Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016–2021

McRae, Jocelynne E; McHugh, Lisa; King, Catherine; Beard, Frank H; Blyth, Christopher C; Danchin, Margie H; Giles, Michelle L; Mohammed, Hassen; Wood, Nicholas; Macartney, Kristine

doi:10.5694/mja2.51989

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Women's health

Environment and public health

Summary

Vaccination in pregnancy is the best strategy to reduce complications from influenza or pertussis infection in infants who are too young to be protected directly from vaccination. Pregnant women are also at risk of influenza complications preventable through antenatal vaccination. Both vaccines are funded under the National Immunisation Program for pregnant women in Australia, but coverage is not routinely reported nationally.
We reviewed all reported Australian maternal influenza and pertussis vaccine coverage data for the period 2016–2021, to identify gaps and information needs.
Maternal influenza vaccine coverage was suboptimal at < 58% for 2016–2018, with higher coverage of 62–75% reported in two states (Victoria and Western Australia) for 2019–2021. Maternal pertussis vaccine coverage from 2016 was generally higher than for influenza at > 70%, with the highest jurisdictional coverage of 89% reported in Western Australia in 2020.
Vaccination rates were often suboptimal among First Nations pregnant women and up to 20% lower than among non‐First Nations Australian women; while data were limited, coverage was low among culturally and linguistically diverse women and among women of lower socio‐economic status.
Jurisdictional perinatal data collections were the best source of information on antenatal vaccine coverage but were only available for a minority of the population; a nationally consistent systematic approach is lacking.
Timely and comprehensive data are needed to provide feedback to improve maternal vaccination coverage, particularly among groups with higher risk and/or low uptake, and as new vaccines are recommended, including COVID‐19 vaccination.

1 National Centre for Immunisation Research and Surveillance, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 University of Queensland, Brisbane, QLD
4 University of Western Australia, Perth, WA
5 Perth Children's Hospital, Perth, WA
6 Royal Children's Hospital, Melbourne, VIC
7 Murdoch Children's Research Institute, Melbourne, VIC
8 Monash University, Melbourne, VIC
9 University of Melbourne, Melbourne, VIC
10 Women's and Children's Health Network, Adelaide, SA
11 Robinson Research Institute, University of Adelaide, Adelaide, SA
12 The Children's Hospital at Westmead, Sydney, NSW

