Improving Tdap vaccine uptake during pregnancy: a five-year analysis at a regional center

OBJECTIVE: To evaluate tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates among pregnant patients before, during, and after the COVID-19 pandemic and identify demographic and care-related factors associated with vaccine uptake at our tertiary-care medical center in Southern West Virginia. METHODS: We conducted a retrospective cohort study of pregnant patients age 18 years or older with viable pregnancies through 36 weeks of gestation from January 11, 2019, to June 30, 2024 at a single tertiary-care medical center. Patients were categorized into pre-COVID-19, during-COVID-19, and post-COVID-19 cohorts. Vaccination uptake was analyzed using ANOVA, and additional bivariate analyses were conducted to identify demographic and clinical factors associated with Tdap receipt during pregnancy. RESULTS: Among 2513 patients, 1705 (67.8%) received Tdap vaccination, which was higher than the national average of 56.6% in 2022-2023. Vaccination rates did not differ across 3 different phases relative to the COVID-19 pandemic (p = .97). Tdap vaccination was more common among patients who were married as compared with unmarried patients (70.4% vs 65.8%, p = .016), white versus non-white patients (68.9% vs 62.5%, p = .011), and patients receiving care in private-practice-based clinics versus hospital-based clinics (76.6% vs 65.6%, p < .001). No statistically significant difference was noted when stratified by insurance type (p = .24) or advanced maternal age (≥35 years) (p = .35). CONCLUSION: Tdap vaccination rates at our institution exceeded national averages and remained stable throughout the COVID-19 pandemic. Persistent disparities by race, marital status, and care setting highlight vaccination inequities and support the need for targeted interventions for patient and provider sub-groups.