Uptake of vaccination in pregnancy

Abstract

Maternal immunisation is a public health strategy that aims to provide protection against certain infections to both mother and her foetus or newborn child. Vaccination of pregnant women induces vaccine-specific antibodies that lead to the subsequent transfer of these antibodies across the placenta or through breastfeeding to the offspring. At present, vaccinations in pregnancy are limited to pertussis, tetanus, diphtheria, polio, and the seasonal Influenza vaccine. Recently, some countries have incorporated routine antenatal vaccinations in their national immunisation programmes. Future vaccines targeted at pregnant women such as respiratory syncytial virus (RSV) and Group B streptococcus (GBS) are under development. The recently approved Covid-19 vaccines have no safety data for use in pregnancy at present, but have been considered in the UK in extremely vulnerable pregnant women or pregnant frontline health and social care workers. In this article, we review the evidence supporting maternal immunisation and discuss the uptake of vaccines in pregnant women, challenges of recording the data on vaccine coverage, and consider reasons behind the present levels of uptake and strategies for future improvements.

Keywords: Covid-19; Immunisation; Influenza; Maternal immunisation; Pertussis; Vaccination uptake.

Fig. 1

Countries with recommendations for immunisation against Pertussis in pregnancy by official authorities [7].

Fig. 2

Monthly pertussis vaccination coverage (%) in pregnant women: England, 2013–2020 [26].

Fig. 3

Observed and extrapolated estimate number of pregnant women registered and who received an influenza vaccine during the 2019 to 2020 season in England.

Fig. 4

Seasonal influenza vaccination coverage rates for pregnant women in nine EU/EEA Member states, during the influenza seasons (2015–2016; 2016–2017; 2017–2018) [39].

Fig. 5

Influenza vaccination coverage among pregnant women by race/ethnicity - Internet panel survey, United States, 2017-18 through 2019-20 influenza seasons [40].