Vaccine attitudes and practices among obstetric providers in New York State following the recommendation for pertussis vaccination during pregnancy

Abstract

To determine factors associated with obstetric provider recommendation of pertussis vaccine (Tdap) to their pregnant patients following the Advisory Committee on Immunization Practices (ACIP) recommendation that Tdap be given in the third trimester of each pregnancy. Obstetric providers across New York State anonymously completed a standard set of questions to assess vaccine recommendation knowledge and practice. Statistical analysis: Descriptive statistical methods were used to define provider characteristics, knowledge and vaccine practices. Factors associated with recommendation were analyzed using odds ratios. 133 obstetric providers were included in the study. 11% and 13% expressed concern with pertussis vaccine safety and efficacy, respectively, in pregnant women. 92% of obstetric providers stated that they knew ACIP recommendations for Tdap during pregnancy, 80% recommended Tdap to all eligible patients, but only 67% provided Tdap vaccine in their office. Provider knowledge of recommendation (OR 23.33), routine provider recommendation of influenza vaccine (OR 12.5), and administration of pertussis vaccine in the office (OR 7.01) were all factors strongly associated with routine provider recommendation of Tdap vaccine to eligible pregnant women (P < 0.05). Providers expressed concerns with cost of Tdap, the need to administer Tdap with each pregnancy, vaccine safety, low incidence of pertussis in the area, and administration of pertussis vaccine at the hospital after delivery. Educational programs are needed to improve provider vaccine confidence and recommendation.

Maternal vaccination against pertussis: a systematic review of the recent literature

“…Moreover, 11% and 13% of them expressed concern about vaccine safety and efficacy, respectively, despite the growing body of literature against these beliefs 61. Concerns raised included vaccine price, the need to vaccinate in each pregnancy, vaccine safety and low incidence of pertussis in the area.…”

Safety of Maternal Immunization Against Pertussis: A Systematic Review

“…Some patients and healthcare providers are hesitant to or do not vaccinate during pregnancy because of perceived (vaccine) safety [23][24][25]. Other barriers to vaccination during pregnancy from the patient and healthcare perspective include negative media, missed vaccination opportunity (immunization not offered or requested), lack of vaccine stock, inadequate reimbursement, and limited patient interest [26][27][28][29][30][31].…”

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

“…In addition, one study showed that providers play an important role in a pregnant woman’s decision to receive influenza vaccination; pregnant women who receive a recommendation and an offer of influenza vaccine are more likely to be vaccinated (70.5%) than women who received a recommendation but no offer (32.0%) or who received no recommendation and no offer (9.7%) [27]. A recent study from providers in New York state found that only 80% of obstetric providers recommended Tdap to all eligible patients, and 67% provided the vaccine in their office [28]. …”