Flu, Tdap vaccine use up in pregnant women, but disparities linger

Pregnant woman receiving vaccine
Pregnant woman receiving vaccine

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The Centers for Disease Control and Prevention (CDC) reported overall increased uptake of flu and tetanus diphtheria, and pertussis (Tdap) vaccines among pregnant women, according to a data published today in Morbidity and Mortality Weekly Report.

CDC researchers noted that, during the 2019-20 flu season, 61.2% of surveyed pregnant women received the flu vaccine, which was 7.5 percentage points higher than the previous flu season (53.7% uptake) and about 12 percentage points higher than 2 years ago.

The improvement from the last flu season was largely due to an increase in vaccinations for black and Hispanic women, the researchers report, but the results still reflect racial disparities.

In addition, 56.6% of the women received the Tdap vaccine during pregnancy, and 40.3% received both vaccines. Tdap coverage increased 1.7 percentage points—it was 54.9% in 2018-19—and the percentage of women receiving both vaccines increased from 35.0% a year ago.

Racial, ethnic disparities

Flu vaccinations among pregnant women were highest among non-white, non-black, and non-Hispanic women (69.6%, up 7.9 percentage points from last flu season), then white women (60.6%, up 3.6 percentage points), Hispanic women (67.2%, up 9.9 percentage points), and Black women (52.7%, up 14.7 percentage points).

Between black and white women, the year-over-year gap of vaccination coverage decreased from 19 percentage points to 8.

Overall, 75.2% of pregnant women said a provider offered or referred them to a flu vaccine. Of that group, though, only 66.7% of black women went on to receive it compared with 75.6% of white women, 79.0% of Hispanic women, and 80.7% of women of other races. The study notes that women who had 10 or more provider visits were 33.4% more likely to receive the flu shot than those who had from 1 to 5 visits (67.5% uptake vs 50.6%).

As for Tdap vaccinations, white pregnant women received the most coverage (65.5%, up 4.1 percentage points) compared to women of non-white, non-Hispanic and non-Black races (54.0%, down 4.5 percentage point); Black women (38.8%, up 1.1 percentage points), and Hispanic women (35.8%, down 15.6 percentage points).

While the study did not suggest reasons why Hispanic pregnant women had such a decrease in rates, it did provide data showing that offerings and referrals were less consistent across patients' races.

Only 55.75% of Black women reported receiving a provider offer or referral, compared with 81.0% of white women; 66.6% of Hispanic women said they had received one. Overall, 72.7% pregnant women said that a provider offered them coverage or a referral. Of those, 52.5% of Hispanic women, 64.7% of black women, 73.1% of other non-White women, and 77.5% of white women went on to receive it.

Importance of provider recommendation

The Advisory Committee on Immunization Practices recommends that women who are or might be pregnant receive the flu and Tdap vaccines with each pregnancy to protect their health and the health of their infants. About 20% of the surveyed pregnant women, however, do not recall receiving a provider offer or referral for one or both of the vaccines.

The CDC authors recommend, "Racial disparities in vaccination coverage could decrease further with consistent provider offers or referrals for vaccination, in combination with culturally competent conversations with patients."

See also:

Oct 8, 2019, CIDRAP News story "Not enough pregnant women get flu or pertussis vaccines, CDC says"

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