Housey Michelle, Zhang Fan, Miller Corinne, Lyon-Callo Sarah, McFadden Jevon, Garcia Erika, Potter Rachel
MMWR Morb Mortal Wkly Rep. 2014 Sep 26;63(38):839-42.
In October 2011, the Advisory Committee on Immunization Practices (ACIP) first recommended the routine administration of a tetanus, diphtheria, and acellular pertussis vaccine (Tdap) during pregnancy as a strategy to protect infants from pertussis (also known as whooping cough). This recommendation applied to women previously unvaccinated with Tdap and specified the optimal vaccination time as late second or third trimester (after 20 weeks' gestation). By vaccinating pregnant women, infants, who are at highest risk for mortality and morbidity from pertussis, gain passive immunity from maternal antibodies transferred to them in utero. Since this recommendation was made, little has been published on the percentage of women receiving Tdap during pregnancy. In Michigan, Medicaid pays for costs of pregnancy for approximately 40% of births. Infants enrolled in Medicaid are a particularly vulnerable population; in Michigan, their all-cause mortality is higher than that of privately insured infants. To assess vaccination coverage among pregnant women enrolled in a publicly funded insurance program in Michigan, Medicaid administrative claims data and statewide immunization information system data for mothers of infants born during November 2011-February 2013 were analyzed. This report describes the results of that analysis, which indicated that only 14.3% of these women received Tdap during pregnancy, with rates highest (17.6%) among non-Hispanic, non-Arab whites and lowest (6.8%) among Arab women. Vaccination was related to maternal age and gestational age at birth, but not to adequacy of prenatal care. In 2013, recognizing the importance of Tdap for every pregnancy, ACIP revised its guidelines to include a Tdap dose during every pregnancy. Ensuring that all infants receive the protection against pertussis afforded by maternal vaccination will require enhanced efforts to vaccinate pregnant women.
2011年10月，免疫实践咨询委员会（ACIP）首次建议在孕期常规接种破伤风、白喉和无细胞百日咳疫苗（Tdap），作为保护婴儿预防百日咳（又称小儿咳嗽）的一项策略。该建议适用于之前未接种过Tdap的女性，并将最佳接种时间指定为孕晚期第二个或第三个月（妊娠20周后）。通过为孕妇接种疫苗，百日咳死亡和发病风险最高的婴儿可在子宫内从母体抗体中获得被动免疫。自该建议发布以来，关于孕期接种Tdap的女性比例的相关报道较少。在密歇根州，医疗补助计划支付了约40%分娩的孕期费用。参加医疗补助计划的婴儿是一个特别脆弱的群体；在密歇根州，他们的全因死亡率高于有私人保险的婴儿。为评估密歇根州参加公共资助保险计划的孕妇的疫苗接种覆盖率，分析了2011年11月至2013年2月期间出生婴儿母亲的医疗补助管理索赔数据和全州免疫信息系统数据。本报告描述了该分析结果，结果表明这些女性中只有14.3%在孕期接种了Tdap，其中非西班牙裔、非阿拉伯白人的接种率最高（17.6%），阿拉伯女性的接种率最低（6.8%）。疫苗接种与产妇年龄和出生时的孕周有关，但与产前护理是否充分无关。2013年，认识到每次孕期接种Tdap的重要性，ACIP修订了其指南，将每次孕期接种一剂Tdap纳入其中。要确保所有婴儿都能获得母体接种疫苗所提供的百日咳防护，就需要加大对孕妇接种疫苗的力度。
