Improving pertussis vaccination in pregnant woman. A new pathway in an Italian Local Health Authority

Pertussis is quite common in adolescents and adults, but it is especially dangerous in new-borns. The national immunization plan (NIP) 2017-2019 recommended a Tdap booster for every pregnancy at 28-36 weeks, but adherence is still far from the optimal level. This work aims to evaluate the effectiveness of a dedicated pathway organized by the department of prevention to improve the Tdap coverage among pregnant woman attending antenatal class. The women attending from November 2019 to October 2019 the public antenatal class organized by the local health authority have been evaluated for their Tdap coverage in pregnancy. From May 2019, public health experts have been involved for 30 minutes during the first lesson to explain the NIP with a focus on vaccination in pregnancy. Then the eligible women (28-36 weeks not yet vaccinated) who voluntarily agree were accompanied to the ambulatory to be vaccinated. Pre-post Tdap vaccination coverage and pregnancy weeks at vaccination have been evaluated respectively by chi2 and t-test. 90 pregnant women have been included in the study. Their mean age was 32.3 (SD 5.2) and the overall Tdap coverage was 44.4%. The Pre-post Tdap coverage was 26.7%(12/45) before May 2019 and 62.2% (28/45) after the introduction of the new pathway (p = 0.001). 50% of the vaccinated women decided to receive the booster the same day of the antenatal lesson, while the remaining 50% delayed the vaccination till a maximum of 30 days. We observed a clinical, but not statistically, significant anticipation in the pregnancy week in which they received Tdap booster (32.4 weeks before and 31.3 after May 2019; p = 0.150). The introduction of a short intervention on vaccination in the antenatal class followed by the opportunity to receive the booster in a dedicated time and without waiting list significantly improved the Tdap coverage in pregnancy. This study encourages the cooperation among the different public health actors involved in the field of antenatal care. Key messages Antenatal class represents a great opportunity to improve vaccine confidence in pregnant women. Intervention aimed to ameliorate vaccine convenience could improve Tdap coverage in pregnancy.