Editorial Commentary: Tetanus-Diphtheria-Pertussis Immunization in Pregnant Women and the Prevention of Pertussis in Young Infants

EDITORIAL COMMENTARY Tetanus-Diphtheria-Pertussis Immunization in Pregnant Women and the Prevention of Pertussis in Young Infants James D. Cherry (See the Major Article by Dabrera et al on pages 333–7.) Keywords. pertussis; Tdap; immunization; pregnancy. A case-control study from England and Wales on the effectiveness of tetanus- diphtheria-pertussis (Tdap) immuniza- tion in pregnant women, authored by Dabrera et al in this issue of Clinical In- fectious Diseases, supports the finding of a previous observational study done by the same group of investigators [1, 2]. As noted by the authors, a single dose of Tdap was recommended in the United Kingdom for pregnant women between 28 and 38 weeks’ gestation in October 2012. In the United States, the Advisory Committee on Immunization Practices (ACIP) made a similar recommendation in October 2011. One aspect of the UK experience with Tdap vaccination of pregnant women is noteworthy—that in England and Wales, pregnant women typically receive care by general practitioners, and these same practitioners are routinely responsible Received 3 October 2014; accepted 5 October 2014; elec- tronically published 19 October 2014. Correspondence: James D. Cherry, MD, MSc, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, MDCC 22-442, Los Angeles, CA 90095 ( jcherry@mednet.ucla.edu). Clinical Infectious Diseases ® 2015;60(3):338–40 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com. DOI: 10.1093/cid/ciu823 CID 2015:60 (1 February) for immunization of all their patients. The present study was carried out between 22 October 2012 and 11 July 2013. There- fore, it was conducted over a 9-month pe- riod that started just 3 weeks after Tdap was recommended for pregnant women. Nevertheless, approximately 64% of the pregnant women were vaccinated. In contrast with the experience in England and Wales, the Tdap program in the United States is struggling, even though it was recommended a full year before the recommendation was made in the United Kingdom [3, 4]. Both Harriman and Winter [4] and Housey et al [3] note some of the difficulties with implementing prenatal vaccination in the United States. For example, in an October 2013 survey of women delivering in California hospitals, only 25% had re- ceived Tdap during pregnancy. Also, in contrast with the United Kingdom where general practitioners routinely administer vaccines, there are a number of barriers relating to vaccine use in obstetrical prac- tices in the United States. These are main- ly financial barriers such as the up-front cost of ordering and storing vaccines, maintaining vaccine inventory, and, most important, inadequate reimbursement [4]. There clearly is something wrong with the US system when 25% of claims are not EDITORIAL COMMENTARY paid by insurance companies. However, it is encouraging to note that in the fourth quarter of 2013, >65% of pregnant women in the Northern California Kaiser system had received Tdap. This was possibly be- cause the vaccine was available in all ob- stetric clinics. At the University of California, Los Angeles (UCLA) Medical Center, an ob- servant pediatrician noted that most of the mothers of the babies she was seeing had not been offered Tdap during their pregnancy (Heidi Woo, personal com- munication). Following her observation, the UCLA health system ensured that all UCLA obstetrical offices are stocked with Tdap vaccines. Rates of Tdap immuniza- tion in obstetric practices at UCLA are now being studied. A concurrent issue is influenza vacci- nation of pregnant women. Ten years ago, ACIP and the American College of Obstetricians and Gynecologists recom- mended influenza vaccination for all women who are or will be pregnant dur- ing the influenza season [5]. In the 2012– 2013 influenza season, only 50.5% of women received influenza vaccine either before or during pregnancy. As with Tdap, financial barriers are cited by obstetri- cians as an impediment to influenza vac- cination of pregnant women [5]. Downloaded from http://cid.oxfordjournals.org/ at University of California, Los Angeles on January 12, 2016 Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles