014; 311: 1760-1769
- Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis.Clin Infect Dis. 2016;
- Influenza and pertussis vaccination coverage in pregnant women.Vaccine. 2015; 33: 2125-2131
- Maternal immunization in Argentina: a storyline from the prospective of a middle income country.Vaccine. 2015; 33: 6413-6419
- Lessons learnt from the implementation of maternal immunization programs in England.Hum Vaccin Immunother. 2016; 12: 2934-2939
- Understanding factors influencing vaccination acceptance during pregnancy globally: a literature review.Vaccine. 2015; 33: 6420-6429
- Engaging expectant parents to receive tdap vaccination.Am J Perinatol. 2014; 31: 407-412
- Evaluation of several approaches to immunize parents of neonates against B pertussis.Vaccine. 2013; 31: 6087-6091
Article info
Publication history
Published online: July 25, 2017
Accepted:
July 24,
2017
Received in revised form:
July 24,
2017
Received:
May 27,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
