Improving Immunization Rates among Pregnant Women
Faculty Mentor: Lacey Eden, College of Nursing
Pertussis cases have been increasing in the United States, over the last decade, as more parents have decided not to vaccinate with the Tdap vaccine. The population of infants less than two months of age is at the greatest risk for experiencing extreme and life-threatening cases of pertussis (whooping cough) because they cannot be vaccinated. The purpose of this project was to create an educational module that can be used during prenatal classes, in doctors’ offices, and in local Health Departments to provide education to pregnant women regarding the importance of the Tdap immunization during pregnancy, in order to reduce infant pertussis cases. A secondary future goal was to evaluate the effectiveness of the educational materials regarding Tdap vaccines during pregnancy. During the researching process the concept of cocooning was also discovered and evaluated in conjunction with research of Tdap during pregnancy. Cocooning is a two-step process where mothers are vaccinated during pregnancy and family members with close infant contact are also vaccinated. Cocooning research supports Tdap vaccination of pregnant women during pregnancy, and provides even greater protection to newborns from infant pertussis.
For this project, the CINAHL and MEDLINE databases were used to facilitate a search for relevant literature using the search terms “Tdap,” “diphtheria, tetanus, acellular pertussis,” “cocoon,” “parents,” “neonatal,” and “vaccine.” Vaccination rates and recommendations for practice were gathered from the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) clinical practice guidelines. An abstracting method was utilized and articles were excluded prior to 2010, if they were not written in the English language, and if human participants were not the research subjects. The term “parents” pulled up many publications that focused on the vaccination of school age children, and these were excluded. Articles were included if they were studies based on mothers receiving Tdap during pregnancy or “cocooning” infants intra/postpartum by having the mother and close relatives receive a Tdap booster. In total, 6 research articles, 1 systematic review, & the CDC and ACIP’s clinical practice guidelines were selected.
Infants less than two months of age are at the highest risk for pertussis morbidity and mortality (ACIP 2011). Quinn et al. (2014) suggested that there is a greater protective effect for the newborns of mothers who reported Tdap vaccination during pregnancy rather than those who reported vaccination after delivery. Research has shown that Tdap vaccination during pregnancy can avoid more infant cases and deaths at lower cost than postpartum vaccination for several reasons. First, when a mother is vaccinated during pregnancy it provides earlier protection to the mother, thereby providing greater protection to the infant at birth. Second, vaccination during later pregnancy allows a maximized transfer of maternal antibodies to the newborn before birth. These antibodies can then serve as an added measure of protection during the first months of life (ACIP 2011). Quinn et al. (2014) additionally suggested in their
research that there is a greater protective effect for the infant in mothers who reported Tdap vaccination during pregnant rather than those who reported vaccination after delivery. Similarly, Terranella et al. (2013) found that vaccination during pregnancy could reduce the overall number of pertussis cases by 33% as compared to only a 20% reduction with postpartum vaccination, reduce hospitalizations by 38% as compared to only 19% with postpartum vaccination, and lower the number of overall pertussis deaths by 49% verses only a 16% reduction with postpartum vaccination. The reason that vaccination during pregnancy provides better protection is because when the mother is vaccinated during pregnancy she passes on antibodies to her infant, through the placenta, before birth (Terranella et al. 2013). Additionally, there is evidence that when family members and others who come in close contact with the infant are immunized a “cocoon” of even greater protection is created. The cocooning strategy or the vaccination of close contacts of newborn infants (new mothers, fathers, grandparents, siblings, caretakers, etc.) is now recommended to reduce infant pertussis exposure and cases (Swamy & Wheeler 2014). Terranella et al. (2013) discovered that when a father or grandparent was vaccinated it reduced the likelihood of infant pertussis by an additional 16%.
Practice guidelines and research suggest that receiving a Tdap vaccine during the third trimester of each pregnancy can reduce the rate of infant pertussis cases. Vaccination rates are currently low in the United States and Utah. This project was able to provide valuable research, educational modules, and brochures for families to better promote this life-saving vaccine. Immunization managers were contacted and free education and education tools with evidence based research were created for OBGYN offices. These educational modules and brochures are capable of being customized to each office and will educate mothers and families during prenatal classes and office visits. All the educational materials were loaded onto a flash drive before delivery to OBGYN offices. Education on the information was provided in conjunction with the free educational tools. Improving education is the best tool we have to promote the Tdap vaccine during pregnancy and protect the lives of the youngest Americans. This project has already provided education and will hopefully continue to improve and provide education to families and practioners for years to come. The hope is that this education will increase immunization rates among pregnant women and possibly families through cocooning.
Tdap during pregnancy should not be the only strategy employed to prevent the outbreak of pertussis but it should be more widely implemented and accepted as standard evidence-based care. Nurses and healthcare providers have the opportunity to educate families on how to protect their infants. Promoting Tdap during pregnancy and cocooning is one way that nurses, practioner’s, and other healthcare workers can contribute to the health of patients and families to reduce the likelihood of infant pertussis and death. Pregnancy and family vaccination should continually be seen as a weapon to combat this vaccine-preventable disease that takes the lives of some of the youngest neighbors, family members, and friends (Rosenblum, McBane, Wang, & Sawyer 2014). This project was able to improve education and hopefully continually improve vaccination rates among pregnant women for years to come, thereby protecting infants from pertussis.
Figure 1 – Best for Baby is a pregnancy app created as a separate project through the BYU College of Nursing but information on the Tdap vaccine during pregnancy was included in the app in conjunction with this Tdap immunization improving project. The Tdap vaccine really is best for baby.