Tetanus, diphtheria, and acellular pertussis vaccination among women of childbearing age—United States, 2013

Lu, Peng–jun; Williams, Walter W.; Ding, Helen; Meyer, Sarah

doi:10.1016/j.ajic.2016.03.048

Cited by 10 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prenatal Tdap immunization also varied regionally, which is consistent with national survey data on Tdap immunization among women regardless of pregnancy status. 29,30 Specifically, prenatal Tdap receipt was highest in the Midwest and lowest in the South. Racial disparities in vaccine receipt may partially explain the geographic distribution, as Black women are less likely to receive prenatal Tdap compared to White women.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Low Uptake of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Immunization in Privately Insured Women in the United States

Butler¹,

Layton²,

Li³

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

OBJECTIVE To examine the uptake of prenatal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) immunization among pregnant women in the United States. METHODS Using MarketScan data, we conducted a historical cohort study among pregnant women with employer-based commercial insurance in the United States who delivered between January 1, 2010 and December 31, 2014. We examined temporal trends of uptake, predictors of uptake, and timing of Tdap immunization. RESULTS Among 1,222,384 eligible pregnancies in 1,147,711 unique women, receipt of prenatal Tdap immunization increased from 0.0% of women who delivered in January 2010 to 9.8% who delivered in October 2012 (the date of the recommendation by the Advisory Committee on Immunization Practices for Tdap during every pregnancy) to 44.4% who delivered in December 2014. Among women who received Tdap during pregnancy, the majority were immunized between 27 weeks and 36 weeks 6 days of gestation, per the ACIP recommendation. In multivariable analyses among women who delivered between November 2012 and December 2014, rates of prenatal Tdap immunization were lower for women under 25 years of age (e.g., 20-24 vs. 30-34 years rate ratio [RR], 0.83, 95% confidence interval [CI], 0.85-0.88), with other children (e.g., 3 vs. 0 children: RR, 0.86, 95% CI, 0.84-0.88), residing in the South vs. Midwest (RR, 0.81, 95% CI, 0.80-0.82), or with emergency department visits in early pregnancy (RR, 0.93, 95% CI, 0.92-0.95). The proportion of pregnant women who received prenatal Tdap increased with increasing gestational age at birth. CONCLUSION By the end of 2014, less than half of pregnant women in the US were receiving prenatal Tdap immunization. Implementation and dissemination strategies are needed to increase Tdap coverage among pregnant women, especially those who are young, have other children, or reside in the South.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of Low Uptake of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Immunization in Privately Insured Women in the United States

Butler¹,

Layton²,

Li³

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…While urbanicity has not been previously reported as a risk factor for maternal vaccination, it may be a proxy for factors that we could not measure in this study, such as race/ethnicity, income, and access to care, which have previously been associated with Tdap and influenza vaccination among pregnant women and Tdap vaccination in women of childbearing age. 18,33,34 A similar recent study by Butler and colleagues using the Marketscan database found that prenatal Tdap vaccination increased from 9.8% among women who delivered in October 2012 to 44.4% among women who delivered in December 2014. 20 Our study provides a more complete examination of the impact of ACIP's revised Tdap recommendations, including two additional years of data in the post-2012 period and more detailed breakdowns of vaccination prior to 27 weeks gestation.…”

Section: Discussionmentioning

confidence: 86%

Trends in Tdap vaccination among privately insured pregnant women in the United States, 2009–2016