Correspondence: jocelynne.mcrae@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. Department of Health and Aged Care. National Notifiable Diseases Surveillance System (NNDSS) fortnightly summary notes – 2019. Fortnight 24: 23 November to 06 December 2019. https://webarchive.nla.gov.au/awa/20210605044019/https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdnareport‐fn24‐19.htm (viewed May 2023).
2. Department of Health and Aged Care. Australian Influenza Surveillance Report (AISR) – 2019 national influenza season summary. 2021. https://www.health.gov.au/resources/publications/aisr‐2019‐national‐influenza‐season‐summary?language=en (viewed May 2023).
3. Nunes MC, Madhi SA. Prevention of influenza‐related illness in young infants by maternal vaccination during pregnancy. F1000 Res 2018; 7: 122.
4. Neuzil KM, Reed GW, Mitchel EF, et al. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998; 148: 1094‐1102.
5. Cox S, Posner SF, McPheeters M, et al. Hospitalizations with respiratory illness among pregnant women during influenza season. Obs Gynecol 2006; 107: 1315‐1322.
6. Lafond KE, Nair H, Rasooly MH, et al. Global role and burden of influenza in pediatric respiratory hospitalizations, 1982–2012: a systematic analysis. PLoS Med 2016; 13: e1001977.
7. Madhi SA, Cutland CL, Kuwanda L, et al. Influenza vaccination of pregnant women and protection of their infants. N Engl J Med 2014; 371: 918‐931.
8. Maltezou HC, Asimakopoulos G, Stavrou S, et al. Effectiveness of quadrivalent influenza vaccine in pregnant women and infants, 2018–2019. Vaccine 2020; 38: 4625‐4631.
9. Molgaard‐Nielson D, Fischer T, Krause T, Hviid A. Effectiveness of maternal immunization with trivalent inactivated influenza vaccine in pregnant women and their infants. J Intern Med 2019; 286: 469‐480.
10. Regan AK, Klerk N, Moore HC, et al. Effectiveness of seasonal trivalent influenza vaccination against hospital‐attended acute respiratory infections in pregnant women: a retrospective cohort study. Vaccine 2016; 34: 3649‐3656.
11. Mertz D, Kim TH, Johnstone J, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta‐analysis. BMJ 2013; 347: 5061.
12. Campbell H, Amirthalingam G, Andrews N, et al. Accelerating control of pertussis in England and Wales. Emerg Infect Dis 2012; 18: 38‐47.
13. Perrett KP, Halperin SA, Nolan T, et al. Immunogenicity, transplacental transfer of pertussis antibodies and safety following pertussis immunization during pregnancy: Evidence from a randomized, placebo‐controlled trial. Vaccine 2020; 38: 2095‐2104.
14. Chu HY, Englund JA. Maternal immunization. Birth Defects Res 2017; 109: 379‐386.
15. Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 2008; 359: 1555‐1564.
16. Quinn HE, Comeau JL, Marshall HS, et al. Pertussis disease and antenatal vaccine effectiveness in Australian children. Pediatr Infect Dis J 2022; 41: 180‐185.
17. National Centre for Immunisation Research and Surveillance (NCIRS). History of immunisation in Australia. Influenza. http://ncirs.org.au/health‐professionals/history‐immunisation‐australia (viewed June 2022).
18. Australian Technical Advisory Group on Immunisation. Australian immunisation handbook. Pertussis (whooping cough). https://immunisationhandbook.health.gov.au/contents/vaccine‐preventable‐diseases/pertussis‐whooping‐cough (viewed Mar 2023).
19. National Centre for Immunisation Research and Surveillance (NCIRS). History of immunisation in Australia. Diphtheria, tetanus, pertussis. https://www.ncirs.org.au/health‐professionals/history‐immunisation‐australia (viewed Mar 2022).
20. Australian Technical Advisory Group on Immunisation. Changes to the recommended use of pertussis vaccines in pregnant women. January 2019. https://consultations.health.gov.au/ohp‐immunisation‐branch/maternal‐pertussis‐vaccination/supporting_documents/Final%20public%20%20changes%20to%20the%20recommended%20use%20of%20pertussis%20vaccines%20in%20pregnant%20women.pdf (viewed Sept 2022).
21. Janagaraj PD, Gurusamy PSR, Webby R. Gaps in maternal influenza vaccine uptake in Northern Territory: a need for a year‐round influenza vaccination campaign. Commun Dis Intell 2019; 43; doi: https://doi.org/10.33321/cdi.2019.43.49.
22. Laurie L, Lambert SB, Jones L, et al. Influenza and pertussis vaccine uptake during pregnancy among Australian women in south‐east Queensland, Australia. Aust N Z J Public Health 2021; 45: 443‐448.
23. Queensland Health. The health of Queenslanders 2018. Report of the Chief Health Officer Queensland. Brisbane: State of Queensland, 2018. https://www.health.qld.gov.au/__data/assets/pdf_file/0032/732794/cho‐report‐2018‐full.pdf (viewed Mar 2022).
