Expected challenges of implementing universal pertussis vaccination during pregnancy in Quebec: a cross-sectional survey

Abstract

Background: Vaccination of all pregnant women with an acellular pertussis-containing vaccine (tetanus, diphtheria, pertussis [Tdap]) was recently recommended in Canada, ideally between 27 and 32 weeks of gestation. This study aimed to describe the existing model of prenatal care in Quebec and determine to what extent maternal vaccination against pertussis could be integrated into this model.

Methods: In Quebec, health care is organized around Local Community Service Centres (LCSCs) that serve specific geographic areas. For each of 158 LCSCs (98.1% of LCSCs in the province), we invited 1 nurse or manager involved in prenatal care to participate in a cross-sectional Web-based survey. The structure of prenatal care visits and potential integration of maternal Tdap vaccination into the existing model were documented and compared according to urbanization level, determined with the use of census data.

Results: A completed survey was obtained for 127 LCSCs (response rate 80.4%). Only 13 (10.2%) and 14 (11.0%) LCSCs offered on-site visits with a nurse for the majority of pregnant women during the second and third trimesters, respectively. A significantly higher proportion of rural LCSCs than urban LCSCs offered on-site visits to pregnant women in the third trimester (13 [18%] v. 1 [2%]) (p = 0.003). In at least 50 LCSC service areas (39.4%), vaccines were not available in most medical clinics offering prenatal care.

Interpretation: Given the current situation in Quebec, implementing universal maternal Tdap vaccination may be challenging, which may result in suboptimal vaccine coverage among pregnant women. As other Canadian provinces may face similar issues, a priority will be to evaluate province-based implementation models to develop efficient ways to provide maternal Tdap vaccination across Canada.

Figure 1:

Proportion of Quebec Local Community Service Centres (LCSCs) offering on-site visits with a nurse, by trimester. Always/most of the time = for the majority of pregnant women from their service area, sometimes = for a minority of pregnant women from their service area, never = for none or almost none of pregnant women from their service area. n = 127 for each trimester.

Figure 2:

Reported settings in which second-trimester blood tests (including the oral glucose challenge test) were offered. Always/most of the time = for the majority of pregnant women from their service area, sometimes = for a minority of pregnant women from their service area, never = for none or almost none of pregnant women from their service area. Note: LCSC = Local Community Service Centre.

Figure 3:

Respondents’ preferred options for tetanus, diphtheria, pertussis (Tdap) vaccine administration if universal maternal Tdap vaccination were to be implemented. Proportions correspond to the proportion of respondents who indicated that a given option would be chosen “always” or “often.” Respondents could select more than 1 option. *Results significantly different between urban and rural Local Community Service Centres (LCSCs) (p < 0.05).