Large numbers of pregnant women not getting key vaccines, CDC says

A significant percentage of pregnant women are not getting a pair of critically important vaccines despite persistent efforts by public health officials to encourage immunizations, according to new data from the Centers for Disease Control and Prevention.

An online survey conducted last spring showed that just over half of pregnant women had received flu and pertussis-containing vaccines during their pregnancies; only 35% received both.

The rates are “not really budging. They’re pretty close to previous years,” Dr. Anne Schuchat, the CDC’s principal deputy director, told STAT. “And that’s disappointing.”

The CDC recommends pregnant women receive pertussis-containing vaccine — the vaccine, called Tdap, is bundled with tetanus and diphtheria vaccines — during each pregnancy. It also recommends that all Americans over the age of 6 months receive a flu shot every year, with a special emphasis placed on the importance of the vaccine for pregnant women, who can become severely ill if they contract influenza.

But the survey, conducted over a two-week period, found that only 55% of pregnant women had received a Tdap vaccination during their pregnancy and 54% had received a flu shot.

Getting these vaccines protects pregnant women. But the antibodies that are passed to the developing fetus protect their babies after birth as well, when they are too young to be vaccinated. Babies get their first shot of pertussis-containing vaccine at 2 months and can’t be vaccinated against flu until they are 6 months old.

“It’s incredibly important,” said Dr. Cynthia Gyamfi-Bannerman, a maternal-fetal medicine specialist at NewYork-Presbyterian/Columbia University’s Irving Medical Center. “We have all seen pregnant women in the ICU with influenza.”

Pregnant women are at especially high risk of developing serious complications from flu. The CDC report noted that during the flu seasons from 2010 through 2018, pregnant women made up between a quarter and a third of all hospitalizations for flu among women of childbearing ages.

Giving pregnant women Tdap late in their pregnancy — the beginning of the third trimester is advised — is critical to protect babies from pertussis, which is also known as whooping cough. The infection can be deadly for infants; in the period from 2010 to 2017, children under the age of 2 months made up 69% of pertussis deaths in the United States.

The CDC reports that about 20 babies a year die of pertussis in the United States and about half of children under the age of 1 who contract the infection end up in the hospital.

Schuchat said she’s particularly disappointed that many women who didn’t get a Tdap shot said they hadn’t realized they needed one during each pregnancy. “I was struck that the word hasn’t gotten out,” she said.

Health care providers have a crucial role to play here, Schuchat said.

“I do think it’s pretty common in pregnancy for women to wonder ‘Well, should I do that? Is that OK? I thought I wasn’t supposed to do anything,’” she said. “So the voice of the clinician can be very powerful: ‘Yes, I do think it’s important to do, it’s safe to do, it’s effective.’”

Only about 75% of the pregnant women reported having received a recommendation from their doctor to get the two vaccines.

Gyamfi-Bannerman, who urges that her patients receive both vaccines, said she generally doesn’t meet with resistance when she recommends Tdap. But she said some of her patients aren’t keen to get a flu shot, arguing that the vaccine’s protection sometimes isn’t optimal. She explains that some protection is better than none.