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Tdap vaccination rate low among pregnant women on Medicaid
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Only 14.3% of women on Medicaid in Michigan received the Tdap vaccine during their pregnancies from November 2011 to February 2013, according to investigators with the Michigan Department of Community Health.
The Advisory Committee on Immunization Practices first recommended that previously unvaccinated women receive the Tdap vaccine during pregnancy to confer passive immunity from maternal antibodies on the child in utero. In 2013, ACIP revised the guidelines to include a Tdap vaccination for every woman during each pregnancy.
“Vaccinating pregnant women remains the best strategy for protecting newborns against pertussis,” the investigators wrote in MMWR. “Future studies should reevaluate vaccination coverage to determine whether coverage improved after the 2013 ACIP recommendation. Further exploration into reasons for racial and ethnic disparities in Tdap vaccination is also needed.”
The investigators linked birth certificates to maternal Medicaid claims data to determine the rate Tdap vaccine coverage among pregnant women. They determined racial/ethnic disparities in vaccination and also other potential predictors, such as gestational age at live birth, plurality of pregnancy, maternal age at live birth and adequacy of prenatal care.
Among the 15,181 women in the study, 14.3% received the Tdap vaccine during pregnancy. The rates of coverage varied by race and ethnicity: 17.6% of white women received the vaccine vs. 8.4% of black women, 11.9% of Asian women and 6.8% of Arab women. The researchers noted that Michigan has the second highest Arab population in the United States. In bivariate analyses, full-term gestational age at birth and maternal age at birth were predictors of Tdap vaccination, but adequacy of care was not.
“Infants enrolled in Medicaid are a particularly vulnerable population; in Michigan, their all-cause mortality is higher than that of privately insured infants,” the researchers wrote. “Increased education for clinicians, parents and families might increase adherence to ACIP recommendations.”
Disclosure: The researchers report no relevant financial disclosures.
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