Ana Llamas1, Gayatri Amirthalingam2, Nick Andrews2, Michael Edelstein3. 1. London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, UK; Public Health England, Wellington House, 133 - 155 Waterloo Road, London SE1 8UG, UK. Electronic address: Ana.Llamas@phe.gov.uk. 2. Immunisation Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. 3. London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Abstract
BACKGROUND: Prenatal pertussis vaccination was introduced in 2012 in England and is primarily delivered through general practice. Since 2017 some maternity services are commissioned to offer it too. We aimed to describe the maternity service delivery of prenatal pertussis vaccination and its impact on vaccine uptake. METHODS: We described the proportion of maternity services in England commissioned to offer pertussis vaccination to pregnant women in 2017/18 and the proportion of women vaccinated in this setting using a self-administered survey of NHS commissioners. We categorised clinical commissioning groups (CCGs) in England into "implementing" and "non-implementing" pertussis vaccination in maternity services. We identified CCGs where vaccination data was reliably transferred from maternity services to primary care records (source of routine data on vaccine uptake) and among those compared changes in vaccine uptake in implementing vs non-implementing CCGs between March 2016 (before implementation) and March 2018 (after). FINDINGS: Of 141 maternity service units in England, 61% delivered prenatal pertussis vaccine in 2017/18. Of those 57.0% of maternity services immunized less than 10% of pregnant women and only 7.1% of maternity services immunized more than 40% of pregnant women. Between March 2016 and March 2018, coverage increased by 19.6% among non-implementing CCGs compared with 17.8% among all implementing CCGs (difference -2.2, p = 0.48) and 28.2% among implementing CCGs with reliable methods of data transfer (difference 8.6, p = 0.04). This difference translated to a difference of 1.6 percentage points in absolute terms. INTERPRETATION: Delivering pertussis vaccine through maternity services has a moderate but important impact on vaccine uptake. There is a need to improve data transfer on vaccines administered in maternity service units to primary care. Maternity services should offer the vaccine to improve coverage and thus optimise protection for young infants. Barriers to effective programme implementation should be investigated and addressed.
BACKGROUND: Prenatal pertussis vaccination was introduced in 2012 in England and is primarily delivered through general practice. Since 2017 some maternity services are commissioned to offer it too. We aimed to describe the maternity service delivery of prenatal pertussis vaccination and its impact on vaccine uptake. METHODS: We described the proportion of maternity services in England commissioned to offer pertussis vaccination to pregnant women in 2017/18 and the proportion of women vaccinated in this setting using a self-administered survey of NHS commissioners. We categorised clinical commissioning groups (CCGs) in England into "implementing" and "non-implementing" pertussis vaccination in maternity services. We identified CCGs where vaccination data was reliably transferred from maternity services to primary care records (source of routine data on vaccine uptake) and among those compared changes in vaccine uptake in implementing vs non-implementing CCGs between March 2016 (before implementation) and March 2018 (after). FINDINGS: Of 141 maternity service units in England, 61% delivered prenatal pertussis vaccine in 2017/18. Of those 57.0% of maternity services immunized less than 10% of pregnant women and only 7.1% of maternity services immunized more than 40% of pregnant women. Between March 2016 and March 2018, coverage increased by 19.6% among non-implementing CCGs compared with 17.8% among all implementing CCGs (difference -2.2, p = 0.48) and 28.2% among implementing CCGs with reliable methods of data transfer (difference 8.6, p = 0.04). This difference translated to a difference of 1.6 percentage points in absolute terms. INTERPRETATION: Delivering pertussis vaccine through maternity services has a moderate but important impact on vaccine uptake. There is a need to improve data transfer on vaccines administered in maternity service units to primary care. Maternity services should offer the vaccine to improve coverage and thus optimise protection for young infants. Barriers to effective programme implementation should be investigated and addressed.