Pregnant women are vaccinated against whooping cough and seasonal influenza to protect them and their babies. Around 30% of pregnant women in England do not receive the whooping cough vaccine, and more miss out on their influenza vaccine, bringing avoidable illness and death. From 2016, maternity services gradually started offering whooping cough vaccines to pregnant women, instead of it only being available at GP surgeries, to make it more accessible. Some also started offering the influenza vaccine. Unfortunately, vaccination rates remain low and there are large differences in vaccination rates across the country.
This study will analyse national GP records to see what characteristics may predict whether a woman is likely to miss out on her recommended vaccines during pregnancy. These will include ethnicity, age, location and number of children. We will be updating a previous study which analysed GP records up to 2015, and found women from Black and other ethnic minority groups, and those from more deprived areas were less likely to be vaccinated. We want to know what difference the shift to maternity services offering vaccines has made.
This study is one of a series of studies designed to explore how maternity services across England can improve delivery of the vaccination programmes for pregnant women. The outcomes of this first study will help define the target groups of women to invite to interview in our follow-on research exploring how the vaccination programme could be adapted to better meet women’s needs, as well as to plan targeted interventions.
Pertussis vaccination is recommended for pregnant women to give neonates passive immunity from birth when they are highly vulnerable to this prevalent infection. In 2016, a national roll-out began of National Health Service (NHS) maternity-service vaccination delivery (in addition to primary care) to increase access and uptake. Nevertheless coverage has remained around 70% since 2016 with Public Health England evidence indicating recent decline and continued vast regional discrepancies in coverage. Maternal influenza vaccination rates are also suboptimal, despite increased availability (including some maternity service provision).
This cohort study aims to describe the characteristics of women who did/did not receive their recommended maternal pertussis and seasonal influenza vaccines. Statistical analyses of national primary care data using the Clinical Practice Research Datalink (CPRD) Aurum and GOLD databases and linked records (mother-baby link, pregnancy register, Hospital Episode Statistics, index of multiple deprivation and rural-urban classification) will use logistic regression modelling to identify predictors of uptake (outcome=Y/N) of maternal vaccines since these have been introduced (2010 for influenza, 2012 for pertussis). Example predictors include; age, ethnicity, location and number of children. This study updates a prior CPRD study (reference:17_030) identifying social factors associated with maternal vaccination using records up to 2015. Re-analysis is needed to bring the findings up-to-date, and to assess the impact of increased maternity service vaccination. Vaccination location (primary care/maternity service/other) will be explored and analyses will compare predictors of pertussis vaccination before and after the major roll-out of maternity service provision of vaccines.
This is the first in a series of studies aiming to identify how NHS maternity services can be supported to improve vaccination coverage and reduce inequities. Identifying risk factors for being unvaccinated will inform targets for subsequent survey and interview research designed to explore and address women’s needs and inform intervention/policy to address inequity in vaccination programmes.
Primary outcomes:
• Maternal pertussis vaccination (Y/N)
• Maternal influenza vaccination (Y/N)
For secondary aim 4, below, we will treat vaccine location (primary care/ elsewhere) as an outcome.
Emma Anderson - Chief Investigator - University of Bristol
Emma Anderson - Corresponding Applicant - University of Bristol
Christie Cabral - Collaborator - University of Bristol
Harriet Forbes - Collaborator - University of Bristol
Helen McDonald - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jemma Walker - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Peter Blair - Collaborator - University of Bristol
CPRD Mother-Baby Link;HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Pregnancy Register;CPRD Aurum Pregnancy Register;CPRD GOLD Mother-Baby Link;CPRD GOLD Pregnancy Register;Rural-Urban Classification