Pregnancy vaccine for whooping cough used by just one in four London women

A survey of pregnant women in London has revealed a low uptake of the whooping cough vaccine.

The vaccine, recommended by the Department of Health to protect their babies, should be offered to women around seven months into their pregnancy.

However, the poll of 200 pregnant women, conducted by researchers from Imperial College London, found that only 63 per cent were aware they could have a whooping cough vaccination, and only 26 per cent had actually been vaccinated. 

Whooping cough (pertussis) is a highly contagious disease that causes violent coughing fits. It can affect people of all ages but is most severe in babies. It is the most common cause of deaths in babies from a vaccine-preventable disease in the UK. An outbreak in 2011 and 2012 resulted in the death of 14 infants.

In response to this, an antenatal vaccination programme was introduced by the Department of Health in October 2012. The vaccine should be available to all women between 27-36 weeks of their pregnancy through their GPs. It boosts their own immunity against pertussis and induces high levels of protective antibody in the mother’s blood, which can then pass to their baby via the placenta. This effectively protects the baby until it receives its own course of vaccination after two months of age via the national infant immunisation schedule.

Despite this antenatal programme, a further ten babies died of whooping cough in the UK in 2013-14. Nine of these babies were born to non-vaccinated mothers. 

Now published in the journal Vaccine, the survey was designed to assess uptake of antenatal pertussis and maternal influenza vaccine in a busy NHS Trust in London and to explore awareness and attitudes of pregnant women towards the pertussis vaccination programme. It was conducted over a one-year period from May 2013 to June 2014 and covered an ethnically diverse sample of pregnant women. The women were all over 18 years old and at least 27 weeks pregnant.

The data suggested only one third of the women (34 per cent) had been offered the pertussis vaccine by their GP (half had been offered the influenza vaccine). 

Of the 126 women who were aware of the pertussis vaccine, nearly 40 per cent had declined to receive it. Further questions revealed that lack of information from healthcare professionals, and uncertainties over the risk and benefit of the vaccine, were the greatest barriers to uptake.

Of the women who received the vaccine, the predominant reason given (78 per cent) was encouragement or recommendation by a healthcare professional.

Study author Professor Beate Kampmann, from the Department of Medicine at Imperial, said: “It’s a tragedy when any baby dies, but to die of an easily preventable disease is shocking. Understanding the barriers to antenatal pertussis vaccine uptake is essential to inform longer term strategies for controlling this disease and preventing unnecessary deaths.”

Dr Beverly Donaldson, research midwife in Professor Kampmann’s team, who conducted the survey explains: “For many women, pregnancy comes with innate inhibitions about doing anything that isn’t absolutely necessary to the health of the baby – especially having vaccines and other interventions.  Our data showed that women overwhelmingly rely on and trust the advice and guidance of healthcare professionals to help them make informed healthcare decisions during pregnancy, and this is key to improving uptake. Many of the women who declined the pertussis vaccine displayed doubts and misconceptions about the vaccine, this suggests that the information they received was difficult to interpret.”

Professor Kampmann believes that the uptake of all vaccinations in pregnancy could be improved if they were given within the antenatal care setting rather than through GP practices, or offered at both places.

“The main support for pregnant women is often delivered within hospital-based antenatal clinics, not with GP practices. This is where most women receive their advice and guidance from midwives and other healthcare professionals who they most trust with pregnancy-related issues. To have vaccines discussed and available in antenatal settings would potentially increase the number of women who receive the vaccine, and we could easily test this hypothesis. ”

"What determines uptake of pertussis vaccine in pregnancy " is published in the journal Vaccine