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DOI: 10.1055/a-2510-3783
Impact of Coronavirus Disease-2019 on Influenza and Tdap Vaccination Rates in Pregnant Patients
Funding None.

Abstract
Objective
Influenza and tetanus toxoid reduced diphtheria toxoid, and acellular pertussis (Tdap) are safe and effective vaccines that are recommended in pregnancy. Despite this, significant vaccine hesitancy exists in pregnancy. However, impact of the coronavirus disease 2019 (COVID-19) pandemic on vaccine hesitancy is not well understood. Thus, we sought to describe impact of the COVID-19 pandemic on influenza and Tdap vaccination rates in pregnant patients.
Study Design
Retrospective cohort study of patients delivering at single academic center from October 1, 2017 to August 31, 2021. Patients with missing vaccine data or delivering before 28 weeks (Tdap range) excluded. Patients delivering pre-COVID (October 1, 2017–August 31, 2019) compared with those delivering mid-COVID (October 1, 2020–August 31, 2021). Primary outcomes were vaccination rates for Tdap and influenza. Secondary outcome was rate of dual vaccination (receiving both) and variation by race/ethnicity. Chi-square tests and logistic regression were used to test for changes in vaccination rates.
Results
Of 8,650 unique patient pregnancies, 5,925(68.5%) occurred pre-COVID. Median patient age (30 years) and gestational age at delivery (39 weeks) not clinically different between groups. Patients in mid-COVID group had lower numbers of government-assisted insurance (47.3%) and higher non-Hispanic Black compared with pre-COVID (31.5%). The rate of influenza vaccination decreased 8.2 percentage points from pre-COVID to mid-COVID (69.9 vs. 61.7%, p < 0.001). Tdap vaccination rates also decreased, although less-so (88.5 vs. 85.1%, p < 0.001). The rate of patients receiving both vaccines during pregnancy decreased from 66.0 to 58.4% (p < 0.001). Significant decreases in influenza vaccination rates mid-COVID versus pre-COVID was seen in all race–ethnicity groups except non-Hispanic White patients. For Tdap vaccinations, the effect of COVID on the odds of receiving Tdap did not differ across race–ethnicity groups.
Conclusion
Rates of influenza, Tdap, and dual vaccination in pregnancy dropped significantly during the COVID-19 pandemic. For influenza, these were most pronounced in all race–ethnicities included with exception of non-Hispanic White. These data emphasize the importance of continued counseling and education on vaccinations in pregnancy and raise important questions regarding vaccine access and patient hesitancy during pandemic-mediated prenatal care.
Key Points
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Influenza vaccination decreased with COVID-19.
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Tdap vaccination decreased with COVID-19.
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Decrease in flu vaccination in most race–ethnicity groups.
Publication History
Received: 15 November 2024
Accepted: 03 January 2025
Article published online:
07 February 2025
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References
- 1 Moniz MH, Beigi RH. Maternal immunization. Clinical experiences, challenges, and opportunities in vaccine acceptance. Hum Vaccin Immunother 2014; 10 (09) 2562-2570
- 2 American College of Obstetricians and Gynecologists. Influenza in Pregnancy: Prevention and Treatment. Committee Statement; 2024 . Accessed November 15, 2024 at: https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-statement/articles/2024/02/influenza-in-pregnancy-prevention-and-treatment.pdf?rev=b2252c95c9c84b7e924b30b05c9897fe&hash=A68FCB97B68E19FF804258AB589F6A16
- 3 Thompson MG, Kwong JC, Regan AK. et al; PREVENT Workgroup. Influenza vaccine effectiveness in preventing influenza-associated hospitalizations during pregnancy: a multi-country retrospective test negative design study, 2010-2016. Clin Infect Dis 2019; 68 (09) 1444-1453
- 4 Liang JL, Tiwari T, Moro P. et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2018; 67 (02) 1-44
- 5 Takeuchi H, Kawashima R. Disappearance and re-emergence of influenza during the COVID-19 pandemic: association with infection control measures. Viruses 2023; 15 (01) 223
- 6 Seong H, Hong JW, Hyun HJ. et al. Correlation between the level of social distancing and activity of influenza epidemic or COVID-19 pandemic: a subway use-based assessment. J Clin Med 2021; 10 (15) 3369
- 7 Melber DJ, Brodsky AL, Rocha CN, McIntyre BB, Jacobs MB, Ramos GA. Vaccination uptake in pregnancy: before and after the start of the COVID-19 pandemic. Am J Obstet Gynecol 2021; 226 (01) S449
- 8 Khubchandani J, Macias Y. COVID-19 vaccination hesitancy in Hispanics and African-Americans: a review and recommendations for practice. Brain Behav Immun Health 2021; 15: 100277