Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage Among Publicly Insured Pregnant Women, U.S., 2016-2019

Abstract

Introduction: Vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine during pregnancy is highly effective against Bordetella pertussis in young infants. We aimed to evaluate the uptake of maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination during the recommended gestation period of 27 through 36 weeks among women enrolled in a public medical insurance plan in the U.S.

Methods: In this analysis using Centers for Medicare and Medicaid Services insurance claims data, we identified women aged 15 through 49 years who delivered a live-born infant from 2016 through 2019. We identified claims for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination to calculate the proportion of women who were vaccinated during Weeks 27 through 36 of gestation in each calendar year. We also assessed the average annual maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis coverage by age group, race and ethnicity, U.S. Census region of residence, and plan type. Data were analyzed in 2021.

Results: Among 4,318,823 deliveries, the 4-year national average for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination was 26%, improving from 22% in 2016 to 31% in 2019 (p<0.001). Within subgroups, the lowest 4-year average coverage was among women aged 15 through 18 years (22%); Black, non-Hispanic (23%) and Hispanic women (24%); those residing in the South (18%); those enrolled in a Children's Health Insurance Program plan (22%); and those covered by a fee-for-service plan (19%). Coverage increased across all subgroups from 2016 through 2019.

Conclusions: Although maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis coverage among publicly insured women in the U.S. increased from 2016 through 2019, it remained considerably lower than estimated national coverage, with notable differences by race and ethnicity.

Keywords: Immunization coverage; Maternal immunization; Medicaid; Pertussis; Pertussis immunization; Pertussis prevention.

Figure 1

Maternal Tdap trends, 2016–2019. Note: Shown is the proportion of publicly insured pregnant women, identified in Centers for Medicare and Medicaid Services Transformed Medicaid Statistical Information System Analytic Files, who received Tdap during gestational Weeks 26‒37 by age group, race and ethnicity, and Census region, U.S., 2016 through 2019 Coverage for women with missing race and ethnicity data was 22.7%, 25.9%, 28.5%, and 32.9% in 2016, 2017, 2018, and 2019, respectively. The Hispanic group includes all races with Hispanic ethnicity. All other race groups include non-Hispanic women. Improvement in Tdap coverage from 2016 to 2019 was statistically significant for all subgroups (p<0.001).