24. Queensland Health. The health of Queenslanders 2020. Report of the Chief Health Officer Queensland. Brisbane: State of Queensland, 2020. https://www.health.qld.gov.au/__data/assets/pdf_file/0019/1011286/cho‐report‐2020‐full.pdf (viewed Mar 2022).
25. Van Buynder PG, Van Buynder JL, Menton L, et al. Antigen specific vaccine hesitancy in pregnancy. Vaccine 2019; 37: 2814‐2820.
26. Carlson S, Dey A, Beard F. An evaluation of the 2016 influenza vaccination in pregnancy campaign in NSW, Australia. Public Heal Res Pract 2019; 30: 29121908.
27. McRae JE, Dey A, Carlson S, et al. Influenza vaccination among pregnant women in two hospitals in Sydney, NSW: What we can learn from women who decline vaccination. Public Heal Res Pract 2021; 32: 3123‐2111.
28. Giles ML, Davey MA, Krishnaswamy S, et al. Maternal influenza vaccination reduces preterm birth and stillbirth. J Paediatr Child Health 2020; 56 Suppl 1: 138.
29. Giles ML, Davey MA, Wallace EM. Associations between maternal immunisation and reduced rates of preterm birth and stillbirth: a population based retrospective cohort study. Front Immunol 2021; 12: 704254.
30. Giles ML, Khai K, Krishnaswamy S, et al. An evaluation of strategies to achieve greater than 90% coverage of maternal influenza and pertussis vaccines including an economic evaluation. BMC Pregnancy Childbirth 2021; 21: 771.
31. Kaufman J, Attwell K, Tuckerman J, et al. Feasibility and acceptability of the multi‐component P3‐MumBubVax antenatal intervention to promote maternal and childhood vaccination: a pilot study. Vaccine 2020; 38: 4024‐4031.
32. Krishnaswamy S, Wallace EM, Cheng AC, et al. Protecting newborns from pertussis: the role of partner vaccination in the era of maternal immunization. Eur J Obstet Gynecol Reprod Biol 2017; 216: 159‐163.
33. Krishnaswamy S, Cheng AC, Wallace EM, et al. Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: a cross‐sectional study. Hum Vaccines Immunother 2018; 14: 1591‐1598.
34. Moir D, Gunter K, Lynch L‐A, et al. Antenatal vaccine uptake: a cross‐sectional study investigating factors influencing women's choices in pregnancy. Aust N Z J Obstet Gynaecol 2020; 60: 729‐737.
35. Rowe SL, Perrett KP, Morey R, et al. Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015–2017. Med J Aust 2019; 210: 454‐462. https://www.mja.com.au/journal/2019/210/10/influenza‐and‐pertussis‐vaccination‐women‐during‐pregnancy‐victoria‐2015‐2017#:~:text=The%20new%3A%20Pertussis%20vaccination%20of,the%20level%20varied%20by%20season
36. Rowe SL, Leder K, Perrett KP, et al. Maternal vaccination and infant influenza and pertussis. Pediatrics 2021; 148: e2021051076.
37. Safer Care Victoria. Victorian perinatal services performance indicators 2019–20. https://www.safercare.vic.gov.au/publications/victorian‐perinatal‐services‐performance‐indicators‐2019‐20 (viewed Mar 2022).
38. Safer Care Victoria. Victorian perinatal services performance indicators 2018–19. https://www.safercare.vic.gov.au/publications/pspi‐2018‐19 (viewed Mar 2022).
39. Mohammed H, Clarke M, Koehler A, et al. Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia. PLoS One 2018; 13: e0197867.
40. Mohammed H, Roberts CT, Grzeskowiak LE, et al. Psychosocial determinants of pertussis and influenza vaccine uptake in pregnant women: a prospective study. Vaccine 2020; 38: 3358‐3368.
41. Department of Health WA. Midwives Notification System. Influenza vaccination. https://ww2.health.wa.gov.au/Reports‐and‐publications/Western‐Australias‐Mothers‐and‐Babies‐summary‐information/data?report=mns_fluv_y (viewed Apr 2022).
42. Danchin MH, Costa‐Pinto J, Attwell K, et al. Vaccine decision‐making begins in pregnancy: correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake. Vaccine 2018; 36: 6473‐6479.
43. Carlson S, McRae J, Wiley K, et al. Knowledge, attitudes and practices regarding influenza vaccination among parents of infants hospitalised for acute respiratory infection in Australia. Public Heal Res Pract 2022; 32:32012202.
44. McRae J, Blyth CC, Cheng AC, et al. Preventing severe influenza in Australian infants: maternal influenza vaccine effectiveness in the PAEDS‐FluCAN networks using the test‐negative design. Vaccine 2022; 40: 2761‐2771.
45. Victorian Government Department of Health. Victorian Perinatal Data Collection (VPDC) manual 2021–22. Section 3 – Data definitions. https://www.health.vic.gov.au/publications/victorian‐perinatal‐data‐collection‐vpdc‐manual‐2021‐22 (viewed Mar 2022).
46. Department of Health WA. Guidelines for midwives notification of case attended. 2021. https://ww2.health.wa.gov.au/~/media/Corp/Documents/Health‐for/Data‐collection/Guidelines_Completion_of_NOCA_202107.pdf (viewed Mar 2022).