Zhou

Black

et al. 2019

Vaccine

Self Cite

View full text Add to dashboard Cite

Background: Infants younger than 6 months are at increased risk of complications and mortality from pertussis infection. In October 2012, the Advisory Committee on Immunization Practices revised its recommendation to include a Tdap dose during each pregnancy, ideally between 27-36 weeks gestation.Objective: Assess trends in Tdap vaccination coverage among privately insured pregnant women from 2009-2016 including timing of Tdap vaccination (before, during, or after pregnancy), trimester of vaccination for women vaccinated during pregnancy, and missed vaccination opportunities for unvaccinated women. Identify factors associated with vaccination during the optimal period of 27-36 weeks gestation.Study Design: Retrospective analysis of privately insured women 15-49 years who delivered live births during 2009-2016 conducted using 2009-2016 MarketScan data. Tdap vaccination coverage and the timing of Tdap vaccine administration were assessed for women continuously enrolled from 6 months before pregnancy to 1 month after delivery. Multivariable logistic regression was performed to identify factors independently associated with receipt of Tdap vaccine at 27-36 weeks gestation.Results: Tdap vaccination coverage during pregnancy increased from 0.4% in 2009 to 6.2% in 2012 and to 53.2% in 2016. The proportion of vaccinated women receiving Tdap at 27-36 weeks gestation increased from <10% in 2009 to nearly 90% in 2016, with most vaccination occurring at 27-32 weeks gestation. Women of older age, residing in a metropolitan statistical area, residing outside the South, and having a capitated health insurance plan were more likely to receive Tdap at 27-36 weeks gestation than their counterparts. Among women not vaccinated during pregnancy, 77.7% had a pregnancy-related medical claim between 27 and 36 weeks gestation.

show abstract

“…1 We estimated the incidence of persisting protection from prepregnancy vaccination by combining the proportion of women of childbearing age who reported being vaccinated in the past 12 years with the average vaccine efficacy against pertussis over a 12-year period. 19,20 We used the annual rate of pertussis infection in unvaccinated people aged 15-65 years to approximate the rate of infection in the unvaccinated strategy. 16 We used the CDC's 2017 Pertussis Surveillance Report to determine the rate of pertussis in 0-1 year of life, as well as the rates of hospitalization and death.…”

Section: Methodsmentioning

confidence: 99%

Universal Tetanus–Diphtheria–Pertussis Vaccination During Pregnancy

Egan

Chaiken

Derrah

et al. 2023

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

OBJECTIVE: To assess the cost effectiveness of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination in pregnant patients in the United States. METHODS: A decision-analytic model in TreeAge was developed to compare universal Tdap vaccination in pregnancy with no Tdap vaccination in pregnancy using a theoretical cohort of 3.66 million pregnant individuals, the approximate number of deliveries per year in the United States. Outcomes included infant pertussis infections, infant hospitalizations, infant encephalopathy cases, infant deaths, and maternal pertussis infections. All probabilities and costs were derived from the literature. Utilities were applied to discounted life expectancies at a rate of 3% to generate quality-adjusted life-years (QALYs). A strategy was considered cost effective if it had an incremental cost-effectiveness ratio of less than $100,000 per QALY. Univariable and multivariable sensitivity analyses were performed to assess the robustness of the model to changes in the baseline assumptions. RESULTS: With a baseline assumption of vaccine cost at $47.75, Tdap vaccination was cost effective at $7,601 per QALY. The vaccination strategy was associated with a decrease of 22 infant deaths, 11 infant encephalopathy cases, 2,018 infant hospitalizations, 6,164 infant pertussis infections, and 8,585 maternal pertussis infections, with an increase of 19,489 QALYs. In sensitivity analyses, the strategy was cost effective until the incidence of maternal pertussis became lower than 1.6 cases per 10,000 individuals, the cost of the Tdap vaccine was greater than $540, or previous pertussis immunity was present in more than 92.1% of pregnant individuals. CONCLUSION: In a theoretical U.S. cohort of 3.66 million pregnant individuals, Tdap vaccination during pregnancy is cost effective and reduces infant morbidity and mortality compared with no vaccination during pregnancy. These findings are especially relevant given that approximately half of individuals are not vaccinated during pregnancy and recent data have shown that postpartum maternal vaccination and cocooning strategies are ineffective. Public health strategies to encourage greater uptake of Tdap vaccination should be used to reduce the morbidity and mortality of pertussis infection.

show abstract

Tetanus, diphtheria, and acellular pertussis vaccination among women of childbearing age—United States, 2013

Cited by 10 publications

References 17 publications

Predictors of Low Uptake of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Immunization in Privately Insured Women in the United States

Predictors of Low Uptake of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Immunization in Privately Insured Women in the United States

Trends in Tdap vaccination among privately insured pregnant women in the United States, 2009–2016

Universal Tetanus–Diphtheria–Pertussis Vaccination During Pregnancy

Contact Info

Product

Resources

About