Experts urge to improve ‘dismal’ pregnancy vaccine rates

Morgan Liotta

15/06/2022 4:12:25 PM

Only 12% of a large study cohort were vaccinated against flu and whooping cough during pregnancy, prompting a review of public health strategies.

Pregnant person with vaccine band aid
Separate public health campaigns for pregnant people would help to boost vaccine uptake, according to Dr Magdalena Simonis.

Earlier this year, health experts raised concern over low levels of vaccination against COVID-19 for expectant mothers.
Now, those concerns are broadened as new Australian-led research has identified that a large proportion of pregnant people may also be more at risk of contracting influenza and whooping cough due to being under-vaccinated against the infections.
The Links2HealthierBubs study observed population-based health administrative datasets of mothers and their infants (live and stillborn) from 20 weeks’ gestation, born between 1 January 2012 to 31 December 2017. The cohorts were from the Northern Territory, Queensland and Western Australia – three jurisdictions which collectively account for 32% of Australia’s birth cohort.
Aiming to identify gaps and predictors of influenza and/or pertussis-containing vaccinations (dTpa) in pregnancies during the six-year period, the study found that out of 591,868 unique pregnancies, uptake of flu vaccine was 15%, and pertussis 27%. Around 12% received both vaccines.
The study also suggests that receiving whooping cough vaccination is ‘strongly associated’ with flu vaccination, prompting the authors to call for urgent reviews of antenatal healthcare practices and public health strategies to help improve the ‘dismal rates’ of vaccination in pregnancy.
Vaccine uptake during pregnancy is not routinely monitored in Australia, but other studies suggest that coverage is sub-optimal across some areas.
While the introduction of free vaccination programs has helped to prompt uptake of both flu and whooping cough vaccines – would better monitoring of vaccine uptake among pregnant people improve rates?
GP and women’s health expert Dr Magdalena Simonis believes it would.
‘We tend not to speak about pregnant women as a public health campaign as much as we should – it’s almost a separate public health campaign,’ she told newsGP.
‘Because if we don’t achieve the right outcomes in pregnancy, we’re affecting not only the woman but the child and the family, so it has an impact on the broader community.
‘We need to think more about conveying the significance of pregnancy as a stage of vulnerability in the community that needs to be monitored, and we need to provide the appropriate information to pregnant women at various points throughout their pregnancy.
‘And that comes from public health messages, the hospital and also from the GP and their midwife.’
With a focus on many diseases having recently been overtaken by discussion around COVID, Dr Simonis said there is now some concern in the community around having too many vaccinations at the one time, presenting a good opportunity to reinstate the importance of vaccination against other diseases for pregnant people.
‘As flu season came, we talked specifically about COVID,’ she said.
‘The questions that we keep getting asked as GPs are: “Is it safe to have the flu with my COVID vaccine? Is it safe to have my Boostrix with my flu? And is it safe to have all three together?”
‘And the good news is that we can have those together.’
There have been some recent changes to the Boostrix vaccination, Dr Simonis said, and GPs can again use the opportunity as part of their antenatal care plans.
‘Once upon a time it was in the third trimester, whereas now we’re recommending that women in the community have their Boostrix vaccination with their obstetric anatomy scan at around 20–23 weeks, which is a lot earlier,’ she said.
‘GPs need to be aware of that change so they can administer that at the same time as they’re reviewing their obstetric patients around the 20–23-week mark.’
Since the Links2HealthierBubs study data was collected, public health campaigns – including free vaccination programs – have helped to significantly increase vaccine uptake.
In the West Australian cohort, around 11% of women had both the influenza and whooping cough vaccines in pregnancy, while around 72% had neither vaccine. Between the study period of 2012–17, around 22% had the whooping cough vaccine.
However, the introduction of the free whooping cough vaccination program in 2015 increased uptake to 76.9% by 2020, with flu vaccination increasing from 17% throughout the study period to 77%.

‘It is fantastic to see a major increase in maternal vaccination over the last five years,’ co-author Associate Professor Hannah Moore from Curtin University School of Population Health and Wesfarmers Centre of Vaccines and Infectious Diseases said.

 ‘This has directly impacted hospitalisation rates for severe cases of influenza and whooping cough and demonstrates the vital role vaccination in pregnancy plays in protecting newborn babies.

‘Our research also identified key factors that affected vaccine uptake in pregnancy, and found that women under 20 years of age, those who smoked during pregnancy and women of Aboriginal or Torres Strait Islander descent were least likely to receive influenza and pertussis vaccinations, so this will be a key focus going forward.’

The study authors say a review would ensure vaccines ‘are offered equitably and optimally to protect against infection’.
‘Determining whether there has been a shift in antenatal vaccine uptake away from women who are traditionally at risk of infection toward those who have better access to, and more affordability of, vaccination options and healthcare is essential,’ the authors wrote.
Dr Simonis emphasises that although flu season is the better-known focus of public health messages, it is important to not forget about whooping cough and its risks, particularly for pregnant people and their babies.
‘We see whooping cough as an old disease, but I think that it also teaches us an important lesson that some old diseases haven’t really disappeared,’ she said.
‘Whooping cough hasn’t been eradicated ever, so we still need to work at [vaccines] conscientiously as a public health measure … and have a very clear, straight message around the safety of that.’
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Dr Megan Elizabeth Elliott-Rudder   17/06/2022 7:24:14 AM

From clinical experience, midwifery care varies in offering Fluvax, in communicating and documenting vaccines given, and reduces contact with familiar GPs who are more trusted by the vaccine-hesitant. There was no automatic transfer of data to AIR at the time of this study, as noted in the paper's discussion of limitations. I'd like to see more vaccination and teamwork, but also to see the study repeated with more reliable data.