47. Regan AK, Effler P V, Thomson C, Mak DB. Potential use of Western Australia's mandatory Midwives Notification System for routinely monitoring antenatal vaccine coverage. Commun Dis Intell 2019; 43: 1‐12.
48. Janagaraj PD, Gurusamy PSR, Webby R. Current antenatal pertussis vaccination guidelines miss preterm infants: an epidemiological study from the Northern Territory. Aust N Z J Obstet Gynaecol 2019; 59: 436‐443.
49. Abdou R, Henry A, Kavanagh‐Patel K. Pertussis vaccination in pregnancy: increasing uptake through free antenatal clinic availability? [abstract]. J Paediatr Child Health 2017; 53 Suppl 2: 3.
50. Krishnaswamy S, Wallace E, Buttery J, Giles M. Strategies to implement maternal vaccination: A comparison between standing orders for midwife delivery, a hospital based maternal immunisation service and primary care. Vaccine 2018; 36: 1796‐1800.
51. Department of Health WA. Midwives Notification System. Pertussis vaccination. https://ww2.health.wa.gov.au/Reports‐and‐publications/Western‐Australias‐Mothers‐and‐Babies‐summary‐information/data?report=mns_pertv_y (viewed Apr 2022).
52. Benowitz I, Esposito DB, Gracey KD, et al. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis 2010; 51: 1355‐1361.
53. Shakib JH, Korgenski K, Presson AP, et al. Influenza in infants born to women vaccinated during pregnancy. Pediatrics 2016; 137: e20152360.
54. Wiley KE, Cooper SC, Wood N, Leask J. Understanding pregnant women's attitudes and behavior toward influenza and pertussis vaccination. Qual Health Res 2015; 25: 360‐370.
55. Australian Institute of Health and Welfare. Australia's mothers and babies. https://www.aihw.gov.au/reports/mothers‐babies/australias‐mothers‐babies/contents/summary (viewed July 2022).
56. UK Health Security Agency. Pertussis vaccination coverage for pregnant women in England, January to March 2021 and annual; coverage 2021 to 2022. https://www.gov.uk/government/publications/pertussis‐immunisation‐in‐pregnancy‐vaccine‐coverage‐estimates‐in‐england‐october‐2013‐to‐march‐2014/pertussis‐vaccination‐coverage‐for‐pregnant‐women‐in‐england‐january‐to‐march‐and‐annual‐coverage‐2021‐to‐20 (viewed Oct 2022).
57. UK Health Security Agency. Seasonal influenza vaccine uptake in GP patients: winter season 2021 to 2022. https://www.gov.uk/government/statistics/seasonal‐influenza‐vaccine‐uptake‐in‐gp‐patients‐winter‐season‐2021‐to‐2022 (viewed Oct 2022).
58. Baissas T, Boisnard F, Cuesta Esteve I, et al. Vaccination in pregnancy against pertussis and seasonal influenza: key learnings and components from high‐performing vaccine programmes in three countries: the United Kingdom, the United States and Spain. BMC Public Health 2021; 21: 2182.
59. McHugh L, Van Buynder P, Sarna M, et al. Timing and temporal trends of influenza and pertussis vaccinations during pregnancy in three Australian jurisdictions: The Links2HealthierBubs population‐based linked cohort study, 2012–2017. Aust N Z J Obstet Gynaecol 2022. doi: https://doi.org/10.1111/ajo.13548 [Epub ahead of print].
60. Menzies R, Aqel J, Abdi I, et al. Why is influenza vaccine uptake so low among Aboriginal adults? Aust N Z J Public Health 2020; 44: 279‐83.
61. Lotter K, Regan AK, Thomas T, et al. Antenatal influenza and pertussis vaccine uptake among Aboriginal mothers in Western Australia. Aust N Z J Obstet Gynaecol 2018; 58: 417‐24.
62. Hendry AJ, Beard FH, Dey A, et al. Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program. Med J Aust 2018; 209: 24‐28. https://www.mja.com.au/journal/2018/209/1/closing‐vaccination‐coverage‐gap‐new‐south‐wales‐aboriginal‐immunisation
63. Australian Digital Health Agency. Australian Immunisation Register. https://developer.digitalhealth.gov.au/products/australian‐immunisation‐register (viewed July 2022).
64. Tuckerman J, Blyth C, Beard F, Danchin M. COVID‐19 and changes in the National Immunisation Program: A unique opportunity to optimise the Australian Immunisation Register (AIR). Med J Aust 2021; 214: 247‐249. https://www.mja.com.au/journal/2021/214/6/covid‐19‐and‐changes‐national‐immunisation‐program‐unique‐opportunity‐optimise
65. Australian Government Department of Health and Aged Care. Australian Immunisation Register linked to the Multi‐Agency Data Integration Project. https://www.health.gov.au/our‐work/australian‐immunisation‐register‐linked‐to‐the‐multi‐agency‐data‐integration‐project (viewed Mar 2023).

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Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016–2021

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