398 - Role of Pediatric Intervention in Improving Tdap Vaccination Rates

Poster Number: 398
Publication Number: 398.134

Nishani Ekanayake, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Floral Park, NY, United States; Courtney Briggs-Steinberg, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Tappan, NY, United States; philip roth, Staten island University Hospital/Northwell Health, teaneck, NJ, United States; Jonathan Blau, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, United States

Background: The American College of Obstetricians and Gynecologists recommends that women receive a Tdap vaccine during each pregnancy between 27 and 36 weeks of gestation to prevent pertussis in infants. Despite this recommendation, many pregnant women remain unvaccinated. Lack of Tdap vaccination in pregnancy has contributed to the 18,975 cases of pertussis reported by the CDC in 2019, including 2,232 infants. While infants first receive Dtap at two months old, the efficacy of those immunizations is inferior to immunity provided through maternal immunization, which provides longer immunity due to placental transfer of antibodies and also improves herd immunity. As the incidence of infant pertussis increases, creative ways of increasing maternal vaccination rates are needed.

Objective: Through this quality improvement study, we aim to identify factors causing low vaccination rates in pregnancy. Additionally, we aim to provide a new opportunity for Tdap vaccination during the immediate postpartum period via counseling by pediatric providers at SIUH (Staten Island University Hospital). 

Design/Methods: We initiated a yearlong study in 2021 during which pediatric providers counsel postpartum mothers admitted to SIUH’s maternity floor on neonatal pertussis and the importance of the Tdap vaccine. Mothers who delivered in 2019 serve as a control group. The study team is administering a survey to postpartum mothers regarding Tdap vaccination during pregnancy. Unvaccinated mothers are recommended to receive Tdap before discharge. Chart review is being conducted on mothers to obtain demographic information in order to stratify and better understand potential factors behind vaccination choices in pregnancy. Data collection and analysis is ongoing.

Results: In 2019, 21% of delivering mothers received the Tdap vaccine prenatally while 0.5% were vaccinated on the maternity floor. Preliminary analysis of six months of surveys in 2021, showed that 39% were vaccinated prenatally while 30% of mothers obtained Tdap in the hospital (Table 1). Conclusion(s): Through demographic data collection and surveys on vaccine choices, we can better understand factors contributing to low vaccination rates in our pregnant population. Thus far, pediatric provider intervention has increased postpartum vaccination rates. While not given during the recommended time period in pregnancy, postpartum Tdap likely increases herd immunity and provides antibody transfer in breast milk.  This process may represent a unique way for pediatricians to reduce the incidence of neonatal pertussis.
Table 1: Tdap Survey Results to date (n=300)