Let's talk about vaccination

The rates of Pertussis infection have surged this year, with over 12 000 laboratory confirmed cases reported to the UK HSA between January and July 2024 in England alone. Whilst any age group can be affected, infants under 3 months are at the highest risk of severe disease. They are reliant on passive immunity from their mother, prior to development of direct immunity from the infant vaccination programme. The good news is that the calculated efficacy of maternal vaccine against infant death is high, at around 92%. Repeated vaccination is needed with each pregnancy, to optimise antibody levels and passive immunity. 

Tragically there have been 9 reported infant deaths with pertussis between January and July 2024. Set against this picture is the alarming statistic that maternal vaccine uptake fell from 74.7% in December 2017 to 58.9% in March 2024. This varies a lot across areas, with uptake in many areas of London particular low (click here to see how your area compares). Notably 24 of the 30 infants that have died since the introduction of the maternal vaccination programme in 2012 were to unvaccinated mothers. 

What influences vaccination decisions?

As a recent article in the BMJ discusses, vaccine hesitancy is a complex issue, with multiple influences, including ‘confidence, communication, complacency, convenience, and sociodemographic contexts’. There is longstanding reduced uptake in deprived regions, and among some ethnic minorities including black and South Asian women. Health inequalities, socio-economic disadvantages and systemic racism are highlighted as factors that reduce confidence in vaccines.

A recent qualitative systematic review (28 studies included, n=1573, 9/28 studies UK based), looked at ‘Facilitators and barriers to vaccination uptake in pregnancy’. It included studies looking at pertussis, influenza and COVID-19 vaccines. Key barriers identified included patient concerns about safety and efficacy of the vaccine (including risk of harm to the foetus), a lack of education about the benefit of vaccines, and a perception of ‘low severity’ of the disease. Misinformation from social media and peers was influential. Some women thought that the baby would be protected sufficiently by breastfeeding, and so did not need vaccination. A lack of awareness of the increased susceptibility of pregnant women and infants to severe illness affected decision making. Logistical barriers to vaccination also played a role, including the need to travel to multiple appointments juggling work and childcare. Availability of vaccines during routine antenatal appointments, rather than having to book an additional appointment/ attend a different location was seen as helpful. 

‘Facilitators’ included recommendation by a trusted healthcare professional, easy access, and consistent clear communication about the vaccines, addressing any concerns. Knowledge that that pertussis vaccine could protect the baby’s health was also a facilitator (i.e. rather that just being for maternal health). 

What can we do about it?

The paper highlights the influence that GPs and health care professionals can have over people’s decision to vaccinate. Access to clear, consistent, evidence-based information about the risks and benefits is key. Whilst not the primary deliverers of antenatal care, we have a longitudinal relationship with patients that can increase trust and provide opportunities for ad hoc education regarding the risks of serious infectious illness during pregnancy and the newborn stage, and the efficacy of the vaccine in protecting infants. We can reassure patients of the evidence of safety of the vaccine, noting that in 2014 the MHRA completed a large study including 18 000 women and found no risks to pregnancy associated with the vaccine. 

The authors of the BMJ article encourage us to consider if there are community leaders that could be involved in spreading knowledge and increasing uptake. What are the logistical barriers to access in your area? Are any modifiable- e.g. timings of clinics.   

Take home message:

One thing that we can all do it to be proactive about discussing vaccination during our consultations. Signpost women who are trying to conceive or pregnant to vaccine information. Links to educational material, including PILS covering the safety data of the vaccines can be found here. Translated options can be found here.

It really could make a difference!

For an update on recent changes to management of pertussis infection join us on our new Hot Topics Course!